Medically-Relevant Members of Salmonella Genus
Typhoidal Salmonella
- Salmonella Enterica Serotype Typhi (Formerly Salmonella Typhi) (see Typhoid Fever, [[Typhoid Fever]])
- Salmonella Enterica Serotype Paratyphi A, B, or C (Formerly Salmonella Paratyphi) (see Typhoid Fever, [[Typhoid Fever]])
Non-Typhoidal Salmonella
- Salmonella Enterica
- Salmonella Arizonae
- Salmonella Diarizonae
- Salmonella Enterica
- Salmonella Choleraesuis (Salmonella Enterica serovar Choleraesuis): however, Salmonella Choleraesuis may occasionally cause a typhoid-like illness
- Salmonella Enteritidis (Salmonella Enterica serovar Enteritidis): however, Salmonella Enteritidis may occasionally cause a typhoid-like illness
- Salmonella Typhimurium (Salmonella Enterica serovar Typhimurium)
- Salmonella Houtenae
- Salmonella Indica
- Salmonella Salamae
- Salmonella Bongori
Microbiology
- Member of Family Enterobacteriaceae (see Enterobacteriaceae, [[Enterobacteriaceae]])
- Non-Lactose Fermenting Gram-Negative Rod
Diagnosis
- CXR/Chest CT patterns: miliary pattern
Clinical Manifestations (Non-Typhoidal Salmonellosis)
Dermatologic Manifestations
Erythema Multiforme (see Erythema Multiforme, [[Erythema Multiforme]])
Gastrointestinal Manifestations
Acalculous Cholecystitis (see Acalculous Cholecystitis, [[Acalculous Cholecystitis]])
Gastroenteritis (see Gastroenteritis, [[Gastroenteritis]])
- Epidemiology
- Exposure
- Ingestion of Contaminated Food
- Ingestion of Contaminated Water
- Incubation Period: 8-72 hrs
- Longer Incubation Periods Have Been Reported in Some Outbreaks, Presumably Due to Exposure to a Lower Bacterial Dose
- Diagnosis
- Clinical
- General Comments
- Clinically Indistinguishable from Other Causes of Infectious Gastroenteritis
- May Be Asymptomatic or Mild in Severity
- Higher Ingested Bacterial Dose Correlates with Severity of Diarrhea, Duration of Illness, and Weight Loss
- Chills (see Chills, [[Chills]])
- Crampy Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]])
- Diarrhea (see Diarrhea, [[Diarrhea]]): not usually grossly bloody (although bloody stools can be seen, particularly in childhood cases) (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
- Fatigue (see Fatigue, [[Fatigue]])
- Fever (see Fever, [[Fever]])
- Headache (see Headache, [[Headache]])
- Malaise
- Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])
- Weight Loss (see Weight Loss, [[Weight Loss]])
- Treatment
- Course is Usually Self-Limited
- Fever Resolves in 48-72 hrs
- Diarrhea Resolves in 4-10 Days
- Fluid/Electrolyte Replacement: by standard means
- Antibiotic Therapy
- Antibiotic Therapy is Indicated in Patients with Severe Disease (>9-10 Stools/Day, High Fever, or Need for Hospitalization) or in Patients with Risk Factors for Invasive Disease (Immunocompromised, Endovascular or Osseous Prostheses, etc)
- Antibiotic Therapy is Generally Not Indicated for Immunocompetent Patients Between 12-50 y/o with Mild-Moderate Symptoms
- Meta-Analysis (Cochrane Database Syst Rev, 2012) [MEDLINE]: no benefit of antibiotic therapy in otherwise healthy patients with mild-moderate Salmonella gastroenteritis, in terms of duration of illness, diarrhea, or fever
- Fluoroquinolones (see Fluoroquinolones, [[Fluoroquinolones]]): typically used agents
- Antibiotic Therapy May Theoretically Increase the Risk for Extending the Period of Asymptomatic Salmonella Carriage
- Prognosis: 0.5-1% (although these are likely overestimates, due to milder cases not being reported)
Bacteremia with Invasive Disease
- General Comments
- Bacteremia Develops in <5% of Patients with Salmonella Gastroenteritis
- Bacteremia Leads to a Variety of Extraintestinal Manifestations
- Bacteremia/Invasiveness is More Commonly Observed with Salmonella Choleraesuis, Salmonella Heidelberg, and Antibiotic-Resistant Strains of Salmonella Typhimurium
- Aortitis/Arteritis
- Epidemiology
- Increased Risk in Adults >50 y/o with Known Atherosclerotic Disease
- Approximately 10% of Adults >50 y/o Diagnosed with Non-Typhoidal Salmonella Bacteremia Will Develop Infective Arteritis
- Endocarditis (see Endocarditis, [[Endocarditis]])
- Meningitis (see Meningitis, [[Meningitis]])
- Epidemiology: occurs primarily in infants
- Mycotic Aneurysm (Infected Aneurysm) (see Mycotic Aneurysm, [[Mycotic Aneurysm]])
- Osteomyelitis (see Osteomyelitis, [[Osteomyelitis]])
Head and Neck Manifestations
Lemierre’s Syndrome (see Lemierre’s Syndrome, [[Lemierres Syndrome]])
- Epidemiology: rare etiology
Treatment
Antibotics
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References
- Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev. 2012;11:CD001167 [MEDLINE]