Salmonella

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]])

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Gastrointestinal Manifestations

Acalculous Cholecystitis (see Acalculous Cholecystitis, [[Acalculous Cholecystitis]])

  • Epidemiology: may occur

Gastroenteritis (see Gastroenteritis, [[Gastroenteritis]])

  • Epidemiology
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  • 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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XXX

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References

  • Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev. 2012;11:CD001167 [MEDLINE]