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==Overview==
==Overview==
 
Symptoms of salmonellosis begin between 6 to 72 hours after [[ingestion]] of contaminated food. These may include [[nausea]], [[vomiting]], crampy [[abdominal pain]], [[diarrhea]], and [[fever]]. Uncomplicated [[infection]] often affects only the [[gastrointestinal]] tract, and resolves within 5 to 7 days. Infants, elderly and [[immunocompromised]] patients may experience severe forms of the disease, and are more prone for the development of [[complications]], such as: [[bacteremia]], and endovascular or focal [[infections]]. Focal [[infections]] may be located in the [[abdomen]], [[CNS]], [[lungs]], [[urinary]] and genital tracts, or in the [[bones]] and [[joints]]. The [[prognosis]] of salmonellosis is good in most cases, however, severe forms of the disease, and presence of [[complications]] are associated with poor [[prognosis]].
==Natural History==
==Natural History==
[[Salmonellosis]] commonly occurs after 6 to 72 hours afters [[ingestion]] of the contaminated food. The [[inoculum]] responsible for the disease is often greater 50000 [[Salmonella|bacteria]].  [[Symptoms]] include acute onset of [[nausea]], [[vomiting]], crampy [[abdominal pain]], and [[diarrhea]] that may be bloody or not. Children with enterocolitic [[infection]] often present with severe [[inflammatory disease]], with [[bloody diarrhea]], increased [[symptom]] duration and risk of [[complications]].<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref>
Salmonellosis may occur at any age, and start with [[symptoms]] that are indistinguishable from those caused by other [[gastrointestinal]] pathogens. [[Symptoms]] typically develop 6 to 72 hours after [[ingestion]] of contaminated food, and include acute onset of [[nausea]], [[vomiting]], crampy [[abdominal pain]], [[fever]] (38-39ºC) and [[diarrhea]]. Diarrhea may be mild nonbloody, loose stools, in moderate volume, or may consist of a large volume of watery, [[bloody stool]]. Children with enterocolitic [[infection]] often present with severe [[inflammatory disease]], with [[bloody diarrhea]], increased [[symptom]] duration and risk of [[complications]].<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref>


Commonly salmonellosis affects the ileum, however, it may also occur in the large bowel (non-typhoyd). The stomach, duodenum and jejunum are commonly spared of inflammation.<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref><ref name="pmid534385">{{cite journal| author=McGovern VJ, Slavutin LJ| title=Pathology of salmonella colitis. | journal=Am J Surg Pathol | year= 1979 | volume= 3 | issue= 6 | pages= 483-90 | pmid=534385 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=534385  }} </ref><ref name="pmid3896961">{{cite journal| author=Boyd JF| title=Pathology of the alimentary tract in Salmonella typhimurium food poisoning. | journal=Gut | year= 1985 | volume= 26 | issue= 9 | pages= 935-44 | pmid=3896961 | doi= | pmc=PMC1432849 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3896961  }} </ref>
[[Salmonellosis]] affects most commonly the [[ileum]], however, the [[large bowel]] may also be affect in certain cases. The [[stomach]], [[duodenum]] and [[jejunum]] are usually spared of [[inflammation]].<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref><ref name="pmid534385">{{cite journal| author=McGovern VJ, Slavutin LJ| title=Pathology of salmonella colitis. | journal=Am J Surg Pathol | year= 1979 | volume= 3 | issue= 6 | pages= 483-90 | pmid=534385 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=534385  }} </ref><ref name="pmid3896961">{{cite journal| author=Boyd JF| title=Pathology of the alimentary tract in Salmonella typhimurium food poisoning. | journal=Gut | year= 1985 | volume= 26 | issue= 9 | pages= 935-44 | pmid=3896961 | doi= | pmc=PMC1432849 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3896961  }} </ref>


For the [[infections]] limited to the [[gastrointestinal tract]], in the absence of treatment, [[symptoms]] commonly have a spontaneous resolution within 5 to 7 days.<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref>
For the [[infections]] that are limited to the [[gastrointestinal tract]], in the absence of treatment, [[symptoms]] commonly have a spontaneous resolution within 5 to 7 days.<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref>


