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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]] 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>
 
Salmonellosis may occur at any age, and start with [[symptoms]] that are indistinguishable from those caused by other [[gastrointestinal]] pathogens. These include acute onset of [[nausea]], [[vomiting]], crampy [[abdominal pain]], fever (38-39ºC) and [[diarrhea]]. Diarrhea may be simply nonbloody, loose stools, in moderate volume, or may be a large volume of watery, bloody stools. 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>


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>
[[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 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>
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>


==Complications==
==Complications==
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. However, in some cases complications may occur. These include:
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===
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]]


===Bacteremia===
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>


===Localized Infections===
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 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====
====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====
 
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====  
====Urinary and Genital Tract Infections====  
====Bone, Joint, and Soft Tissue 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]]
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.
*[[Epididymitis]]
 
====Joint Infection====
BACTEREMIA AND ENDOVASCULAR INFECTIONS
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>
 
Up to 8% of patients with NTS gastroenteritis develop bacteremia; of these, 5–10% develop localized infections. Bacteremia and metastatic infection are most common with S.choleraesuis and S. Dublin and among infants, the elderly, and immunocompromised patients. NTS endovascular infection should be suspected in high-grade or persistent bacteremia, especially with preexisting valvular heart disease, atherosclerotic vascular disease, prosthetic vascular graft, or aortic aneurysm. Arteritis should be suspected in elderly patients with prolonged fever and back, chest, or abdominal pain developing after an episode of gastroenteritis. Endocarditis and arteritis are rare (<1% of cases) but are associated with potentially fatal complications, including valve perforation, endomyocardial abscess, infected mural thrombus, pericarditis, mycotic aneurysms, aneurysm rupture, aortoenteric fistula, and vertebral osteomyelitis. In some areas of sub-Saharan Africa, NTS may be among the most common causes—or even the most common cause—of bacteremia in children. NTS bacteremia among these children is not associated with diarrhea and has been associated with nutritional status and HIV infection.
 
LOCALIZED INFECTIONS
 
Intraabdominal Infections
 
Intraabdominal infections due to NTS are rare and usually manifest as hepatic or splenic abscesses or as cholecystitis. Risk factors include hepatobiliary anatomic abnormalities (e.g., gallstones), abdominal malignancy, and sickle cell disease (especially with splenic abscesses). Eradication of the infection often requires surgical correction of abnormalities and percutaneous drainage of abscesses.
 
Central Nervous System Infections
 
NTS meningitis most commonly develops in infants 1–4 months of age. It often results in severe sequelae (including seizures, hydrocephalus, brain infarction, and mental retardation) with death in up to 60% of cases. Other rare central nervous system infections include ventriculitis, subdural empyema, and brain abscesses.
 
Pulmonary Infections
 
NTS pulmonary infections usually present as lobar pneumonia, and complications include lung abscess, empyema, and bronchopleural fistula formation. The majority of cases occur in patients with lung cancer, structural lung disease, sickle cell disease, or glucocorticoid use.
 
Urinary and Genital Tract Infections
 
Urinary tract infections caused by NTS present as either cystitis or pyelonephritis. Risk factors include malignancy, urolithiasis, structural abnormalities, HIV infection, and renal transplantation. NTS genital infections are rare and include ovarian and testicular abscesses, prostatitis, and epididymitis. Like other focal infections, both genital and urinary tract infections can be complicated by abscess formation.
 
Bone, Joint, and Soft Tissue Infections
 
Salmonella osteomyelitis most commonly affects the femur, tibia, humerus, or lumbar vertebrae and is most often seen in association with sickle cell disease, hemoglobinopathies, or preexisting bone disease (e.g., fractures). Prolonged antibiotic treatment is recommended to decrease the risk of relapse and chronic osteomyelitis. Septic arthritis occurs in the same patient population as osteomyelitis and usually involves the knee, hip, or shoulder joints. Reactive arthritis (Reiter's syndrome) can follow NTS gastroenteritis and is seen most frequently in persons with the HLA-B27 histocompatibility antigen. NTS rarely can cause soft tissue infections, usually at sites of local trauma in immunosuppressed patients
 
-->


==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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