Internal Medicine, Unit ofInfectious Diseases,

We retrospectively reviewed the charts of 51 patients with primary nontyphoid salmonella (NTS) bacteremia who did not have AIDS and who had no history ofgastroenteritis and no other identified source of infection. We compared these patients with 58 patients who developed sec-ondary NTS bacteremia following an episode of gastroenteritis. The following characteristics were more frequently associated with primary NTS bacteremia than with secondary NTS bacter-emia: age> 60 years (51 % vs. 33%; P <.05), glucocorticoid therapy (41 % vs. 13%; P <.01), and severe immunosuppression (65 % vs. 14%; P <.01). More patients with primary NTS bacteremia had hematologic malignancies, solid tumors, and connective-tissue diseases; in eight cases, pri-mary NTS bacteremia occurred simultaneously with or preceded these disorders. We suggest that the possibility of severe immunosuppression be investigated for patients with salmonella bacteremia who have not had or do not have gastroenteritis. The real incidence of bacteremia following enterocolitis due to nontyphoid salmonellae (NTS) remains unknown be-cause many cases are never investigated, and many patients are not admitted to the hospital. It appears that bacteremi