In the case of neonates with [[gastrointestinal]] infection, in order to prevent invasion, [[antibiotic]] therapy is indicated. For '''adults''', [[antibiotic treatment]] is only indicated in certain conditions, mentioned in ''medical therapy''. For these cases, the treatment does not decrease severity nor the duration of [[symptoms]].<ref name="pmid17146467">{{cite journal| author=Coburn B, Grassl GA, Finlay BB| title=Salmonella, the host and disease: a brief review. | journal=Immunol Cell Biol | year= 2007 | volume= 85 | issue= 2 | pages= 112-8 | pmid=17146467 | doi=10.1038/sj.icb.7100007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17146467  }} </ref>
==Complications==
 
Persons with [[diarrhea]] usually recover completely, although it may take several months before their bowel habits become entirely normal. In some cases [[complications]] may occur, including:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
<!--
===Bacteremia===
Enteric fever is a misnomer, in that the hallmark features of this disease—fever and abdominal pain—are variable. While fever is documented at presentation in >75% of cases, abdominal pain is reported in only 30–40%. Thus, a high index of suspicion for this potentially fatal systemic illness is necessary when a person presents with fever and a history of recent travel to a developing country.
About 8% of patients develop [[bacteremia]]. This complication is more common in children, elderly and [[immunocompromised]] patients. Of the different [[serotype]]s of [[salmonella enterica]] non-typhi, [[bacteremia]] is most common among patients infected with the serotypes ''Choleraesuis'' and ''Dublin''.<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
 
===Endovascular Infection===
The incubation period for S. typhi averages 10–14 days but ranges from 3–21 days, depending on the inoculum size and the host's health and immune status. The most prominent symptom is prolonged fever (38.8°–40.5°C; 101.8°–104.9°F), which can continue for up to 4 weeks if untreated. S. paratyphi A is thought to cause milder disease than S. typhi, with predominantly gastrointestinal symptoms. However, a prospective study of 669 consecutive cases of enteric fever in Kathmandu, Nepal, found that the infections were clinically indistinguishable. In this series, symptoms reported on initial medical evaluation included headache (80%), chills (35–45%), cough (30%), sweating (20–25%), myalgias (20%), malaise (10%), and arthralgia (2–4%). Gastrointestinal symptoms included anorexia (55%), abdominal pain (30–40%), nausea (18–24%), vomiting (18%), and diarrhea (22–28%) more commonly than constipation (13–16%). Physical findings included coated tongue (51–56%), splenomegaly (5–6%), and abdominal tenderness (4–5%).
In the presence of persistent [[bacteremia]], endovascular infection should be suspected. Previous conditions that are prone to the development of endovascular infection include:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
 
*[[Atherosclerotic]] vascular disease
Early physical findings of enteric fever include rash ("rose spots"; 30%), hepatosplenomegaly (3–6%), epistaxis, and relative bradycardia at the peak of high fever (<50%). Rose spots (Fig. 153-2; see also Fig. e7-9) make up a faint, salmon-colored, blanching, maculopapular rash located primarily on the trunk and chest. The rash is evident in 30% of patients at the end of the first week and resolves without a trace after 2–5 days. Patients can have two or three crops of lesions, and Salmonella can be cultured from punch biopsies of these lesions. The faintness of the rash makes it difficult to detect in highly pigmented patients.
*Preexisting [[valvular heart disease]]
 
*[[Prosthetic]] vascular graft
The development of severe disease (which occurs in 10–15% of patients) depends on host factors (immunosuppression, antacid therapy, previous exposure, and vaccination), strain virulence and inoculum, and choice of antibiotic therapy. Gastrointestinal bleeding (10–20%) and intestinal perforation (1–3%) most commonly occur in the third and fourth weeks of illness and result from hyperplasia, ulceration, and necrosis of the ileocecal Peyer's patches at the initial site of Salmonella infiltration. Both complications are life-threatening and require immediate fluid resuscitation and surgical intervention, with broadened antibiotic coverage for polymicrobial peritonitis (Chap. 127) and treatment of gastrointestinal hemorrhages, including bowel resection. Neurologic manifestations occur in 2–40% of patients and include meningitis, Guillain-Barré syndrome, neuritis, and neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects.
*[[Aortic aneurysm]]


