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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==
The symptoms of salmonellosis may occur at any age, and typically develop after 6 to 72 hours after [[ingestion]] of the contaminated food. The [[inoculum]] responsible for the disease is often greater 50000 [[Salmonella|bacteria]]. Salmonellosis may occur at any age, and start with [[symptoms]] indistinguishable from those caused by other [[gastrointestinal]] pathogens. These may include
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>


[[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]] 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>


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>
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>


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>
==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>
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>
===Bacteremia===
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===
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
*Preexisting [[valvular heart disease]]
*[[Prosthetic]] vascular graft
*[[Aortic aneurysm]]


<!--
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>


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]].


Without treatment, the patient will develop symptoms of ___, which will/ may eventually lead to ___.
These [[complications]] are prone to occur in patients with:
 
*[[Splenic]] abscesses from [[sickle cell]] disease
 
*Hepatobiliary anatomic abnormalities
GASTROENTERITIS
*Abdominal [[malignancy]]
 
====Central Nervous System Infections====
Nausea, vomiting, and diarrhea occur 6–48 h after the ingestion of contaminated food or water. Patients often experience abdominal cramping and fever (38–39°C; 100.5–102.2°F). Diarrheal stools are usually loose, nonbloody, and of moderate volume. However, large-volume watery stools, bloody stools, or symptoms of dysentery may occur. Rarely, NTS causes pseudoappendicitis or an illness that mimics inflammatory bowel disease.
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]]
Gastroenteritis caused by NTS is usually self-limited. Diarrhea resolves within 3–7 days and fever within 72 h. Stool cultures remain positive for 4–5 weeks after infection and—in rare cases of chronic carriage (<1%)—for >1 year. Antibiotic treatment usually is not recommended and may prolong fecal carriage. Neonates, the elderly, and immunosuppressed patients (e.g., transplant recipients, HIV-infected persons) with NTS gastroenteritis are especially susceptible to dehydration and dissemination and may require hospitalization and antibiotic therapy. Acute NTS gastroenteritis was associated with a threefold increased risk of dyspepsia and irritable bowel syndrome at 1 year in a recent study from Spain.
*[[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>
==Complications==
*[[Bronchopleural fistula]]
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.
*[[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>


==Prognosis==
==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>
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>  


==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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