Harrison's Practice
[Display All Sections]

Nontyphoidal Salmonellosis

Monitoring

  • The median duration of stool excretion of Salmonella is ~5 weeks for all age groups.
  • Of patients < 5 years of age, 2.6% excrete salmonellae for >1 year.
  • Routine follow-up cultures are not recommended after uncomplicated Salmonella gastroenteritis in immunologically normal patients.
  • Some states require one or more negative stool cultures (>48 hours after discontinuation of antibiotics, if given) before food handlers or health care workers with Salmonella gastroenteritis can return to work. A similar approach may be followed in day-care centers.
  • Consideration may be given to monitoring stool cultures in immunocompromised patients and attempting to eradicate carriage.

Complications

  • Bacteremia/endovascular infections
    • If >50% of three or more blood cultures are positive, an endovascular infection should be suspected.
    • Endocarditis
      • Preexisting valvular heart disease is a strong risk factor for the development of endocarditis.
      • Endocarditis can be complicated by cardiac valve perforation or by ring or septal abscesses.
    • Arteritis is associated with:
      • Atherosclerotic plaque, prosthetic grafts, and aortic aneurysms
      • Mycotic aneurysms, ruptured aneurysms, or vertebral osteomyelitis
    • Endocarditis and arteritis are rare (< 1% of cases) but are associated with potentially morbid complications.
    • Unlike most nontyphoidal Salmonella serotypes, S. choleraesuis and S. dublin are frequently associated with sustained bacteremia and fever, often in the absence of a history of gastroenteritis.
      • These serotypes appear to be especially invasive and are often associated with metastatic infection.
  • Localized infections
    • Intraabdominal infections (rare)
    • Central nervous system infections
      • Meningitis
      • Cerebral abscesses
      • Severe sequelae
        • Residual seizure
        • Hydrocephalus
        • Ventriculitis
        • Abscess formation
        • Subdural empyema
        • Permanent disability (e.g., mental retardation and paralysis)
    • Pulmonary infections
    • Urinary tract infections
    • Genital tract infections
      • Ovarian and testicular abscesses
      • Prostatitis
      • Epididymitis
    • Bone, joint, and soft tissue infections
      • Salmonella osteomyelitis commonly affects femur, tibia, humerus, or lumbar vertebrae.
      • Septic arthritis usually presents in the knee, hip, or shoulder joints.
      • Reactive arthritis (Reiter’s syndrome)
      • Soft tissue infections (rare), usually at site of local trauma

Prognosis

  • Gastroenteritis
    • Usually self-limited
    • Diarrhea resolves within 3–7 days.
    • Fever resolves within 72 hours.
    • Stool cultures typically remain positive for 4–5 weeks after infection.
    • Rare cases of chronic carriage (< 1%) remain positive for >1 year.
    • Up to 5% of patients have positive blood cultures, and 5–10% of these patients develop localized infections that can lead to complications.
  • Morbidity and mortality associated with salmonellosis are highest among:
    • Elderly patients
    • Infants
    • Immunocompromised individuals, including those with hemoglobulinopathies and those infected with HIV or other pathogens that cause reticuloendothelial blockade (e.g., patients with bartonellosis, malaria, schistosomiasis, or histoplasmosis)

Prevention

  • Monitor every step of food production, from handling of raw products to preparation of finished foods.
    • With the increasing prevalence of S. enteritidis in egg-laying hens, it is recommended that pasteurized eggs be used at all nursing homes, hospitals, and commercial food-service establishments.
    • Transmission via contaminated eggs can be prevented by cooking so that the liquid yolk is solidified or through pasteurization.
  • All cases of nontyphoidal salmonellosis should be reported to public health departments.
    • Tracking and monitoring of these cases lead to identification of the sources of local outbreaks and anticipation of large-scale international outbreaks.
  • Prudent use of antimicrobial agents in both humans and animals is necessary to minimize further emergence of antibiotic-resistant strains.

Nontyphoidal Salmonellosis is a sample topic found in
Harrison's Practice.

To find other Harrison's Practice topics
please login or purchase a subscription.

[Top]

<< PreviousNontyphoidal SalmonellosisNext >>
[ TREATMENT ]ONGOING CARE
Last updated: March 13, 2008
[ RESOURCES ]
Content Manager
Related Content
Salmonellosis
more ...