Invasive Non-typhoidal Salmonella Enterocolitis and Bacteraemia with Negative initial stool culture following consumption of ``Ceviche''- A Case Report

Salmonellosis is a global public health concern, mainly presenting with non-specific signs and symptoms of gastrointestinal illness associated with the consumption of contaminated chicken, meat, eggs, unpasteurized milk, raw fruits and vegetables irrigated with fecally contaminated water. While non-typhoidal serotypes are known to cause mild, self-resolving symptoms, typhoidal serotypes such as Salmonella typhi and paratyphi may present with severe symptoms, including hyperpyrexia, bloody stools, osteomyelitis, and other symptoms. Such diseases are relatively uncommon in developed countries due to improved hygiene practices and are most often related to travel to endemic countries. Although vaccination against the disease has been recommended for international travellers, its true effectiveness remains variable. Since the disease is uncommon in the developed world, its presentation may be missed, particularly when the stool culture, seen as the gold standard for diagnosis, is negative. However, stool culture has variable sensitivity and may be negative despite bacteraemia and other signs and symptoms of infection, leading to inappropriate management and eventual worsening of the disease. This case report presents the challenging case of a vaccinated international traveler, where the diagnosis was repeatedly missed and was eventually managed appropriately after an in-depth review of clinical and diagnostic findings.