Salmonella: Difference between revisions

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{{Salmonellosis}}
{{Salmonellosis}}
{{Main|Salmonellosis}}
{{About0|Salmonellosis}}
 
{{CMG}}; {{AE}} {{JS}} {{JM}}
{{CMG}}; {{AE}} {{JS}} {{JM}}


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''Salmonella'' is a [[gram-negative]], facultative [[intracellular]], [[anaerobic]], non-spore-forming [[bacillum]]. It measures 2 to 3 by 0.4 to 0.6 μm. [[Salmonella]] is a non-[[lactose]] fermenting bacterium. It reduces [[nitrates]], produces acid on glucose fermentation and does not produce cytochrome oxidase.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> Due to the presence of [[flagella]], almost all [[salmonella]] species are motile. 1% of the bacteria is able to ferment [[lactose]], which may be responsible for its non-detection in some culture media.
''Salmonella'' is a [[gram-negative]], facultative [[intracellular]], [[anaerobic]], non-spore-forming bacillus. It measures 2 to 3 by 0.4 to 0.6 μm. [[Salmonella]] is a non-[[lactose]] fermenting bacterium. It reduces [[nitrates]], produces acid on glucose fermentation and does not produce cytochrome oxidase.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> Due to the presence of [[flagella]], almost all [[salmonella]] species are motile. 1% of the bacteria is able to ferment [[lactose]], which may be responsible for its non-detection in some culture media.


