Salmonella

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

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II. Pathophysiology

  1. Characteristics
    1. Facultative Anaerobic Gram Negative Rod in Enterobacteriaceae family
      1. Grouped with SS Gram Negative Bacteria (Salmonella, Shigella)
    2. Salmonella is distinguished from other Enterobacteriaceae
      1. Motile with flagella (unlike Shigella)
      2. Does not ferment lactose (unlike E. coli)
      3. Produces Hydrogen Sulfide or H2S (unlike Shigella)
  2. Salmonellosis Pathogenesis
    1. Non-typhoid Salmonella is gastrointestinal colonizing flora in animals (reservoir)
      1. Natural Hosts (Ducks, birds)
      2. Pets (Reptiles, birds)
    2. All serotypes are pathogenic in humans
      1. More then 2000 serotypes have been identified (<100 are infectious in humans)
      2. Salmonellosis is most commonly caused by one of two Salmonella species
        1. Salmonella typhimurium (non-typhoid)
        2. Salmonella enteritidis
        3. Contrast with Salmonella typhi which causes Typhoid Fever
    3. Vi Antigen (Virulence Antigen)
      1. Surrounds the Salmonella Bacterial cell surface
      2. Protects surface Antigen O from immune response (Opsonization, Phagocytosis)
    4. Salmonella causes three distinct disease courses in humans
      1. Typhoid Fever (as well as chronic carrier state in up to 5%)
      2. Gastroenteritis
        1. Most common type of Salmonella infection (and described on this page)
      3. Invasive Disease and Sepsis
        1. Higher risk in children, esp. Asplenic (including Sickle Cell Anemia)
  3. Foodborne Illness Sources (95% of cases)
    1. Eggs
    2. Cheese
    3. Dry cereal
    4. Unpasterurized milk or juice
    5. Ice Cream
    6. Poultry
    7. Contaminated unpeeled fruit
    8. Contaminated vegetables

III. Symptoms

  1. Abdominal cramps
  2. Diarrhea
    1. Watery Diarrhea (most common) OR
    2. Infammatory Diarrhea with blood and mucous
  3. Fever (>50-70% of cases)
  4. Vomiting
  5. Bloody stools (34% of cases)

IV. Differential Diagnosis

  1. Ulcerative Colitis

V. Labs

  1. See Acute Diarrhea
  2. Identification
    1. Enteric Pathogens Nucleic Acid Test Panels (or if unavailable, then routine Stool Culture)

VI. Management: General

  1. See Acute Diarrhea
  2. See Traveler's Diarrhea
  3. Supportive Care
    1. Oral Rehydration

VII. Management: Antibiotics

  1. Antibiotics are 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

VIII. 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

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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Related Studies

Ontology: Salmonella (C0036111)

Definition (NCI_CDISC) Any bacteria that is not assigned to the species level but can be assigned to the Salmonella genus level.
Definition (NCI) A genus of motile, rod-shaped Gram-negative enterobacteria in the phylum Proteobacteria.
Definition (MSH) A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility.
Definition (CSP) genus of gram negative, facultatively anaerobic, rod shaped bacteria that utilizes citrate as a sole carbon source; it is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia; food poisoning is the most common clinical manifestation; organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility.
Concepts Bacterium (T007)
MSH D012475
SnomedCT 27268008
LNC LP20766-9
English Salmonella, Genus Salmonella (organism), Salmonella (organism), Salmonella Lignieres 1900, salmonella, salmonella bacteria, salmonellas, SALMONELLA SEROGROUP D (NOT S. TYPHI), SALMONELLA, Salmonella, NOS, Genus Salmonella
French Salmonelles, Salmonella, Salmonelle
Swedish Salmonella
Czech Salmonella
Spanish género Salmonella (organismo), Salmonella (organismo), Salmonella, género Salmonella
Finnish Salmonella
Russian SAL'MONELLY, САЛЬМОНЕЛЛЫ
Croatian SALMONELLA
Polish Salmonella, Pałeczki durowe i rzekomodurowe
Norwegian Salmonella
German Salmonella
Italian Salmonella
Dutch Salmonella
Portuguese Salmonella
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Salmonella food poisoning (C0036114)

