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

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

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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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
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Polish Salmonella, Pałeczki durowe i rzekomodurowe
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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
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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, サルモネラチュウドク, 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
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