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Salmonella Infection

Salmonella Infections

Salmonella infection causes common gastroenteritis as well as typhoid fever, which is a serious, sometimes fatal, disease. Whereas treatment with antibiotics is not required for most patients with enteritis, timely antibiotic therapy is crucial for typhoid fever.


Presentation

The Salmonella genus has more than 2500 different serotypes [1], which cause a variety of symptoms. The set of syndromes resulting from Salmonella infection (salmonellosis) are gastroenteritis, septicemia, focal disease, and enteric fever, in addition to the carrier state, which is asymptomatic.

Gastroenteritis, of which there are more than one million cases per year in the USA, is brought on by salmonellae belonging to the non-typhoidal group, most commonly by serotypes Enteritidis, Typhimurium, Newport, Heidelberg, and Javiana of Salmonella enterica subspecies enterica. Most non-typhoidal Salmonellae have broad host ranges, and animals are their main reservoir. Salmonella is transmitted to humans mainly by contaminated foods: meat, milk, eggs, vegetables, or any food not carefully handled. However, direct contact with animals, and with products consumed or used by them may also lead to infections [2]. Children under the age of 5, infants who are not breastfed [3], the elderly, those with gastrectomy or reduced stomach acid [4], the immunocompromised, and people with hemolytic conditions have an increased risk for salmonella infection.

The symptoms of salmonella enteritis are abdominal pain, diarrhea, fever, nausea, and vomiting. The episode may last from a few days to a week and usually does not require antimicrobial treatment, although in some cases, the diarrhea may cause severe dehydration.

Salmonellae invade the enterocytes in the gut, and in some rare cases continue to spread through the lymph nodes to other organs, among them the liver, spleen, and bones. Invasive infections can cause bacteremia, osteomyelitis, meningitis and septic arthritis. Bacteremia occurs infrequently, mainly in the very young and in the elderly population [5] [6], after infection with a few particular serotypes, for example, Salmonella enterica subspecies enterica serotype Typhimurium (commonly, although inaccurately referred to in an abbreviated form as S.Typhimurium). A strain of Salmonella typhimurium is causing serious bacteremic infections in tropical Africa [7].

Salmonella typhi and paratyphi give rise to typhoid fever, which is a serious systemic disease with relatively high mortality rates. There are only a few hundred cases in the USA per year, mainly in travelers, but there are about 21 million infections per year in developing countries [8].