For the isolation of [[salmonella]] in culture, freshly passed stool are preferred. Common media for the growth of [[salmonella]] include: [[MacConkey agar]], deoxycholate agar, and xylose-lysine-deoxycholate agar.<ref name="PerezCavalli2003">{{cite journal|last1=Perez|first1=J. M.|last2=Cavalli|first2=P.|last3=Roure|first3=C.|last4=Renac|first4=R.|last5=Gille|first5=Y.|last6=Freydiere|first6=A. M.|title=Comparison of Four Chromogenic Media and Hektoen Agar for Detection and Presumptive Identification of Salmonella Strains in Human Stools|journal=Journal of Clinical Microbiology|volume=41|issue=3|year=2003|pages=1130–1134|issn=0095-1137|doi=10.1128/JCM.41.3.1130-1134.2003}}</ref>
For the isolation of [[salmonella]] in culture, freshly passed stool are preferred. Common media for the growth of [[salmonella]] include: [[MacConkey agar]], deoxycholate agar, and xylose-lysine-deoxycholate agar.<ref name="PerezCavalli2003">{{cite journal|last1=Perez|first1=J. M.|last2=Cavalli|first2=P.|last3=Roure|first3=C.|last4=Renac|first4=R.|last5=Gille|first5=Y.|last6=Freydiere|first6=A. M.|title=Comparison of Four Chromogenic Media and Hektoen Agar for Detection and Presumptive Identification of Salmonella Strains in Human Stools|journal=Journal of Clinical Microbiology|volume=41|issue=3|year=2003|pages=1130–1134|issn=0095-1137|doi=10.1128/JCM.41.3.1130-1134.2003}}</ref>
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*[[Dendritic cells]] - relevant for dissemination of [[bacteria]] in the initial stages of [[infection]], yet, they are not considered adequate reservoirs for Salmonella at latter stages
*[[Dendritic cells]] - relevant for dissemination of [[bacteria]] in the initial stages of [[infection]], yet, they are not considered adequate reservoirs for Salmonella at latter stages
*[[Neutrophils]] - interaction is based on the [[immune response]] against the [[bacteria]], hence this might not be considered true [[tropism]]
*[[Neutrophils]] - interaction is based on the [[immune response]] against the [[bacteria]], hence this might not be considered true [[tropism]]
==Differential diagnosis==
Salmonella gastroenteritis must be differentiated from other causes of viral, bacterial, and parasitic gastroentritis.
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Organism
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Age predilection
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Travel History
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Size (cell)
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Time
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;"|History and Symptoms
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|Diarrhea type8
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Food source
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Specific consideration
|-
!style="background:#4479BA; color: #FFFFFF|Fever
!style="background:#4479BA; color: #FFFFFF|N/V
!style="background:#4479BA; color: #FFFFFF|Cramping Abd Pain
!style="background:#4479BA; color: #FFFFFF|Small Bowel
!style="background:#4479BA; color: #FFFFFF|Large Bowel
!style="background:#4479BA; color: #FFFFFF|Inflammatory
!style="background:#4479BA; color: #FFFFFF|Non-inflammatory
|-
| rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Viral'''
| colspan="2"  style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rotavirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10<sup>2</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly in day cares, most common in winter.
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Norovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 -10<sup>3</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Most common cause of gastroenteritis, abdominal tenderness,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Adenoviridae|Adenovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>5</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |No seasonality
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Astrovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |72-96 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafood
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly during winter
|-
| rowspan="11" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Bacterial'''
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Escherichia coli]]''
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[ETEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>8</sup> -10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EPEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<1 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6-12 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw beef and chicken
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EIEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hamburger meat and unpasteurized milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Similar to [[shigellosis]], can cause bloody diarrhea
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EHEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |3-4 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked or raw hamburger (ground beef) 
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Known as ''[[Escherichia coli O157:H7|E. coli]]'' [[Escherichia coli O157:H7|O157:H7]], can cause [[Hemolytic-uremic syndrome|HUS]]/[[TTP]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EAEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-18 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause prolonged or persistent diarrhea in children
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Salmonella|Salmonella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6 to 72 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can cause [[salmonellosis]] or [[typhoid fever]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Shigella|Shigella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 - 200
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Campylobacter|Campylobacter sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y, 15-29 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables,  seafood and contaminated water.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[bacteremia]], [[Guillain-Barré syndrome]] (GBS), [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] (HUS) and recurrent [[colitis]]