Definition (MSHCZE) Otrava způsobená požitím potravy infikované různými druhy salmonel. Podmínky pro chov, přepravu, porážku a marketing domácích zvířat přispívají k rozšíření této bakterie.
Definition (MSH) Poisoning caused by ingestion of food harboring species of SALMONELLA. Conditions of raising, shipping, slaughtering, and marketing of domestic animals contribute to the spread of this bacterium in the food supply.
Definition (CSP) poisoning caused by ingestion of food harboring species of Salmonella; conditions of raising, shipping, slaughtering, and marketing of domestic animals contribute to the spread of this bacterium in the food supply.
Concepts Injury or Poisoning (T037)
MSH D012478
ICD9 003.0
ICD10 A02.0
SnomedCT 302229004, 42338000, 186094005, 170879007, 154271008, 266072007, 15025004
English Food Poisoning, Salmonella, Food Poisonings, Salmonella, Poisoning, Salmonella Food, Poisonings, Salmonella Food, Salmonella Food Poisoning, Salmonella Food Poisonings, Salmonella enteritis, Salmonella food poisoning, FOOD POIS SALMONELLA, SALMONELLA FOOD POIS, Salmonella gastroenteritis (diagnosis), Gastroenteritis salmonella, Salmonella poisoning, Salmonellosis, Salmonella Food Poisoning [Disease/Finding], poisoning salmonella, salmonellosis, Enteritis;salmonella, Poisoning;food;salmonella, salmonella poisoning, salmonella gastroenteritis, salmonella poison, salmonella enteritis, Salmonellosis (& [gastroenteritis] or [food poisoning]), Salmonellosis (& [gastroenteritis] or [food poisoning]) (disorder), Salmonella gastroenteritis, Enteric paratyphosis, Salmonella food poisoning (disorder), Salmonella gastroenteritis (disorder), Salmonella; gastroenteritis, Salmonella; infection, with (gastro)enteritis, Salmonella; poisoning, food; poisoning, due to salmonella, with gastroenteritis, food; poisoning, due to salmonella, gastroenteritis; Salmonella, infection; Salmonella, with (gastro)enteritis, poisoning; Salmonella, poisoning; food, due to salmonella, with gastroenteritis, poisoning; food, due to salmonella, Salmonella gastroenteritis [Ambiguous], salmonella food poisoning
Italian Gastroenterite da salmonella, Gastroenterite da Salmonella, Avvelenamento da salmonella, Enterite da salmonella, Intossicazione alimentare da Salmonella
Dutch Salmonella-enteritis, Salmonella-vergiftiging, Salmonella; gastro-enteritis, Salmonella; infectie, met {gastro}enteritis, Salmonella; vergiftiging, gastro-enteritis; Salmonella, infectie; Salmonella, met {gastro}enteritis, vergiftiging; Salmonella, vergiftiging; voedsel, door Salmonella, met gastro-enteritis, vergiftiging; voedsel, door Salmonella, voedsel; vergiftiging, door Salmonella, met gastro-enteritis, voedsel; vergiftiging, door Salmonella, Enteritis door Salmonella, Salmonella-gastro-enteritis, Salmonella-voedselvergiftiging, Vergiftiging, Salmonella-voedsel-, Voedselvergiftiging, Salmonella-
French Gastroentérite à Salmonella, Entérite à Salmonella, Intoxication à Salmonella, Gastro-entérite à salmonelles, Toxi-infection alimentaire à Salmonella, Toxi-infection alimentaire à salmonelles
German Salmonellenvergiftung, Salmonella enteritis, Salmonella Gastroenteritis, Salmonellenenteritis, Gastroenteritis durch Salmonellen, Lebensmittelvergiftung, Salmonellen-
Portuguese Enterite a salmonela, Intoxicação por salmonela, Gastrenterite a salmonela, Intoxicação por Salmonella, Gastroenterite a salmonela, Intoxicação Alimentar por Salmonella
Spanish Enteritis por salmonella, intoxicación alimentaria por Salmonella, envenenamiento alimentario por Salmonella (trastorno), envenenamiento alimentario por Salmonella, intoxicación alimentaria por Salmonella (trastorno), enteritis por Salmonella, Envenenamiento Alimentario por Salmonella, Intoxicación por Salmonella, Envenenamiento por Salmonella, gastroenteritis por Salmonella (trastorno), gastroenteritis por Salmonella, Gastroenteritis por salmonella, Intoxicación Alimentaria por Salmonella
Japanese サルモネラ中毒, サルモネラ菌性腸炎, サルモネラ菌性胃腸炎, ｻﾙﾓﾈﾗｷﾝｾｲﾁｮｳｴﾝ, ｻﾙﾓﾈﾗｷﾝｾｲｲﾁｮｳｴﾝ, ｻﾙﾓﾈﾗﾁｭｳﾄﾞｸ, サルモネラ食中毒, 食中毒-サルモネラ
Swedish Salmonella-matförgiftning
Czech Salmonella - otrava alimentární, Salmonelová otrava, Salmonelová enteritida, Salmonelová gastroenteritida
Finnish Salmonellaruokamyrkytys
Russian PISHCHEVAIA INTOKSIKATSIIA SAL'MONELLEZNAIA, OTRAVLENIE PISHCHEVOE SAL'MONELLEZNOE, SAL'MONELLEZNAIA PISHCHEVAIA INTOKSIKATSIIA, PISHCHEVOE OTRAVLENIE SAL'MONELLEZNOE, ОТРАВЛЕНИЕ ПИЩЕВОЕ САЛЬМОНЕЛЛЕЗНОЕ, ПИЩЕВАЯ ИНТОКСИКАЦИЯ САЛЬМОНЕЛЛЕЗНАЯ, ПИЩЕВОЕ ОТРАВЛЕНИЕ САЛЬМОНЕЛЛЕЗНОЕ, САЛЬМОНЕЛЛЕЗНАЯ ПИЩЕВАЯ ИНТОКСИКАЦИЯ
Korean 살모넬라 창자염
Polish Zatrucie pokarmowe Salmonellą, Zatrucie pokarmowe pałeczką duru
Hungarian Salmonella gastroenteritis, Salmonella mérgezés, Salmonella okozta gastroenteritis, Salmonella enteritis
Norwegian Salmonellaenteritt, Matforgiftning, Salmonella, Salmonellamatforgiftning
Derived from the NIH UMLS (Unified Medical Language System)

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