Salmonella

Aka: Salmonella, Salmonellosis, Nontyphoidal Salmonellosis, Salmonella Food Poisoning

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II. Epidemiology

  1. Natural Hosts: Ducks, birds
  2. Pets
    1. Reptiles
    2. Birds
  3. Foodborne Illness Sources (95%)
    1. Eggs
    2. Cheese
    3. Dry cereal
    4. Unpasterurized milk or juice
    5. Ice Cream
    6. Poultry
    7. Contaminated unpeeled fruit
    8. Contaminated vegetables
  4. All serotypes are pathogenic

III. Pathophysiology

  1. Caused by Salmonella typhimurium (non-typhoid) and Salmonella enteritidis
    1. Contrast with Salmonella typhi that causes Typhoid Fever

IV. Symptoms

  1. Abdominal cramps
  2. Diarrhea
  3. Fever (>71% of cases)
  4. Vomiting
  5. Bloody stools (34% of cases)

V. Differential Diagnosis

  1. Ulcerative Colitis

VI. Labs

  1. Routine Stool Culture

VII. Complications

  1. Gastrointestinal Bleeding
  2. Toxic Megacolon
  3. Bacteremia (5%)
  4. Cardiovascular (25% bacteremic patients over age 50)
    1. Abdominal aorta infection
    2. Endocarditis
  5. Focal infections in Immunocompromised patients
    1. Meningitis
    2. Septic Arthritis
    3. Osteomyelitis
    4. Cholangitis
    5. Pneumonia

VIII. Management: Antibiotics

  1. Not indicated in uncomplicated non-typhi Salmonella Diarrhea
  2. Indications
    1. Severe infection or hospitalized
    2. Bacteremia or Sepsis
    3. Dysentery (Inflammatory Diarrhea)
    4. Disseminated disease (treat for 4-6 weeks)
    5. Age <12 months or >50 years
    6. Prosthesis (e.g. joint replacements)
    7. Valvular heart disease
    8. Severe Coronary Artery Disease
    9. Malignancy
    10. Uremia
    11. Liver disease
    12. Sickle Cell Anemia
    13. HIV or AIDS
    14. Immunocompromised (treat for 14 days)
  3. Precaution: Growing Antibiotic Resistance
    1. Third Generation Cephalosporin resistance increasing
    2. Fluoroquinolone resistance increasing (especially in Asia)
    3. Hohmann (2001) Clin Infect Dis 32:263-9 [PubMed]
  4. Antibiotic course
    1. Typical duration: 7-10 days
    2. Immunocompromised: 14 days
  5. Adults with severe disease
    1. Infection not acquired in Asia
      1. Ciprofloxacin 500 mg twice daily OR
      2. Levofloxacin 500 mg once orally daily
    2. Infection acquired in Asia (Fluoroquinolone resistance)
      1. Azithromycin 500 mg orally daily OR
      2. Ceftriaxone 2 g IV every 24 hours (or Cefotaxime 2 g IV every 8 hours)
    3. Other alternatives
      1. Carbapenem (e.g. Imipenem)
      2. Trimethoprim-sulfamethoxazole (TMP-SMZ) 160/800 mg twice daily for 5-7 days
        1. Higher resistance rates
  6. Children with severe disease
    1. Ceftriaxone every 24 hours (or Cefotaxime every 8 hours)
    2. Azithromycin
    3. Carbapenem (e.g. Imipenem)
    4. Trimethoprim-sulfamethoxazole 8-10 mg/kg/day of TMP component divided twice daily
      1. Higher resistance rates

IX. Course

  1. Onset: 6 to 24 hours (up to 48 hours)
  2. Duration: 4 to 7 days (untreated)
  3. Infectious: Asymptomatic shedding for 3-4 weeks

X. Resources

  1. CDC Salmonella
    1. http://www.cdc.gov/salmonella/
  2. CDC Yellow Book - Salmonella
    1. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/salmonellosis-nontyphoidal

XI. References

  1. (2014) Sanford Guide to Antimicrobials, accessed IOS app 5/8/2016
  2. Switaj (2015) Am Fam Physician 92(5): 358-65 [PubMed]

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