Review Article

A Comprehensive Review of Disseminated Salmonella arizona Infection with an Illustrative Case Presentation

Authors: Jeffrey B. Hoag, MD, MS, Curtis N. Sessler, MD


Salmonella arizona is known to cause infection in reptiles and other animals. Disseminated human infection is rare, except in the setting of a deficient immune system. The following is a unique account of disseminated infection including pericardial involvement. Unusual features include nonreptile vector transmission and eastern seaboard (rather than southwestern) locale. A comprehensive literature review of disseminated S arizona infections is presented describing the types of infection, sources of exposure, underlying conditions, locale, treatments, and outcomes.

Key Points

* Disseminated Salmonella arizona infection should prompt investigation into underlying immunocompromise.

* Although most cases in the literature have occurred in the southwestern United States, eastern seaboard infections occur.

* Recurrence after adequate antibiotic therapy is common, thus requiring prolonged antibiotic therapy and vigilance in removing possible sources of exposure.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1.Riley KB, Antoniskis D, Maris R, Leedom JM. Rattlesnake capsule-associated Salmonella arizonainfections. Arch Intern Med 1988;48:1207–1210.
2.Bhatt BD, Zuckerman MJ, Foland JA, Polly SM, Marwah RK. Disseminated Salmonella arizona infection associated with rattlesnake meat ingestion. Am J Gastroenterol 1989;84:433–435.
3.Caravalho J Jr, McMillan VM, Ellis RB, Betancourt A. Endogenous endophthalmitis due to Salmonella arizonae and Hafnia alvei. South Med J 1990;83:325–327.
4.Cone LA, Boughton WH, Cone LA, Lehv LH. Rattlesnake capsule-induced Salmonella arizonae bacteremia. West J Med 1990;153:315–316.
5.Waterman SH, Juarez G, Carr SJ, Kilman L. Salmonella arizona infections in Latinos associated with rattlesnake folk medicine. Am J Public Health 1990;80:286–289.
6.Quismorio FP Jr, Jakes JT, Zarnow AJ, Barber D, Kitridou RC. Septic arthritis due to Arizona hinshawii. J Rheumatol 1983;10:147–150.
7.Smilack JD, Goldberg MA. Bone and joint infection with Arizona hinshawii: report of a case and a review of the literature. Am J Med Sci 1975;270:503–507.
8.Guckian JC, Byers EH, Perry JE. Arizona infection of man, report of a case and review of the literature. Arch Intern Med 1967;119:170–175.
9.Fainstein V, Yancey R, Trier P, Bodey GP. Overwhelming infection in a cancer patient caused by Arizona hinshawii: its relation to snake pill ingestion. Am J Infect Control 1982;10:147–153.
10.Marzouk JB, Joseph P, Lee TK, Livermore T, Benjamin R. Arizona hinshawii septicemia associated with rattlesnake powder. Calif Mobidity Weekly Report 1983; No. 25.
11.Fleischman S, Haake DA, Lovett MA. Salmonella arizona infections associated with ingestion of rattlesnake capsules. Arch Intern Med 1989;149:701–705.
12.Woolf GM, Runyon BA. Spontaneous Salmonella infection of high-protein noncirrhotic ascites. J Clin Gastroenterol 1990;12:430–432.
13.Cortes E, Zuckerman MJ, Ho H. Recurrent Salmonella arizona infection after treatment for metastatic carcinoma. J Clin Gastroenterol 1992;14:157–159.
14.Sharma J, Von Hoff DD, Weiss GR. Salmonella arizonae peritonitis secondary to ingestion of rattlesnake capsules for gastric cancer. J Clin Oncol 1993;11:2288–2289.
15.Johnson RH, Lutwick LI, Huntley GA, Vosti KL. Arizona hinshawii infections: New cases, antimicrobial sensitivities, and literature review. Ann Intern Med 1976;85:587–592.
16.Fisher RH. Multiple lesions of bone in Letterer-Siwe disease. J Bone Joint Surg 1953; 35A:445–464.
17.Jacobson MA, Hahn SM, Gerberding JL, Lee B, Sande MA. Ciprofloxacin for Salmonella bacteremia in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1989;110:1027–1029.
18.Noskin GA, Clarke JT. Salmonella arizonae bacteremia as the presenting manifestation of human immunodeficiency virus infection following rattlesnake meat ingestion. Rev Infect Dis 1990;12:514–517.
19.Casner PR, Zuckerman MJ. Salmonella arizonae in patients with AIDS along the US-Mexican border.N Engl J Med 1990;323:198–199.
20.Babu K, Sonnenberg M, Kathpalia S, Ortega P, Swiatlo AL, Kocka FE. Isolation of salmonellae from dried rattlesnake preparations. J Clin Microbiol 1990;28:361–362.
21.Nowinski RJ, Albert MC. Salmonella osteomyelitis secondary to iguana exposure. Clin Orthop2000;372:250–253.
