Salmonellosis


SALMONELLOSIS

Description:

Infection with bacteria of the genus Salmonella. Patients with sickle cell anemia and compromised immune systems are particularly susceptible.

Alternative Name: Salmonella Enterocolitis.

Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States - Salmonellosis. Salmonellosis is the most commonly reported cause of enteric disease, and overall it is the second most common bacterial food-borne illness reported (usually slightly less frequent than Campylobacter infection).

The bacteria find their way into a person's stomach and intestines, they can cause cramps, nausea, vomiting, and diarrhea. There are several different types, or strains, of Salmonella bacteria, and they all can make you sick.

Every year, approximately 40,000 cases of salmonellosis are reported in the U.S. Because many milder cases are not diagnosed or reported, the actual number of infections may be 30 or more times greater.1 Salmonellosis is more common in the summer than winter. Children are the most likely to get salmonellosis; young children, older adults, and people with impaired immune systems are the most likely to have severe infections.

The reported incidence of Salmonella illnesses is about 14 cases per each 100,000 persons, amounting to approximately 30,000 confirmed cases of salmonellosis yearly in the U.S. In 2005, just over 36,000 cases were reported from public health laboratories across the nation, representing a 12 percent decrease compared with the previous decade, but a 1.5 percent increase over 2004.

Salmonella can be found in soil, water, raw food, and the bowel movements (poop) of some animals, including reptiles like turtles and snakes. If poop gets on the animal's skin, the bacteria will get on the skin, too. Then if a person touches the animal, she can get the bacteria and might develop salmonellosis.

Someone also can be infected if he or she eats food that has not been handled or prepared well. Sometimes Salmonella bacteria are found in raw foods — such as eggs, milk, chicken, turkey, and meat — that have touched animal poop. If these foods are not processed or cooked well, the bacteria stay alive in the food and can infect someone who eats it.

Salmonellosis usually lasts for about 4 - 7 days, with a maximum duration of up to 2 weeks. Infected individuals develop fever, diarrhea, and abdominal cramps within 12 - 72 hours of being infected. The majority of them recover without treatment.

People who have salmonellosis have the bacteria in their own poop, too. So if the sick person doesn't wash his or her hands carefully after using the bathroom, and then touches food, the bacteria can get in the food and spread to other people. Also, children in diapers who have salmonellosis can spread the infection because their poop will be infected. People who change the child's diapers could get the infection that way.

Because Salmonella bacteria are spread through poop, one of the best ways to prevent illness is to wash your hands often with warm water and soap.

Another way to protect against Salmonella infection is to never eat raw or undercooked eggs, meat, chicken, or turkey. Meat, chicken, and turkey should be cooked until they are no longer pink in the center, and eggs should be cooked so they aren't wet and runny. Raw fruit and vegetables make healthy snacks, but be sure to wash them well before you start munching.

Complications of Salmonella Infection include:

Typhoid fever, also known as enteric fever, is caused by Salmonella serotype typhi. The onset of symptoms usually occurs between 5 and 21 days after ingestion of Salmonela typhi bacteria. Symptoms may include constipation, cough, sore throat, headache, and a rash on the infected individual's chest, as well as the slowing of the heartbeat and enlargement of the liver and spleen.

Bacteremia is characterized by infection of tissues surrounding the brain and spinal cord (meningitis) and infection within the bloodstream (sepsis). This condition occurs when Salmonella enter and circulate within an infected individual's bloodstream, and is accompanied by few symptoms.

Reiter's syndrome, which includes and is sometimes referred to as “reactive arthritis” is an uncommon, but debilitating, result of a Salmonella infection. Reiter's syndrome is a disorder that causes at least two of three seemingly unrelated symptoms: reactive arthritis, eye irritation, and urinary tract infection. The reactive arthritis associated with Reiter's develops when a person eats food that has been tainted with bacteria. Reactive arthritis is characterized by the inflammation of one or more joints following an infection localized in another portion of the body, commonly the gastrointestinal tract. The symptoms of Reiter's Syndrome usually occur between one and three weeks after the infection.

Symptoms:

Symptoms of salmonellosis include diarrhea, fever, and abdominal cramps. They develop 12 to 72 hours after infection, and the illness usually lasts 4 to 7 days. Most people recover without treatment. But diarrhea and dehydration may be so severe that it is necessary to go to the hospital. Older adults, infants, and those with impaired immune systems are at highest risk.

If you only have diarrhea, you usually recover completely, although it may be several months before your bowel habits are entirely normal. A small number of people who are infected with salmonellosis develop Reiter's syndrome, a disease that can last for months or years and can lead to chronic arthritis.

Some of the most common symptoms are the following-

    Diarrhea.

  • Headache.

  • Fever.

  • Abdominal cramping or tenderness.

  • Loss of appetite.

  • Decreased urine output.

  • Body pain.

  • Dry mouth.

Causes and Risk factors:

Salmonella bacteria live in the intestines of people, animals and birds. Most people are infected with salmonella by eating foods that have been contaminated by feces. Commonly infected foods include:

    Raw meat, poultry and seafood: Feces may get onto raw meat and poultry during the butchering process. Seafood may be contaminated if it is harvested from contaminated water.