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Yersinia enterocolitica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-11 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[reactive arthritis]]; [[glomerulonephritis]]; [[endocarditis]]; [[erythema nodosum]].
can mimic [[appendicitis]] and mesenteric [[lymphadenitis]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Clostridium perfringens]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |> 10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |16 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can survive high heat,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Vibrio cholerae]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>6</sup>-10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypotension]], [[tachycardia]], decreased [[Turgor|skin turgor]]. Rice-water stools
|-
| rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Parasites'''
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Protozoa
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Giardia lamblia]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 cyst
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-2 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[malabsorption syndrome]] and severe [[weight loss]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Entamoeba histolytica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |4-11 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 cysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water and raw foods
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause intestinal amebiasis and amebic liver abscess
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cryptosporidium parvum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Juices and milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause copious diarrhea and [[dehydration]] in patients with [[AIDS]] especially with  180 > [[CD4|CD<sub>4</sub>]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cyclospora cayetanensis]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fresh produce, such as raspberries, basil, and several varieties of lettuce.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in rainy areas
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Helminths
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Trichinella]]'' [[Trichinella|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Two viable larvae (male and female)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked meats
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in hunters or people who eat traditionally uncooked meats
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Taenia (tapeworm)|Taenia]]'' [[Taenia (tapeworm)|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva or egg
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 m
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked beef and pork
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Neurocysticercosis]]: Cysts located in the brain may be asymptomatic or [[seizures]], increased [[intracranial pressure]], [[headache]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Diphyllobothrium|Diphyllobothrium latum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |15 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw or undercooked fish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause vitamin B<sub>12</sub> deficiency
|}
<br><br>
<small><small>
8'''Small bowel diarrhea''': watery, voluminous with less than 5 WBC/high power field
'''Large bowel diarrhea''': Mucousy and/or bloody with less volume and more than 10 WBC/high power field<br>
† It could be as high as 1000 based on patient's immunity system.
</small></small>
'''The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea'''<ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref>
{| class="wikitable"
!Cause
!History
!Laboratory findings
!Diagnosis
!Treatment
|-
|[[Diverticulitis]]
|
* [[Bloody diarrhea]]
* Left lower quadrant [[abdominal pain]]
* [[Abdominal tenderness]] on [[physical examination]]
* Low grade [[fever]]
|
* [[Leukocytosis]]
* Elevated serum [[amylase]] and [[lipase]]
* [[Sterile]] [[pyuria]] on [[urinalysis]]
|Abdominal [[CT scan]] with oral and intravenous [[Contrast medium|(IV) contrast]]
|bowel rest, [[Intravenous fluids|IV fluid]] resuscitation, and [[Broad-spectrum antibiotic|broad-spectrum antimicrobial therapy]] which covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]
|-
|[[Ulcerative colitis]]
|
* [[Diarrhea]] mixed with blood and [[mucus]], of gradual onset.
* Signs of [[weight loss]]
* [[Rectal pain|Rectal urgency]]
* [[Tenesmus]]
* [[Blood]] is often noticed on underwear
* Different degrees of [[abdominal pain]]
|
* [[Anemia]]
* [[Thrombocytosis]]
* A high [[platelet]] count
* Elevated [[ESR]] (>30mm/hr)
* Low [[albumin]]
|[[Endoscopy]]
|Induction of  [[Remission (medicine)|remission]] with [[mesalamine]] and [[corticosteroids]] followed by the administration of [[sulfasalazine]] and [[Mercaptopurine|6-Mercaptopurine]] depending on the severity of the [[disease]].
|-
|[[Entamoeba histolytica]]
|
* [[Abdominal cramps]]
* [[Diarrhea]]
** Passage of 3 - 8 semiformed [[stools]] per day
** Passage of soft [[stools]] with [[mucus]] and occasional [[blood]]
* [[Fatigue]]
* [[Intestinal]] gas (excessive [[flatus]])
* [[Rectal pain]] while having a [[bowel movement]] ([[tenesmus]])
* Unintentional [[weight loss]]
|cysts shed with the stool
|detects ameba [[DNA]] in feces
|[[Amebic dysentery]]
* [[Metronidazole]] 500-750mg three times a day for 5-10 days
* [[Tinidazole]] 2g once a day for 3 days is an alternative to [[metronidazole]]
Luminal amebicides for ''[[E. histolytica]]'' in the [[colon]]:
* [[Paromomycin]] 500mg three times a day for 10 days
* [[Diloxanide furoate]] 500mg three times a day for 10 days
* [[Iodoquinol]] 650mg three times a day for 20 days
For [[Amoebiasis|amebic liver abscess]]:
* [[Metronidazole]] 400mg three times a day for 10 days
* [[Tinidazole]] 2g once a day for 6 days is an alternative to [[metronidazole]]
* [[Diloxanide furoate]] 500mg three times a day for 10 days must always be given afterwards.
|}


