Salmonella typhi: The Story beyond Typhoid
Abstract
Background: Urinary Tract Infections (UTIs) caused by Salmonella typhi are rare, but there are a few reports of bacteria in urine from nontyphoidal Salmonellae and other Gram-negative bacilli. However, cases of bacteriuria with UTI due to nontyphoidal Salmonellae were more frequently reported in the past among individuals having urolithiasis. Case Study: We, herein, report a case of Salmonella Typhi bacteriuria with urolithiasis in a woman aged 35 years who has a poor socio-economic background and comes from the rural belt of western Nepal with inadequate and hygienically unsatisfactory drinking water facilities. Results: The woman's multiple episodes of vaginal bleeding led to an abdominal and pelvic ultrasound, which revealed several renal stones. The tests on both the stone and urine sample showed the presence of Salmonella typhi, and they reacted the same way to antibiotics. Conclusion: Our report highlighted the association of renal stones with urinary excretion of Salmonella typhi. Isolation of the organism from the crushed-out material of the renal stone as well as from the urine could suggest the persistence of the organism in the stone matrix being excreted from time to time, giving rise to intermittent bacteriuria. Based on the clinical, imaging, and lab results in this case, we are trying to understand how Salmonella typhi can stay in the body without causing symptoms.
Keywords:
Biofilms, Salmonella, Urinary Stones, Typhoid Carrier
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References
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Brain, E., Geraghty, R. M., Cook, P., Roderick, P., & Somani, B. (2021). Risk of UTI in kidney stone formers: a matched-cohort study over a median follow-up of 19 years. World Journal of Urology, 39(8), 3095–3101. https://doi.org/10.1007/s00345-020-03564-7
Buchta, R. M., & Dunn, M. (2003). Urinary tract infection due to Salmonella species in children/adolescents. Clinical Pediatrics, 42(7), 647–648. https://doi.org/10.1177/000992280304200712
Collee, J. G., Miles, R. S., & Watt, B. (1996). Tests for identification of bacteria. Mackie and McCartney Practical Medical Microbiology, 14, 131-149.
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Dawar, R., Jasuja, S., Imdadi, F., & Ghonge, N. P. (2017). Salmonella typhi bacteriuria, predispositions and complications: two case reports and review of literature. World Journal of Nephrology and Urology, 6(3-4), 32-34. https://doi.org/10.14740/wjnu310w
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Maiwall, R., Pasupuleti, S. S. R., Bihari, C., Rastogi, A., Singh, P. K., Naik, V., ... & Sarin, S. K. (2020). Incidence, risk factors, and outcomes of transition of acute kidney injury to chronic kidney disease in cirrhosis: a prospective cohort study. Hepatology, 71(3), 1009-1022. https://doi.org/10.1002/hep.30859
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Mathai, E., John, T. J., Rani, M., Mathai, D., Chacko, N., Nath, V., & Cherian, A. M. (1995). Significance of Salmonella typhi bacteriuria. Journal of Clinical Microbiology, 33(7), 1791–1792. https://doi.org/10.1128/jcm.33.7.1791-1792.1995
McLean, R. J., Stickler, D. J., & Nickel, J. C. (1996). Biofilm mediated calculus formation in the urinary tract. cells and Materials, 6(1-3), 65-174. Available at: https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1146&context=cellsandmaterials
Melzer, M., Altmann, G., Rakowszcyk, M., Yosipovitch, Z. H., & Barsilai, B. (1965). Salmonella Infections of The Kidney. The Journal of Urology, 94, 23–27. https://doi.org/10.1016/S0022-5347(17)63560-2
Mourani, C., Hagge, G., Mallat, S. G., Chehab, G., & Sabbagh, M. (2005). Salmonella typhi in a child with urinary tract infection and urolithiasis. Le Journal medical libanais. The Lebanese Medical Journal, 53(4), 234–235. Available at: https://applications.emro.who.int/imemrf/Lebanese_Med_J/Lebanese_Med_J_2005_53_4_234_235.pdf
Pandeya, D. R., Adhikari, D., Risal, S., Baxi, J., & Singh, P. P. (2006). Epidemiology and etiopathogenesis of urinary calculi in western Nepal (Pokhara). Nepal Medical College Journal: NMCJ, 8(3), 190–193.
