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Salmonella Infection

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.

Images

WIKIDATA, Public Domain
WIKIDATA, Public Domain

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].

Immune System

  • Splenomegaly

    […] strains of S. typhimurium and S. enteritidis) which have a high burden amongst immunocompromised or malnourished individuals, and results in bacteriemia, systemic febrile disease, and variable manifestations including lower respiratory tract infection and splenomegaly [orpha.net]

  • Generalized Lymphadenopathy

    This patient had continuous high fever for one month, bronchopneumonia, pancytopenia, mucous bloody diarrhea and generalized lymphadenopathy. [ncbi.nlm.nih.gov]

Entire Body System

  • 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]

    Other types of Salmonella – Salmonella Typhi and Salmonella Paratyphi – cause typhoid fever and paratyphoid fever. [cdc.gov]

    Typhoid fever, a more serious disease caused by Salmonella, is not common in the United States. It frequently occurs in developing countries. NIH: National Institute of Allergy and Infectious Diseases [web.archive.org]

  • 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]

    Many foodborne illnesses can be prevented by following these safe food-handling practices: cook, clean, chill and separate. You can report any concerns about restaurant food to your local inspection authority. [inspection.gc.ca]

    Symptoms of infection include nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache and bloody stool. Contact Robin Erb : [email protected] or 313-222-2708. Follow her on Twitter @Freephealth. [freep.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]

    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]

  • Reiter Syndrome

    Reiter's syndrome and reactive arthritis in perspective. N Engl J Med. 1983;309:1606–15. 3. Ruppert GB, Lindsay J, Barth WF. Cardiac conduction abnormalities in Reiter's syndrome. Am J Med. 1982;73:335–40. 4. Keat A. [aafp.org]

    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]

    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]

    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]

  • Veterinarian

    Pediatricians, veterinarians, and pet store owners should inform their patients and customers of the potential risks of owning reptiles and provide appropriate preventive education. [ncbi.nlm.nih.gov]

    Pediatricians, veterinarians, and pet store owners should inform their patients and customers of the potential risks of owning reptiles and provide appropriate preventive education. antibiotics Salmonella Marina infant pediatric Received January 24, 1996 [doi.org]

Gastrointestinal

  • 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]

    The symptoms of salmonella enteritis are abdominal pain, diarrhea, fever, nausea, and vomiting. [symptoma.com]

    NOS ( R19.7 ) functional diarrhea ( K59.1 ) infectious gastroenteritis and colitis NOS ( A09 ) neonatal diarrhea (noninfective) ( P78.3 ) psychogenic diarrhea ( F45.8 ) infectious NOS A09 ICD-10-CM Diagnosis Code A09 Infectious gastroenteritis and colitis [icd10data.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]

    […] last In adults and children: diarrhoea usually lasts 5 to 7 days vomiting usually lasts 1 to 2 days Diarrhoea and vomiting can spread easily If you have a stomach bug, you could be infectious to others. [nhs.uk]

    The symptoms of Salmonella infection usually appear 12–72 hours after infection, and include fever, abdominal pain, diarrhoea, nausea and sometimes vomiting. The illness usually lasts 4–7 days, and most people recover without treatment. [who.int]

  • 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]

    The symptoms of Salmonella infection usually appear 12–72 hours after infection, and include fever, abdominal pain, diarrhoea, nausea and sometimes vomiting. The illness usually lasts 4–7 days, and most people recover without treatment. [who.int]

  • 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]

    The symptoms of Salmonella infection usually appear 12–72 hours after infection, and include fever, abdominal pain, diarrhoea, nausea and sometimes vomiting. The illness usually lasts 4–7 days, and most people recover without treatment. [who.int]

  • Food Poisoning

    Food contaminated by bacteria, viruses and parasites (foodborne pathogens) can make you sick. Some people can have foodborne illness, also known as "food poisoning", and not even know they have it. [inspection.gc.ca]

    Six food handlers at its factory and two at its outlet tested positive for Salmonella Enteritidis, a bacteria that causes food poisoning. [web.archive.org]

    […] salmonellosis [noun] (medical) food poisoning caused by eating food contaminated with salmonella bacteria; salmonella Salmonellosis is one of the most common foodborne diseases. [dictionary.cambridge.org]