Generalized Lymphadenopathy
  • This patient had continuous high fever for one month, bronchopneumonia, pancytopenia, mucous bloody diarrhea and generalized lymphadenopathy.[ncbi.nlm.nih.gov]
Fever
  • The symptoms of salmonella enteritis are abdominal pain, diarrhea, fever, nausea, and vomiting.[symptoma.com]
  • Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors.[ncbi.nlm.nih.gov]
  • Research is urgently needed to combat emerging agents of enteric fever such as S. Paratyphi A as well as nontyphoidal serovars, which commonly cause invasive disease in Africa.[ncbi.nlm.nih.gov]
  • This patient had continuous high fever for one month, bronchopneumonia, pancytopenia, mucous bloody diarrhea and generalized lymphadenopathy.[ncbi.nlm.nih.gov]
  • We present a case of enteric fever in which both Salmonella Typhi and Salmonella Paratyphi A were isolated from the blood of a patient traveling from India.[ncbi.nlm.nih.gov]
Reiter's Syndrome
  • Jones M.B., Smith P.W., Olnhansen R.W.: Reiter's syndrome after Salmonella infection: occurence in HLA-B27 positive brothers. Arthritis Rheum. 1979, 22: 1141–1142. Google Scholar 13.[link.springer.com]
  • Complications Reiter's Syndrome While most people recover successfully from salmonella, a few may develop a chronic condition called Reiter's syndrome. This syndrome can last for months or years and can lead to arthritis.[health24.com]
  • In rare cases, salmonella infection can lead to Reiter's syndrome (inflammation and pain of the joints, eye and urinary tract). Chronic arthritis may result.[nmihi.com]
  • The result is an autoimmune disease cause Reiter’s Syndrome, which produces chronic joint pain (arthritis), eye irritation (conjunctivitis with or without iritis) and problems with urination (urethritis).[livestrong.com]
  • Salmonella can lead to a condition called Reiter's syndrome that involves joint pain, eye irritation and painful urination. Chronic arthritis may result, regardless of whether a person takes antibiotics.[edition.cnn.com]
Chills
  • We report a renal transplant recipient who presented with fever and chills for 2 days. The blood and stool cultures revealed the growth of Salmonella enteriditis.[ncbi.nlm.nih.gov]
  • You have chills, a cough, or feel weak and achy. Your diarrhea or vomiting gets worse. You are dizzy or weak. You have questions or concerns about your condition or care. When should I seek immediate care or call 911? You have severe abdominal pain.[drugs.com]
  • Credit: istockphoto Chills often go hand in hand with fever. If you feel chilly, doctors recommend a simple treatment: put a couple of extra blankets on the bed, and dive under them.[cbsnews.com]
  • Symptoms of infection include nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache and bloody stool. Read or Share this story: From The USA TODAY NETWORK These sites are part of the USA TODAY NETWORK.[freep.com]
Diarrhea
  • Diarrhea was absent in one-third of cases. Among 12 recipients of allogeneic HSCT, 8 presented with bacteremia and only 6 had diarrhea. A total of 9 of these 12 patients had chronic GVHD.[ncbi.nlm.nih.gov]
  • This patient had continuous high fever for one month, bronchopneumonia, pancytopenia, mucous bloody diarrhea and generalized lymphadenopathy.[ncbi.nlm.nih.gov]
  • Iron fortification has been associated with a modest increase in diarrhea risk among children. Herein, we investigate the correction for this unwanted side effect with probiotic/prebiotic supplementation in weaning mice.[ncbi.nlm.nih.gov]
  • A 32-year-old nulligravid woman presented with abdominal pain, fever, and bloody diarrhea. On imaging, she was found to have complex pelvic masses highly suspicious for neoplasm. Surgical exploration revealed tubo-ovarian abscesses and peritonitis.[ncbi.nlm.nih.gov]
  • The symptoms of salmonella enteritis are abdominal pain, diarrhea, fever, nausea, and vomiting.[symptoma.com]
Vomiting
  • By the fourth day of hospital admission the patient's abdomen was distended in the absence of pain, nausea or vomiting. An abdominal radiograph showed marked gastric dilatation with no evidence of obstruction or ileus.[ncbi.nlm.nih.gov]
  • Your diarrhea or vomiting gets worse. You are dizzy or weak. You have questions or concerns about your condition or care. When should I seek immediate care or call 911? You have severe abdominal pain.[drugs.com]
