Salmonella Ovarian Abscess: A Case Report*

procedure was performed. Salmonella infection may have set in resulting in PID, periappendicitis
and ultimately ovarian abscess formation in a pre-existing ovarian cyst. Hence, the
condition may be nosocomially acquired. Second, she may have had salmonella secondarily
infecting an ovarian cyst during the bacteremic phase of typhoid fever, producing a latent
infection, which was activated by a more recent infection.
Salmonella genital infections are difficult to eradicate with medical therapy alone,
presumably because of the abscess formation requiring surgical intervention. Surgical drainage of
the localized collection of purulent material and antibiotic coverage are the cornerstones of
therapy. Common antibiotics proven effective in treating salmonella infection are ampicillin,
chloramphenicol, trimethoprim-sulfamethoxazole and amoxicillin. 6 Ampicillin or
chloramphenicol is commonly used for extra intestinal salmonella infections. Trimethoprimsulfamethoxazole
is generally used for organisms resistant to the above two drugs. Evans-Jones
used chloramphenicol successfully in the treatment of salmonella ovarian abscess given at a dose
of 4 gms/day iv for 5 days followed by 2 gms/day PO for 5 more days. 3 Salztsmann et al used
chloramphenicol in combination with ampicillin for 14 days. 14 Ghose et al on the other hand
combined amoxycillin with cotrimoxazole successfully for 2 weeks. 9 These antibiotics had been
used either alone or in combination in the treatment of salmonella ovarian abscess, with varying
degrees of success.
Salmonella isolates have become increasingly resistant to these antibiotics. Outbreaks of
salmonella resistant to multiple antibiotics are being reported with increasing frequency. 15,16,17
Since typhoid fever remains an important health problem especially in the Philippines emergence
of resistance makes it necessary to develop potential therapeutic alternatives.
Ciprofloxacin, a quinolone carboxylic acid derivative, has a greater antibacterial activity
than earlier compounds such as nalidixic acid, pipemidic acid, or norfloxacin. Its bactericidal
activity against members of the Enterobacteriaceae, to which salmonella belongs, suggests its
usefulness in the treatment of typhoid fever. Several studies have shown its success in the
treatment of patients with uncomplicated typhoid fever. 18,19,20
There have been no reports however, on the use of ciprofloxacin in localized infections.
The use of ciprofloxacin in this patient may be a precedent for future therapy of salmonella
ovarian abscess.
CONCLUSION
Although salmonella ovarian abscess is a rare condition, it should be considered in the
differential diagnosis of patients with pelvic inflammatory disease who have had a history of
typhoid fever. Treatment must be surgical and suitable antibiotics must be started.
Chloramphenicol is still the drug of choice for uncomplicated typhoid fever.
The onset of complications while on chloramphenicol therapy should make one consider
clinical resistance inspite of in vitro sensitivity of S. typhi. It has also been shown in this report
that ciprofloxacin may be used successfully in the treatment of salmonella ovarian abscess.
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