Nontyphoid salmonellosis in renal transplant recipients: report of five cases and review of the literature.

Five cases of nontyphoid salmonella infection among renal transplant recipients are reported, and 32 cases from the literature are reviewed. Contrary to the nontyphoid salmonella infection in normal hosts, such infection in renal transplant recipients manifested as bacteremia (62%) and in extraintestinal foci (35%). Asymptomatic bacteriuria, at times prolonged, was common, whereas gastrointestinal symptoms were noted in only 19%. The course of infection may be prolonged, with relapse occurring in 43.2% and death in 5.4%. Extraintestinal manifestations were located at very unusual sites, such as testes, maxillary sinus, axillary vein thrombus, and hemodialysis fistula. Because relapses were so frequent, the suggestion is made that every effort be made to find silent foci of infection after clinical recovery and to eradicate such foci with prolonged antibiotic therapy and with surgical measures, if necessary. Stool and urine should be screened for nontyphoid Salmonella before and after transplantation.