  • Symptoms include: Fever Stomach cramps Diarrhea Vomiting Nausea Diagnosing Salmonella infection A healthcare provider takes a sample of your stool and checks for Salmonella . More than one stool sample may be needed.[saintlukeskc.org]
  • Symptoms include: Fever Stomach cramps Diarrhea Vomiting Nausea Diagnosing Salmonella infection A health care provider takes a sample of your stool and checks for Salmonella . More than one stool sample may be needed.[mountnittany.org]
Nausea
  • By the fourth day of hospital admission the patient's abdomen was distended in the absence of pain, nausea or vomiting. An abdominal radiograph showed marked gastric dilatation with no evidence of obstruction or ileus.[ncbi.nlm.nih.gov]
  • After Salmonella clearance (postinfectious phase), women experienced loose stools, nausea, and flatulence more frequently than men.[ncbi.nlm.nih.gov]
  • Symptoms include Fever Diarrhea Abdominal cramps Headache Possible nausea, vomiting, and loss of appetite Symptoms usually last 4-7 days. Your health care provider diagnoses the infection with a stool test. Most people get better without treatment.[nlm.nih.gov]
  • Symptoms include: Fever Diarrhea Abdominal cramps Headache Possible nausea, vomiting and loss of appetite Symptoms usually last four to seven days. Your healthcare provider diagnoses the infection with a stool test.[wexnermedical.osu.edu]
Abdominal Pain
  • A 52-year-old woman presented to our hospital with the chief complaint of left abdominal pain for 1 day. The plain kidney-ureter-bladder film and abdominal computed tomography scan showed foreign bodies in the peritoneum.[ncbi.nlm.nih.gov]
  • This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss.[ncbi.nlm.nih.gov]
  • A 32-year-old nulligravid woman presented with abdominal pain, fever, and bloody diarrhea. On imaging, she was found to have complex pelvic masses highly suspicious for neoplasm. Surgical exploration revealed tubo-ovarian abscesses and peritonitis.[ncbi.nlm.nih.gov]
  • We report a 12-year-old girl admitted to the hospital with fever, abdominal pain, and anorexia.[ncbi.nlm.nih.gov]
  • We analyzed the molecular characteristics of a ceftriaxone-resistant strain of Salmonella enterica serotype typhimurium isolated from a 12-year-old boy with fever, abdominal pain, and diarrhea.[ncbi.nlm.nih.gov]
Food Poisoning
  • Salmonellosis (Salmonella enterocolitis; food poisoning) is an infection of the lining of the small intestine caused by the bacteria Salmonella. Statistics on Salmonella infection In the U.S. approxiamatley 40,000 people are infected each year.[myvmc.com]
  • One of the most common causes of food poisoning in the United States, Salmonella enterica bacteria sicken about 1.2 million people a year, according to the Centers for Disease Control and Prevention.[baltimoresun.com]
  • All About Food Poisoning • Centers for Disease Control and Prevention[edition.cnn.com]
  • The presence of salmonella bacteria in the intestines causes gastroenteritis (also known as " food poisoning "), in which the intestines become irritated and their normal function is disrupted.[nmihi.com]
Headache
  • Symptoms include Fever Diarrhea Abdominal cramps Headache Possible nausea, vomiting, and loss of appetite Symptoms usually last 4-7 days. Your health care provider diagnoses the infection with a stool test. Most people get better without treatment.[nlm.nih.gov]
  • Symptoms include: Fever Diarrhea Abdominal cramps Headache Possible nausea, vomiting and loss of appetite Symptoms usually last four to seven days. Your healthcare provider diagnoses the infection with a stool test.[wexnermedical.osu.edu]
  • Signs and Symptoms: Symptoms of Salmonella infection include fever, headache, diarrhoea, abdominal pain, nausea and vomiting. Symptoms usually develop 6–72 hours after exposure to the bacteria, but sometimes up to 2 weeks.[conditions.health.qld.gov.au]
  • Diarrhoea Fever Abdominal cramps Headache These symptoms, along with possible nausea, loss of appetite, and vomiting, usually last for 4 to 7 days.[health24.com]
Dizziness
  • You are dizzy or weak. You have questions or concerns about your condition or care. When should I seek immediate care or call 911? You have severe abdominal pain. Your abdomen is tender and hard, or feels swollen.[drugs.com]