==Natural Reservoir==
==Natural Reservoir==
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[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]

Latest revision as of 18:40, 18 September 2017

Salmonellosis Microchapters

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This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Salmonellosis.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]

Overview

Salmonella is a rod-shaped, facultative intracellular, gram-negative enterobacteria.[1] Salmonella species shows motility, produces hydrogen sulfide, and only 1% is able to ferment lactose.[2] It may be isolated from the stool of infected patients, and grown in culture media, such as MacConkey agar and deoxycholate agar. Salmonella enters the body through contaminated food or water, and invades the intestinal epithelial cells, causing inflammation.

This bacterium may be classified into 2 different species: Salmonella enterica and Salmonella bongori. Salmonella enterica is divided in 6 different subspecies, of which I, contains most pathogenic serotypes for humans. Salmonella may be serogrouped into more than 2500 serovars with polyvalent antisera, according to the capsular antigen, polysaccharide O antigens, and flagellar antigens. The bacteria show tropism for the epithelial cells of the gastrointestinal tract, macrophages, dendritic cells, and neutrophils. Different serotypes of Salmonella may have different natural reservoirs, some have humans as their only natural reservoir (serotypes Sendai and Typhi), while others (serotype Dublin) may infect humans and cattle.

Taxonomy

Cellular organism; Bacteria; Proteobacteria; Gammaproteobacteria; Enterobacteriales; Enterobacteriaceae[3]

Biology

Computer-generated image of three drug-resistant non-typhoidal Salmonella bacteria. Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[4]
Colonial growth pattern displayed by Salmonella enterica subsp. arizonae, formerly Salmonella choleraesuis and Arizona hinshawii bacteria grown on a blood agar culture plate Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.[4]

Salmonella is a gram-negative, facultative intracellular, anaerobic, non-spore-forming bacillus. It measures 2 to 3 by 0.4 to 0.6 μm. Salmonella is a non-lactose fermenting bacterium. It reduces nitrates, produces acid on glucose fermentation and does not produce cytochrome oxidase.[5] Due to the presence of flagella, almost all salmonella species are motile. 1% of the bacteria is able to ferment lactose, which may be responsible for its non-detection in some culture media.

For the isolation of salmonella in culture, freshly passed stool are preferred. Common media for the growth of salmonella include: MacConkey agar, deoxycholate agar, and xylose-lysine-deoxycholate agar.[6]

When the sample has a low number of bacteria, special enrichment broths, such as the selenite-based enrichment broth, may be used to raise the number of bacteria.[6]

Infectious Cycle

Salmonella enterica enters the body through the mouth, by ingestion of contaminated food and water. For the bacteria to cause disease, an inoculum of about 50 000 pathogens is often required. Once in the intestine, the bacteria will first infect the apical epithelium. Salmonella will then initiate bacterial mechanisms that allow invasion of the host cells, inducing inflammatory changes, such as:[7][8][9][10]

Different serovars will have different preferable intestinal locations. An example is the enterocolitis at the terminal ileum, cecum, and proximal colon caused by serovar Typhimurium. Intestinal disease is marked by neutrophil migration to the intestinal epithelium. This recruitment is done by the secretion of interleukin-8, induced by Salmonella.[11]

Classification

Before 1983 Salmonella was classified in several species. However, its genome study has shown high levels of DNA similarities among different types of salmonella, which leads to the actual classification of salmonella in 2 different species:

Salmonella enterica

  • Contains six subspecies - I, II, IIIa, IIIb, IV, and VI:[12][13]
    • I - enterica
    • II - salamae
    • III - arizonae
    • IIIb - diarizonae
    • IV - houtenae
    • VI - indica
  • Subspecies I contains most pathogenic serotypes for humans
  • Subspecies IIIa and IIIb, formerly belonging to the genus Arizonae, are responsible for rare human infections

Salmonella bongori

Serovars

Salmonella subspecies may be serogrouped into more than 2500 serovars with polyvalent antisera. For this division the following bacterial structures are considered:[15]

Different salmonella serotypes may also be distinguished in culture, according to their different metabolism of sugars.[16] Different serovars may also have different disease manifestations. For example, Salmonella enterica, serovar Typhimurium is the causative agent of typhoid fever, and is not associated with classical salmonellosis.

Tropism

In vitro, Salmonella is able to interact with different types of cells. However, in vivo, the bacteria was found to enter only certain human cells, namely:[17]

Differential diagnosis

Salmonella gastroenteritis must be differentiated from other causes of viral, bacterial, and parasitic gastroentritis.