  • Raw eggs: While an egg's shell may seem to be a perfect barrier to contamination, some infected chickens produce eggs that contain salmonella before the shell is even formed. Raw eggs are used in homemade versions of mayonnaise and hollandaise sauce.

  • Fruits and vegetables: Some fresh produce, particularly imported varieties, may be watered in the field or washed during processing with water contaminated with salmonella. Contamination can also occur in the kitchen, when juices from raw meat and poultry come into contact with uncooked foods, such as salads.

  • Many foods become contaminated when prepared by people who don't wash their hands thoroughly after using the toilet or changing a diaper. Infection also can occur if you touch something that is contaminated and then put your fingers in your mouth. This includes pets — especially birds and reptiles.

Risk Factors:

Factors that may increase your risk of salmonella infection include activities that may bring you into closer contact with salmonella bacteria and health problems that may weaken your resistance to infection in general.

    Owning a pet bird or reptile: Some pets, particularly birds and reptiles, can be infected with salmonella bacteria.

  • Living in groups: People who live in college dorms or nursing homes might be at higher risk of infection simply because they are exposed to more people. In addition, food prepared at institutions often uses large amounts of ground meat or unshelled eggs that have been pooled from many different sources. This allows one infected egg or one pound of infected hamburger to contaminate the entire batch.

  • Your body has many natural defenses against salmonella infection. For example, strong stomach acid can kill many types of salmonella bacteria. But some medical problems or medications can short-circuit these natural defenses. Taking antacids lowering your stomach's acidity allows more salmonella bacteria to survive.

Diagnosis:

    Freshly passed stool is the preferred specimen for isolation of nontyphoidal Salmonella species. Since stool carriage of S typhi may be prolonged, the interpretation of positive results merits caution, and the diagnosis should be established only when accompanied by clinical findings that are typical of infection.

  • Bone marrow aspirate and culture is superior to blood culture, since the bacterial concentration in bone marrow is 10 times that of peripheral blood. In patients who received antibiotic therapy prior to hospitalization, bone marrow aspirate may still be positive for Salmonella even if blood culture results are negative.

  • In cases of typhoid fever, S typhi or S paratyphi may also be isolated from urine, rose spot biopsy, or gastric or intestinal secretions.

  • Grouping of Salmonella isolates is usually performed with polyvalent antisera specific for O and Vi antigen. S typhimurium belongs to group B; S enteritidis and S typhi belong to group D.

  • Radiologic findings in salmonellosis are nonspecific, and literature reports are scarce. The explanation lies in the fact that most individuals who develop acute Salmonella infection do not seek specialized medical assistance, do not undergo radiographic or endoscopic workup, and, when necessary, are treated empirically but successfully with supportive therapy and broad-spectrum antibiotic therapy.

  • Serological tests used in the diagnosis of enteric fever yield limited sensitivity and specificity. The Widal test is used to measure antibodies against O and H antigens of S typhi. Newer diagnostic tests (Typhidot, Tubex) allow direct detection of immunoglobulin M (IgM) antibodies against specific S typhi antigens. These tests are promising but need further evaluation in large community settings.31

  • Nested polymerase chain reaction (PCR) using H1-d primers has been used to amplify specific genes of S typhi, with high sensitivity and specificity. This may eventually replace blood culture as the criterion standard.32

Treatment:

Normally, Salmonella infections last for just a week. Rigorous treatment is often not required to control the illness. Diarrhea, in these patients, may be completely cured although it will take a while before normalcy is regained in the bowels. However, medical help must be sought if the patient suffers from severe dehydration or if the infection reaches the blood stream and spreads to other body parts.

A small group of Salmonella-infected people will go on to develop Reiter's syndrome, which is characterized, by joint pains, painful urination and eye irritation. This may last for several months or even years leading to chronic arthritis, a condition that does not respond to treatment. Arthritis may develop, irrespective of the person being treated with antibiotics.

    Self-treatment in persons with severe diarrhea consists of rehydration with intravenous fluids containing electrolytes.

  • Infected Infants may be treated with electrolytes while continuing to be breast-fed.

  • Antibiotics are administered only if the infection spreads from the intestine to other body parts. Antibiotics, such as ampicillin, gentamicin, ciprofloxacin or trimethoprim/ sulfamethoxazole are employed in the treatment. It needs to be ruefully accounted those certain mutants of Salmonella bacteria are resistant to antibiotics.

  • Changing your diet while you have diarrhea may help reduce symptoms. This may include avoiding milk products and following a BRAT diet. BRAT stands for bananas, rice, applesauce, and toast. These are binding foods that make the stools firmer.

Medicine and medications:

    Ciprofloxacin (Cipro).

  • Azithromycin (Zithromax).

  • Ceftriaxone (Rocephin).

  • Trimethoprim and sulfamethoxazole (Bactrim DS, Septra).

  • Chloramphenicol (Chloromycetin).

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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