Workup

Enteritis is diagnosed by culturing the organisms from the stool, whereas bacteremic samples are obtained from blood or other extraintestinal sites. Samples are plated on several media (both nonselective and selective), often with initial growth on enrichment media. Metabolic characteristics of the organism are further examined in various media such as triple sugar iron agar. Group assignment of Salmonellae is based on antigenic analysis. S. Typhimurium, for example, belongs to group B. Pulsed-field gel electrophoresis (PFGE) and multiple locus variable number tandem repeat analysis are also used to determine the infecting organism.

Culturing and then examining the bacteria by immunological and biochemical methods is work-intensive. Identifying the bacterial species based on their proteome using mass spectrometry methods [9] is a newer, simpler method. Syndromic panels, using multiplexed nucleic acid tests, are also in use [10] [11]. Whether these methods will completely replace bacterial cultures is questionable, because without cultures no biological testing (for example antimicrobial resistance assays) can be performed. Ultrasonography may serve to distinguish salmonellosis – or other types of enteritis – from Crohn's disease.

The diagnosis of typhoid fever is difficult, as blood cultures and the standard immunological test, the Widal test, are not sufficiently sensitive or specific [12]. Newer immunological assays, and nested polymerase chain reactions [13] may offer faster and more specific diagnosis.

In the USA, Salmonella infections are reportable. Clinical laboratories submit samples to state agencies from where questionable strains are sent to the Centers for Disease Control and Prevention (CDC).

Mediastinal Mass
  • A patient with hairy cell leukemia who developed mediastinal mass and fever is described. A CT-guided aspiration of the mass yielded Salmonella tiphymurium.[ncbi.nlm.nih.gov]
  • Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi.[ncbi.nlm.nih.gov]
Colitis
  • Using a Salmonella-colitis mouse model and cultured colonic epithelial cells, we found that pathogenic Salmonella colonization significantly increases the levels of claudin-2 protein and mRNA in the intestine, but not that of claudin-3 or claudin-7 in[ncbi.nlm.nih.gov]
  • Malaria: Zyklus Malaria: Therapie Multiple Sklerose: Therapie HIV/AIDS: Therapie HIV/AIDS: Stadium C HIV/AIDS: Stadium B HBV: Therapie Hepatitis B: Diagnostik E. coli: EHEC und HUS Folsäurezyklus Morbus Crohn: Therapie Morbus Crohn: Klinik 2, Diagnostik Colitis[meditricks.de]
HLA-B27
  • Human leucocyte antigen (HLA)-B27 was positive in 42% of patients with ReA. The Salmonella O antigens of the 496 subjects belonged to eight groups (B, C, D1, E, G, I, L, and O), all with different major O antigenic determinants.[ncbi.nlm.nih.gov]
  • Aho, K., Ahuonen P., Alkio P.: HLA-B27 in reactive arthritis following infection. Ann. Rheum. Dis. 1975, 34 (suppl.), 29–31. Google Scholar 15.[link.springer.com]

Treatment

  • Quinolone antibiotic treatment resulted in a significantly higher number of negative stool cultures for NTS during the first week of treatment (microbiological failure: RR 0.33, 95% CI 0.20 to 0.56; 166 participants, four trials).Antibiotic treatment[ncbi.nlm.nih.gov]
  • In women, L. plantarum treatment was associated with more abdominal pain, whereas in men L. plantarum treatment reduced the prevalence of hard stools, and increased the presence of diarrheal symptoms in the postinfectious phase.[ncbi.nlm.nih.gov]
  • Under sonographic guidance a percutaneous drain was inserted into the cyst, followed by systemic antibiotic treatment and, later, intracystic instillation of tetracycline. The sclerosing treatment was successful, thus preventing laparotomy.[ncbi.nlm.nih.gov]
  • Aggressive antibiotic treatment and surgical drainage had little effect and the patient's condition continued to deteriorate.[ncbi.nlm.nih.gov]
  • A 16-month treatment with cotrimoxazole failed, as evidenced by culture and electron microscopy, despite persisting low MIC after therapy.[ncbi.nlm.nih.gov]

Prognosis

  • These two complications have severe clinical progress, poor prognosis and high mortality.[ncbi.nlm.nih.gov]
  • Recurrence of infection in 29% of the patients and the high mortality rate (28.5%), despite the conventional period of appropriate antimicrobial treatment, show a poor prognosis of salmonellosis in SLE patients.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of salmonella bacteremia, mycotic aneurysm, the risk factors, diagnosis, and treatment are discussed.[ncbi.nlm.nih.gov]
  • Etiology Nontyphoidal salmonellosis is caused by infection with Salmonella enterica other than S Typhi or S Paratyphi.[online.epocrates.com]
  • They are the etiologic agents of a variety of diseases globally defined as salmonellosis. Salmonellosis is one of the most important human enteric diseases worldwide.[qiagen.com]

