Salmonellosis natural history, complications and prognosis

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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

Salmonellosis symptoms may start after 6 to 72 hours after ingestion of the contaminated food. Symptoms include nausea, vomiting, cramp abdominal pain, diarrhea, and fever. Uncomplicated infection often affects only the gastrointestinal tract, and resolved 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, endovascular infection, and focal infections. Focal infections may be located in the abdomen, CNS, lungs, urinary and genital tracts, or in the bones and joints.

Natural History

Salmonellosis may occur at any age, and start with symptoms that are indistinguishable from those caused by other gastrointestinal pathogens. These typically develop after 6 to 72 hours after ingestion of the contaminated food and 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 stool. Children with enterocolitic infection often present with severe inflammatory disease, with bloody diarrhea, increased symptom duration and risk of complications.[1]

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.[1][2][3]

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

For adults, antibiotic treatment is only indicated in certain conditions, mentioned in medical therapy. For these cases, the treatment does not decrease severity nor duration of symptoms.[1]

Complications

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

Bacteremia

About 8% of patients develop bacteremia. This progress 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, subsequently to an episode of gastroenteritis, arteritis should be suspected.[7]

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

Focal Infections

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

Intra-abdominal Infections

Rare complications that when present, manifest as cholecystitis, splenic or hepatic abscesses. Common risk factors for their development include:

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, is associated with bad prognosis.[14]

References

  1. 1.0 1.1 1.2 1.3 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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