Myositis associated with <i>Salmonella paratyphi</i> A bacteremia appears to be common.

Abstract

Fever and severe myalgia in a tropical country like India bring to mind leptospirosis, rickettsioses, dengue, and other viral fevers. Enteric fever is widely prevalent in Asia, but myositis has not been previously described in <i>Salmonella paratyphi</i> A bacteremia. Retrospectively, we recruited patients with enteric fever admitted to our treating unit over a 6-month period. Demography, historical, clinical, and laboratory data were obtained. Data of culture-positive <i>S. paratyphi</i> A patients were analyzed and were compared with those patients with culture-negative enteric fever. Forty-three cases were found in total with 19 of <i>S. paratyphi</i> A bacteremia. Elevations in creatine kinase (CK) ranged from one-and-half to six times normal. Forty-seven percent had thrombocytopenia and alanine transaminase elevations, while aspartate transaminase elevations were seen in 17 patients, which corresponded to those with elevated CK levels. Myositis associated with <i>S. typhi</i> and <i>S. paratyphi</i> is very rare and is more often due to non-typhoidal Salmonellae. Elevated creatine kinase was seen in most of our patients with <i>S. paratyphi</i> A bacteremia. Such myositis has not been described previously and hence, myalgia with fever in a tropical country could be a harbinger of paratyphoid fever.