Epidemiology

  • We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries.[ncbi.nlm.nih.gov]
  • It allows rapid analysis of multiple samples, thus can be used for sero-epidemiological studies of large population-based serum collections in order to estimate the population incidence of salmonella infections.[ncbi.nlm.nih.gov]
  • Two major changes in the epidemiology of nontyphoid salmonellosis in Europe and in the USA occurred in the second half of the 20(th) century: the emergence of foodborne human infections caused by Salmonella enterica serotype Enteriditis and by multidrug-resistant[ncbi.nlm.nih.gov]
  • We have demonstrated a way to use routinely collected surveillance data to enhance the knowledge of spatial disease epidemiology.[ncbi.nlm.nih.gov]
  • Data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD) were analysed.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The most common serotypes identified in the US associated with human disease are S Typhimurium, S Enteritidis, and S Newport, in descending order. [20] Pathophysiology Salmonella infections occur mainly via ingestion of contaminated foodstuffs, although[online.epocrates.com]

Prevention

  • The present study demonstrated strain-specific properties of probiotics to prevent Salmonella infection and elucidated their underlying mechanisms.[ncbi.nlm.nih.gov]
  • The sclerosing treatment was successful, thus preventing laparotomy.[ncbi.nlm.nih.gov]
  • This may prevent the need of acute intervention.[ncbi.nlm.nih.gov]
  • However, stimulation of such microbes does not necessarily imply a preventive effect against pathogen infection.[ncbi.nlm.nih.gov]
  • While it is extremely rare for those who work in the intensive care unit (ICU) to care for such patients, it is essential for health care professionals to recognize this disease in order to make a rapid diagnosis to prevent complications, such as mycotic[ncbi.nlm.nih.gov]

References

Article

  1. Popoff MY, Bockemühl J, Brenner FW. Supplement 1999 (no. 43) to the Kauffmann-White scheme. Res Microbiol. 2000 Dec;151(10):893-896.
  2. Behravesh CB, Ferraro A, Deasy M 3rd, et al, and the Salmonella Schwarzengrund Outbreak Investigation Team. Human Salmonella infections linked to contaminated dry dog and cat food, 2006-2008. Pediatrics. 2010 Sep;126(3):477-483.
  3. Jones TF, Ingram LA, Fullerton KE, et al. A case-control study of the epidemiology of sporadic Salmonella infection in infants. Pediatrics. 2006 Dec;118(6):2380-2387.
  4. Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 2011 Dec;34(11-12):1269-1281.
  5. Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015 Jan;28(1):3-31.
  6. Shimoni Z, Pitlik S, Leibovici L, et al. Nontyphoid Salmonella bacteremia: age-related differences in clinical presentation, bacteriology, and outcome. Clin Infect Dis. 1999 Apr;28(4):822-827.
  7. Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon MA. Invasive non-typhoidal salmonella disease: an emerging and neglected tropical disease in Africa. Lancet. 2012;379:2489–2499.
  8. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004 May;82(5):346-353.
  9. He Y, Li H, Lu X, Stratton CW, Tang YW. Mass spectrometry biotyper system identifies enteric bacterial pathogens directly from colonies grown on selective stool culture media. J Clin Microbiol. 2010 Nov;48(11):3888-3892.
  10. Buchan BW, Olson WJ, Pezewski M, et al. Clinical evaluation of a real-time PCR assay for identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and shiga toxin-producing Escherichia coli isolates in stool specimens. J Clin Microbiol. 2013 Dec;51(12):4001-4007.
  11. Wessels E, Rusman LG, van Bussel MJ, Claas EC. Added value of multiplex Luminex Gastrointestinal Pathogen Panel (xTAG® GPP) testing in the diagnosis of infectious gastroenteritis. Clin Microbiol Infect. 2014 Mar;20(3):O182-O187.
  12. Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul;333:78-82.
  13. Shirakava T, Acarya B, Kinoshita S, et al. Decreased susceptibility to fluoroquinolones and gyrA gene mutation in the Salmonella enterica serovar Typhi and Paratyphi A isolated in Kathmandu, Nepal, in 2003. Diagn Microbiol Infect Dis. 2006 Apr;54:299-303.

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Last updated: 2018-06-22 02:39