22.Buck JJ, Nicholls SW. Salmonella arizona enterocolitis acquired by an infant from a pet snake. J Pediatr Gastroenterol Nutr 1997;25:248–249.
23.Sanyal D, Douglas T, Roberts R. Salmonella infection acquired from reptilian pets. Arch Dis Child1997;77:345–346.
24.Kelly J, Hopkin R, Rimsza ME. Rattlesnake meat ingestion and Salmonella arizona infection in children: case report and review of the literature. Pediatr Infect Dis J 1995;14:320–322.
25.Ichord R, Brook I, Controni G. Arizona hinshawii bacteraemia and meningitis in a child: a case report. J Clin Pathol 1980;33:848–850.
26.Ogden JA, Light TR. Pediatric osteomyelitis: Arizona hinshawii osteomyelitis. Clin Orthop1979;139:110–113.
27.Hruby MA, Honig GR, Lolekha S, Gotoff SP. Arizona hinshawii osteomyelitis in sickle cell anemia.Am J Dis Child 1973;125:867–868.
28.Butt E, Morris JF. Arizona paracolon recovered from middle ear discharge. J Infect Dis 1952;91:283–284.
29.Krag D, Shean DB. Serious human infections due to bacilli of the Arizona Group. California Medicine1959;90:230–233.
30.Lindsay KL, Canawati HN. Spontaneous Arizona hinshawii peritonitis in cirrhosis with ascites.Gastroenterology 1981;81:349–351.
31.Petru MA, Richman DD. Arizona hinshawii infection of an atherosclerotic abdominal aorta. Arch Intern Med 1981;141:537–538.
32.McIntyre KE Jr, Malone JM, Richards E, Axline SG. Mycotic aortic pseudoaneurysm with aortoenteric fistula caused by Arizona hinshawii. Surgery 1982;91:173–177.
33.Ripley GD. Mexican-American folk remedies: Their place in health case. Texas Med 1986;82:41–44.
34.Soloway M. Paracolon organisms in spray dried whole egg powder. J Bacteriol 1947;53:667.
35.Edwards PR. Studies on the Arizona subgroup of enterobactereaceae. Bacteriol Rev 1959;23:155.–
36.Edwards PR, McWhorter AC, Fife MA. The Arizona subgroup of enterobactereaceae. Bull WHO1956;14:511.–
37.Sechter I. Arizona isolates in Israel (1957–69). Ann Inst Pasteur (Paris) 1970;119:323.–
38.D’Aoust JY, Daley E, Crozier M, Sewell AM. Pet turtles: A continuing international threat to public health. Am J Epidemiol 1990;132:233–238.
39.Croop JM, Shapiro B, Alpert G, Campos JM, Zavod W. Arizona hinshawii osteomyelitis associated with a pet snake. Pediatr Infect Dis 1984;3:188.–
40.Caldwell MC, Hyerson DL. Salmonellosis in certain reptiles. J Infect Dis 1939;65:242.–
41.Seligman E, Saphra I, Wasserman M. Occurrence of some unusual Salmonella types in man including a new type, Salmonella georgia. Am J Hyg 1944;40:227–231.
42.Hentges K, Shields CE, Cantu C. Folk Medicine and Medical Practice. Texas Med 1986;82:27–29.
43.Centers for Disease Control (CDC). Arizona hinshawii septicemia associated with rattlesnake powder: California. MMWR Morb Mortal Wkly Rep 1983;32:464–465.
44.Lesnick ML, Reiner NE, Fierer J, Guiney DG. The Salmonella spvB virulence gene encodes an enzyme that ADP-ribosylates actin and destabilizes the cytoskeleton of eukaryotic cells. Mol Microbiol2001;39:1464–1470.
45.Kraus A, Guerra-Bautista G, Alarcon-Segovia D. Salmonella arizona arthritis and septicemia associated with rattlesnake ingestion by patients with connective tissue diseases. A dangerous complication of folk medicine. J Rheumatol 1991;18:1328–1331.
46.Dember LM. Critical care issues in the patient with chronic renal failure. Crit Care Clin 2002;18:421–440.
47.Figueras J, Juncal A, Carballo J, Cortadellas J, Soler JS. Nature and progression of pericardial effusion in patients with a first myocardial infarction: Relationship to age and free wall rupture. Am Heart J 2002;144:251–258.
48.Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulation treatment. Chest 2001;119:108–121s.
49.Braunwald. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Company, 2001:1854–1856.
50.Richter-Dahlfors AA, Buchan MJ, Finlay BB. Murine Salmonellosis studied by confocal microscopy: Salmonella typhimurium resides intracellularly inside macrophages and exerts cytotoxic effects on phagocytes in vivo. J Exp Med 1997;186:287–299.
51.Libby SJ, Lesnick M, Hasegawa P, Kurth M, Belcher C, Fierer J, Guiney DG. Characterization of the spv locus in Salmonella enterica serovar Arizona. Infect Immun 2002;70:3290–3294.
52.Keren DF, Rawlings W Jr, Murray HW, Leonard WR. Arizona hinshawii osteomyelitis with antecedent enteric fever and sepsis: A case report with a review of the literature. Am J Med1976;60:577–582.
53.Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36:3–15s.