Prouty, A. M., Schwesinger, W. H., & Gunn, J. S. (2002). Biofilm formation and interaction with the surfaces of gallstones by Salmonella spp. Infection and Immunity, 70(5), 2640–2649. https://doi.org/10.1128/IAI.70.5.2640-2649.2002
Ripa, F., Pietropaolo, A., Montanari, E., Hameed, B. M. Z., Gauhar, V., & Somani, B. K. (2022). Association of Kidney Stones and Recurrent UTIs: the Chicken and Egg Situation. A Systematic Review of Literature. Current Urology Reports, 23(9), 165–174. https://doi.org/10.1007/s11934-022-01103-y
Shafi, H., Shahandeh, Z., Heidari, B., Sedigiani, F., Ramaji, A. A., Pasha, Y. R. Y., ... & Mir, M. R. A. (2013). Bacteriological study and structural composition of staghorn stones removed by the anatrophic nephrolithotomic procedure. Saudi Journal of Kidney Diseases and Transplantation, 24(2), 418-423. https://doi.org/10.4103/1319-2442.109623
Shah, P., Baral, R., Agrawal, C. S., Lamsal, M., Baral, D., & Khanal, B. (2020). Urinary Calculi: A Microbiological and Biochemical Analysis at a Tertiary Care Hospital in Eastern Nepal. International Journal of Microbiology, 2020(1). https://doi.org/10.1155/2020/8880403
Stickler, D. J., & Zimakoff, J. (1994). Complications of urinary tract infections associated with devices used for long-term bladder management. The Journal of Hospital Infection, 28(3), 177–194. https://doi.org/10.1016/0195-6701(94)90101-5
Tavichakorntrakool, R., Prasongwattana, V., Sungkeeree, S., Saisud, P., Sribenjalux, P., Pimratana, C., Bovornpadungkitti, S., Sriboonlue, P., & Thongboonkerd, V. (2012). Extensive characterizations of bacteria isolated from catheterized urine and stone matrices in patients with nephrolithiasis. Nephrology, Dialysis, Transplantation, 27(11), 4125–4130. https://doi.org/10.1093/ndt/gfs057
Weissfeld, A. S., Sahm, D. F., & Forbes, B. A. (1998). Bailey & Scott's Diagnostic Microbiology. 10th Edition, Mosby Inc., St. Louis Missouri.
Yongzhi, L., Shi, Y., Jia, L., Yili, L., Xingwang, Z., & Xue, G. (2018). Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort. BMC Urology, 18(1). https://doi.org/10.1186/s12894-018-0359-y
Bauer, A. W. (1966). Antibiotic susceptibility testing by a standardized single disc method. American Journal of Clinical Pathology, 45(4), 493–496. https://doi.org/10.1093/ajcp/45.4_ts.493
Bichler, K. H., Eipper, E., Naber, K., Braun, V., Zimmermann, R., & Lahme, S. (2002). Urinary infection stones. International Journal of Antimicrobial Agents, 19(6), 488–498. https://doi.org/10.1016/s0924-8579(02)00088-2
Brain, E., Geraghty, R. M., Cook, P., Roderick, P., & Somani, B. (2021). Risk of UTI in kidney stone formers: a matched-cohort study over a median follow-up of 19 years. World Journal of Urology, 39(8), 3095–3101. https://doi.org/10.1007/s00345-020-03564-7
Buchta, R. M., & Dunn, M. (2003). Urinary tract infection due to Salmonella species in children/adolescents. Clinical Pediatrics, 42(7), 647–648. https://doi.org/10.1177/000992280304200712
Collee, J. G., Miles, R. S., & Watt, B. (1996). Tests for identification of bacteria. Mackie and McCartney Practical Medical Microbiology, 14, 131-149.
Cotran, R. S., Rennke, H., & Kumar, V. (2003). The kidney and its collection system. In V. Kumar, R. S. Cotran, & S. L. Robbins (Eds.), Robbins Basic Pathology (7th ed.). Saunders.
Dawar, R., Jasuja, S., Imdadi, F., & Ghonge, N. P. (2017). Salmonella typhi bacteriuria, predispositions and complications: two case reports and review of literature. World Journal of Nephrology and Urology, 6(3-4), 32-34. https://doi.org/10.14740/wjnu310w
Di Domenico, E. G., Cavallo, I., Pontone, M., Toma, L., & Ensoli, F. (2017). Biofilm producing Salmonella typhi: chronic colonization and development of gallbladder cancer. International Journal of Molecular Sciences, 18(9),http://doi.org/10.3390/ijms18091887
González, J. F., Alberts, H., Lee, J., Doolittle, L., & Gunn, J. S. (2018). Biofilm formation protects Salmonella from the antibiotic ciprofloxacin in vitro and in vivo in the mouse model of chronic carriage. Scientific Reports, 8(1), https://doi.org/10.1038/s41598-017-18516-2
Huang, W. Y., Chen, Y. F., Chen, S. C., Lee, Y. J., Lan, C. F., & Huang, K. H. (2012). Pediatric urolithiasis in Taiwan: a nationwide study, 1997-2006. Urology, 79(6), 1355–1359. https://doi.org/10.1016/j.urology.2012.01.036
Kapoor, R., Tewari, A., Dhole, T. N., & Ayyagiri, A. (1992). Salmonella typhi urinary tract infection: a report of two cases. Indian Journal of Urology, 8, 94-95.