    Print & Share (PDF 555KB) Español WATCH a video on Playing it Safe With Eggs Fresh eggs, even those with clean, uncracked shells, may contain bacteria called Salmonella that can cause foodborne illness, often called “food poisoning.” The U.S. [fda.gov]

Cardiovascular

  • Hypotension

    Acute abdomen and hypotensive shock developed suddenly without warning signs in advance. Image and tissue culture confirmed the diagnosis. The patient had an uneventful recovery. The rare clinical scenario is reported. [ncbi.nlm.nih.gov]

Neurologic

  • 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. [web.archive.org]

    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]

    […] something poisonous What we mean by a severe headache or stomach ache Causes of diarrhoea and vomiting You probably won't know exactly what the cause is, but the main causes of diarrhoea and vomiting are treated in the same way. [nhs.uk]

  • 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]

  • Confusion

    In severe cases there may be confusion. Without treatment symptoms may last weeks or months. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. [play.google.com]

    Foodborne illness can sometimes be confused with other illnesses that have similar symptoms. [fda.gov]

    The combination of facial dysmorphism and skeletal deformities, muscle stiffness and contractures, and myotonic discharges without waxing and waning are characteristic for SJS and render it difficult to be confused with other disorders. [advbiores.net]

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).

Colonoscopy

  • Colitis

    unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Infectious colitis NOS Infectious enteritis NOS Infectious gastroenteritis NOS Type 1 Excludes colitis NOS ( K52.9 ) diarrhea NOS ( R19.7 ) enteritis NOS ( K52.9 ) gastroenteritis [icd10data.com]

    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]

    In the pediatric setting, a high prevalence of Clostridium difficile was seen in both active and inactive Crohn's disease and ulcerative colitis patients. [doi.org]

    Reactive arthritis following Clostridium difficile colitis in a 3-year-old patient. J Clin Rheum. 1997;3:102–4. 8. Nasution AR, Mardjuadi A, Kunmartini S, Suryadhana NG, Setyohadi B, Sudarsono D, et al. [aafp.org]

HLA Type

  • 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]

    Over two thirds of these patients are HLA-B27 positive. [aafp.org]

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]

Prognosis

These two complications have severe clinical progress, poor prognosis and high mortality. [ncbi.nlm.nih.gov]

Prognosis The disease appears to stabilise after adolescence. The documents contained in this web site are presented for information purposes only. [orpha.net]

This patient with the neonatal form of SJS illustrates the bad prognosis and lack of therapeutic response to carbamazepine. However, this medication should be employed for the other forms. [scielo.br]

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]

Etiology The causative gene for SJS, HSPG2 (1p36), encodes perlecan, a major component of the cellular matrix. Diagnostic methods Electromyography reveals myotonia and the osteoarticular anomalies are visible on radiographs. [orpha.net]

View/Print Table TABLE 3 Etiologic Organisms in Reactive Arthritis Chlamydia trachomatis Salmonella enteritidis Salmonella typhimurium Shigella flexneri Shigella dysenteriae Campylobacter jejuni Yersinia enterocolitica Clostridia difficile TABLE 3 Etiologic [aafp.org]

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

Whitehead, Egg age and the growth of Salmonella enteritidis PT4 in egg contents, Epidemiology and Infection, 10.1017/S0950268800056910, 111, 2, (209-220), (2009). J. Dolman and R. G. [doi.org]

We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries. Copyright © 2012. Published by Elsevier B.V. [ncbi.nlm.nih.gov]

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]

The pathophysiology of the disease is not clearly understood, but electromyography shows nonvariable, continuous high frequency electrical activity (10). [ajnr.org]

더 이상 측면의 과학적 이해를 개발 하기 위해 PLP에 관련 된 그것은 더 나은 특성을 기본 neuroplastic 변화 산에서 제공 하는 통증 증상의 개선 뿐 아니라 사지 사지에서 그 결과에 중요 한 이와 관련, neuroimaging, fMRI, 같은 대뇌 피 질의 개편 연관 pathophysiologic 메커니즘 명료 수 있도록 강력한 도구로 등장 기술과 최적화에 PLP 가진 개인의 재활을 향해 단서 제공 임상 컨텍스트30,31. [jove.com]

Prevention

The present study demonstrated strain-specific properties of probiotics to prevent Salmonella infection and elucidated their underlying mechanisms. [ncbi.nlm.nih.gov]

References

  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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