Rare complications whose incidences are reduced by prompt antibiotic treatment include disseminated intravascular coagulation, hematophagocytic syndrome, pancreatitis, hepatic and splenic abscesses and granulomas, endocarditis, pericarditis, myocarditis, orchitis, hepatitis, glomerulonephritis, pyelonephritis and hemolytic-uremic syndrome, severe pneumonia, arthritis, osteomyelitis, and parotitis. Up to 10% of patients develop mild relapse, usually within 2–3 weeks of fever resolution and in association with the same strain type and susceptibility profile.
In elder patients presenting with prolonged [[chest pain|chest]], [[back pain|back]] or [[abdominal pain]], and prolonged [[fever]], that are subsequent to an episode of [[gastroenteritis]], [[arteritis]] should be suspected.<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>


Up to 10% of untreated patients with typhoid fever excrete S. typhi in the feces for up to 3 months, and 1–4% develop chronic asymptomatic carriage, shedding S. typhi in either urine or stool for >1 year. Chronic carriage is more common among women, infants, and persons who have biliary abnormalities or concurrent bladder infection withSchistosomahaematobium. The anatomic abnormalities associated with the latter conditions presumably allow prolonged colonization.
In rare cases (<1%) [[arteritis]] and [[endocarditis]] may complicate and lead to severe, often fatal, [[complications]], such as:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
*[[Heart valve|Valve]] perforation
*[[Endomyocardial]] abscess
*[[Mycotic aneurysm]]s
*[[Infected]] mural [[thrombus]]
*Aorto-enteric [[fistula]]
*[[Aneurysm]] rupture
*[[Pericarditis]]
===Focal Infections===
Of the 8% of patients who develop [[bacteremia]], 5-10% evolve into localized [[infections]]. These may include:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
====Intra-abdominal Infections====
Intra-abdominal [[complications]] may include [[cholecystitis]], [[splenic]] or [[hepatic abscess]]es. They may be identified and monitored with abdominal [[CT]], or [[ultrasound]].  


-->
These [[complications]] are prone to occur in patients with:
*[[Splenic]] abscesses from [[sickle cell]] disease
*Hepatobiliary anatomic abnormalities
*Abdominal [[malignancy]]
====Central Nervous System Infections====
Non-typhoid salmonella may lead to different [[CNS infection]]s, such as:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
*[[Subdural empyema]]
*[[Brain abscess]]
*[[Ventriculitis]]
*[[Meningitis]]
====Pulmonary Infections====
Pulmonary infections caused by non-typhoid salmonella commonly lead to [[lobar pneumonia]].  [[Complications]] may include:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
*[[Bronchopleural fistula]]
*[[Lung abscess]]
*[[Empyema]]
====Urinary and Genital Tract Infections====
Non-typhoid salmonella may complicate into [[UTI|urinary]] and genital tract infections, such as:<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
*[[Cystitis]]
*[[Pyelonephritis]]
*Ovarian abscess
*Testicular abscess
*[[Prostatitis]]
*[[Epididymitis]]
====Joint Infection====
Non-typhoid salmonella may lead to [[Reiter's syndrome]]<ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>


==Complications==
==Prognosis==
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons with Salmonella develop pain in their joints, irritation of the eyes, and painful urination. This is called Reiter's syndrome. It can last for months or years, and can lead to chronic arthritis which is difficult to treat. Antibiotic treatment does not make a difference in whether or not the person develops arthritis.
The [[prognosis]] of salmonellosis is good for most patients. Persons with [[diarrhea]] usually recover completely, although in some cases, it may take several months until their bowel habits become entirely normal. The development of a severe form of the disease, or [[complications]], are associated with poor [[prognosis]].<ref name=WHO>{{cite web | title = Salmonella (non-typhoidal) | url = http://www.who.int/mediacentre/factsheets/fs139/en/ }}</ref>  
 
== Prognosis==
Persons with [[diarrhea]] usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons who are infected with Salmonella, will go on to develop [[pains in their joints]], irritation of the eyes, and painful [[urination]]. This is called [[Reiter's syndrome]]. It can last for months or years, and can lead to chronic [[arthritis]] which is difficult to treat. [[Antibiotic]] treatment does not make a difference in whether or not the person later develops arthritis.<ref>http://www.cdc.gov/ncidod/dbmd/diseaseinfo/salmonellosis_g.htm </ref>