Organism Age predilection Travel History Incubation Size (cell) Incubation Time History and Symptoms Diarrhea type8 Food source Specific consideration
Fever N/V Cramping Abd Pain Small Bowel Large Bowel Inflammatory Non-inflammatory
Viral Rotavirus <2 y - <102 <48 h + + - + + - Mostly in day cares, most common in winter.
Norovirus Any age - 10 -103 24-48 h + + + + + - Most common cause of gastroenteritis, abdominal tenderness,
Adenovirus <2 y - 105 -106 8-10 d + + + + + - No seasonality
Astrovirus <5 y - 72-96 h + + + + + Seafood Mostly during winter
Bacterial Escherichia coli ETEC Any age + 108 -1010 24 h - + + + + - Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
EPEC <1 y - 10 6-12 h - + + + + Raw beef and chicken -
EIEC Any ages - 10 24 h + + + + + Hamburger meat and unpasteurized milk Similar to shigellosis, can cause bloody diarrhea
EHEC Any ages - 10 3-4 d - + + + + Undercooked or raw hamburger (ground beef)  Known as E. coli O157:H7, can cause HUS/TTP.
EAEC Any ages + 1010 8-18 h - - + + + - May cause prolonged or persistent diarrhea in children
Salmonella sp. Any ages + 1 6 to 72 h + + + + + Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad. Can cause salmonellosis or typhoid fever.
Shigella sp. Any ages - 10 - 200 8-48 h + + + + + Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken) Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
Campylobacter sp. <5 y, 15-29 y - 104 2-5 d + + + + + Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables, seafood and contaminated water. May cause bacteremia, Guillain-Barré syndrome (GBS), hemolytic uremic syndrome (HUS) and recurrent colitis
Yersinia enterocolitica <10 y - 104 -106 1-11 d + + + + + Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk. May cause reactive arthritis; glomerulonephritis; endocarditis; erythema nodosum.

can mimic appendicitis and mesenteric lymphadenitis.

Clostridium perfringens Any ages > 106 16 h - - + + + Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods. Can survive high heat,
Vibrio cholerae Any ages - 106-1010 24-48 h - + + + + Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish. Hypotension, tachycardia, decreased skin turgor. Rice-water stools
Parasites Protozoa Giardia lamblia 2-5 y + 1 cyst 1-2 we - - + + + Contaminated water May cause malabsorption syndrome and severe weight loss
Entamoeba histolytica 4-11 y + <10 cysts 2-4 we - + + + + Contaminated water and raw foods May cause intestinal amebiasis and amebic liver abscess
Cryptosporidium parvum Any ages - 10-100 oocysts 7-10 d + + + + + Juices and milk May cause copious diarrhea and dehydration in patients with AIDS especially with 180 > CD4
Cyclospora cayetanensis Any ages + 10-100 oocysts 7-10 d - + + + + Fresh produce, such as raspberries, basil, and several varieties of lettuce. More common in rainy areas
Helminths Trichinella spp Any ages - Two viable larvae (male and female) 1-4 we - + + + + Undercooked meats More common in hunters or people who eat traditionally uncooked meats
Taenia spp Any ages - 1 larva or egg 2-4 m - + + + + Undercooked beef and pork Neurocysticercosis: Cysts located in the brain may be asymptomatic or seizures, increased intracranial pressure, headache.
Diphyllobothrium latum Any ages - 1 larva 15 d - - - + + Raw or undercooked fish. May cause vitamin B12 deficiency



8Small bowel diarrhea: watery, voluminous with less than 5 WBC/high power field

Large bowel diarrhea: Mucousy and/or bloody with less volume and more than 10 WBC/high power field
† It could be as high as 1000 based on patient's immunity system.

The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea[18][19][20][21][21]

Cause History Laboratory findings Diagnosis Treatment
Diverticulitis Abdominal CT scan with oral and intravenous (IV) contrast bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers anaerobic bacteria and gram-negative rods
Ulcerative colitis Endoscopy Induction of remission with mesalamine and corticosteroids followed by the administration of sulfasalazine and 6-Mercaptopurine depending on the severity of the disease.
Entamoeba histolytica cysts shed with the stool detects ameba DNA in feces Amebic dysentery

Luminal amebicides for E. histolytica in the colon:

For amebic liver abscess:

Natural Reservoir

Different salmonella serovars may have different natural reservoirs. Common types of serovars of salmonella enterica that infect the human gastrointestinal tract include serovars Sendai, Typhi, and Paratyphi. Humans are their only natural reservoir. Other serotypes, such as serotype Dublin, have cattle as their natural reservoir, but has also the capacity to cause infection in humans.[22][23]

Drug Side Effect

Related Chapters

Gallery

References

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