Kaur, A., Sarma, S., Kumar, N., & Sengupta, S. (2015). Renal Abscess Caused by Salmonella Typhi. Journal of Laboratory Physicians, 7(2), 121–123. https://doi.org/10.4103/0974-2727.163132
Klosterman, S. A. (2014). Salmonella-related urinary tract infection in an elderly patient. Case Reports, 2014. https://doi.org/10.1136/bcr-2014-204552
Maiwall, R., Pasupuleti, S. S. R., Bihari, C., Rastogi, A., Singh, P. K., Naik, V., ... & Sarin, S. K. (2020). Incidence, risk factors, and outcomes of transition of acute kidney injury to chronic kidney disease in cirrhosis: a prospective cohort study. Hepatology, 71(3), 1009-1022. https://doi.org/10.1002/hep.30859
Marcus, R. J., Post, J. C., Stoodley, P., Hall-Stoodley, L., McGill, R. L., Sureshkumar, K. K., & Gahlot, V. (2008). Biofilms in nephrology. Expert Opinion on Biological Therapy, 8(8), 1159–1166. https://doi.org/10.1517/14712598.8.8.1159
Mathai, E., John, T. J., Rani, M., Mathai, D., Chacko, N., Nath, V., & Cherian, A. M. (1995). Significance of Salmonella typhi bacteriuria. Journal of Clinical Microbiology, 33(7), 1791–1792. https://doi.org/10.1128/jcm.33.7.1791-1792.1995
McLean, R. J., Stickler, D. J., & Nickel, J. C. (1996). Biofilm mediated calculus formation in the urinary tract. cells and Materials, 6(1-3), 65-174. Available at: https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1146&context=cellsandmaterials
Melzer, M., Altmann, G., Rakowszcyk, M., Yosipovitch, Z. H., & Barsilai, B. (1965). Salmonella Infections of The Kidney. The Journal of Urology, 94, 23–27. https://doi.org/10.1016/S0022-5347(17)63560-2
Mourani, C., Hagge, G., Mallat, S. G., Chehab, G., & Sabbagh, M. (2005). Salmonella typhi in a child with urinary tract infection and urolithiasis. Le Journal medical libanais. The Lebanese Medical Journal, 53(4), 234–235. Available at: https://applications.emro.who.int/imemrf/Lebanese_Med_J/Lebanese_Med_J_2005_53_4_234_235.pdf
Pandeya, D. R., Adhikari, D., Risal, S., Baxi, J., & Singh, P. P. (2006). Epidemiology and etiopathogenesis of urinary calculi in western Nepal (Pokhara). Nepal Medical College Journal: NMCJ, 8(3), 190–193.
Prouty, A. M., Schwesinger, W. H., & Gunn, J. S. (2002). Biofilm formation and interaction with the surfaces of gallstones by Salmonella spp. Infection and Immunity, 70(5), 2640–2649. https://doi.org/10.1128/IAI.70.5.2640-2649.2002
Ripa, F., Pietropaolo, A., Montanari, E., Hameed, B. M. Z., Gauhar, V., & Somani, B. K. (2022). Association of Kidney Stones and Recurrent UTIs: the Chicken and Egg Situation. A Systematic Review of Literature. Current Urology Reports, 23(9), 165–174. https://doi.org/10.1007/s11934-022-01103-y
Shafi, H., Shahandeh, Z., Heidari, B., Sedigiani, F., Ramaji, A. A., Pasha, Y. R. Y., ... & Mir, M. R. A. (2013). Bacteriological study and structural composition of staghorn stones removed by the anatrophic nephrolithotomic procedure. Saudi Journal of Kidney Diseases and Transplantation, 24(2), 418-423. https://doi.org/10.4103/1319-2442.109623
Shah, P., Baral, R., Agrawal, C. S., Lamsal, M., Baral, D., & Khanal, B. (2020). Urinary Calculi: A Microbiological and Biochemical Analysis at a Tertiary Care Hospital in Eastern Nepal. International Journal of Microbiology, 2020(1). https://doi.org/10.1155/2020/8880403
Stickler, D. J., & Zimakoff, J. (1994). Complications of urinary tract infections associated with devices used for long-term bladder management. The Journal of Hospital Infection, 28(3), 177–194. https://doi.org/10.1016/0195-6701(94)90101-5
Tavichakorntrakool, R., Prasongwattana, V., Sungkeeree, S., Saisud, P., Sribenjalux, P., Pimratana, C., Bovornpadungkitti, S., Sriboonlue, P., & Thongboonkerd, V. (2012). Extensive characterizations of bacteria isolated from catheterized urine and stone matrices in patients with nephrolithiasis. Nephrology, Dialysis, Transplantation, 27(11), 4125–4130. https://doi.org/10.1093/ndt/gfs057
Weissfeld, A. S., Sahm, D. F., & Forbes, B. A. (1998). Bailey & Scott's Diagnostic Microbiology. 10th Edition, Mosby Inc., St. Louis Missouri.
Yongzhi, L., Shi, Y., Jia, L., Yili, L., Xingwang, Z., & Xue, G. (2018). Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort. BMC Urology, 18(1). https://doi.org/10.1186/s12894-018-0359-y
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Nayak, N., Thapa, N., Bhatta, D., Subramanya, S., Shrestha, R., Hamal, D., Chhetri, K., Subba, S. and Gokhale, S. (2025) “Salmonella typhi: The Story beyond Typhoid”, International Journal of Advancement in Life Sciences Research, 8(2), pp. 194-201. doi: https://doi.org/10.31632/ijalsr.2025.v08i02.016.
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Case Study
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