==References==
==References==
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Latest revision as of 18:41, 18 September 2017

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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

Symptoms of salmonellosis begin between 6 to 72 hours after ingestion of contaminated food. These may include nausea, vomiting, crampy abdominal pain, diarrhea, and fever. Uncomplicated infection often affects only the gastrointestinal tract, and resolves within 5 to 7 days. Infants, elderly and immunocompromised patients may experience severe forms of the disease, and are more prone for the development of complications, such as: bacteremia, and endovascular or focal infections. Focal infections may be located in the abdomen, CNS, lungs, urinary and genital tracts, or in the bones and joints. The prognosis of salmonellosis is good in most cases, however, severe forms of the disease, and presence of complications are associated with poor prognosis.

Natural History

Salmonellosis may occur at any age, and start with symptoms that are indistinguishable from those caused by other gastrointestinal pathogens. Symptoms typically develop 6 to 72 hours after ingestion of contaminated food, and include acute onset of nausea, vomiting, crampy abdominal pain, fever (38-39ºC) and diarrhea. Diarrhea may be mild nonbloody, loose stools, in moderate volume, or may consist of a large volume of watery, bloody stool. Children with enterocolitic infection often present with severe inflammatory disease, with bloody diarrhea, increased symptom duration and risk of complications.[1]

Salmonellosis affects most commonly the ileum, however, the large bowel may also be affect in certain cases. The stomach, duodenum and jejunum are usually spared of inflammation.[1][2][3]

For the infections that are limited to the gastrointestinal tract, in the absence of treatment, symptoms commonly have a spontaneous resolution within 5 to 7 days.[1]

Complications

Persons with diarrhea usually recover completely, although it may take several months before their bowel habits become entirely normal. In some cases complications may occur, including:[4]

Bacteremia

About 8% of patients develop bacteremia. This complication is more common in children, elderly and immunocompromised patients. Of the different serotypes of salmonella enterica non-typhi, bacteremia is most common among patients infected with the serotypes Choleraesuis and Dublin.[5]

Endovascular Infection

In the presence of persistent bacteremia, endovascular infection should be suspected. Previous conditions that are prone to the development of endovascular infection include:[6]

In elder patients presenting with prolonged chest, back or abdominal pain, and prolonged fever, that are subsequent to an episode of gastroenteritis, arteritis should be suspected.[7]

In rare cases (<1%) arteritis and endocarditis may complicate and lead to severe, often fatal, complications, such as:[8]

Focal Infections

Of the 8% of patients who develop bacteremia, 5-10% evolve into localized infections. These may include:[9]

Intra-abdominal Infections

Intra-abdominal complications may include cholecystitis, splenic or hepatic abscesses. They may be identified and monitored with abdominal CT, or ultrasound.

These complications are prone to occur in patients with:

Central Nervous System Infections

Non-typhoid salmonella may lead to different CNS infections, such as:[10]

Pulmonary Infections

Pulmonary infections caused by non-typhoid salmonella commonly lead to lobar pneumonia. Complications may include:[11]

Urinary and Genital Tract Infections

Non-typhoid salmonella may complicate into urinary and genital tract infections, such as:[12]

Joint Infection

Non-typhoid salmonella may lead to Reiter's syndrome[13]

Prognosis

The prognosis of salmonellosis is good for most patients. Persons with diarrhea usually recover completely, although in some cases, it may take several months until their bowel habits become entirely normal. The development of a severe form of the disease, or complications, are associated with poor prognosis.[14]

References

  1. ↑ 1.0 1.1 1.2 Coburn B, Grassl GA, Finlay BB (2007). "Salmonella, the host and disease: a brief review". Immunol Cell Biol. 85 (2): 112–8. doi:10.1038/sj.icb.7100007. PMID 17146467.
  2. ↑ McGovern VJ, Slavutin LJ (1979). "Pathology of salmonella colitis". Am J Surg Pathol. 3 (6): 483–90. PMID 534385.
  3. ↑ Boyd JF (1985). "Pathology of the alimentary tract in Salmonella typhimurium food poisoning". Gut. 26 (9): 935–44. PMC 1432849. PMID 3896961.
  4. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  5. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  6. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  7. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  8. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  9. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  10. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  11. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  12. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  13. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  14. ↑ "Salmonella (non-typhoidal)".

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