Salmonellosis (Nontyphoidal salmonella infections) is an inflammatory gastroenteritis. Incubation period is 12-36 hours. Fever, if present, usually resolves in 2-3 days, and diarrhea usually resolves in 3-7 days. It is commonly transmitted by food of animal origin (milk, eggs, meat, and poultry).
CASES/YEAR
1,027,561 (US); 20,551,220 (Global)
OTHER NAMES
Nontyphoidal salmonella infections; S. enteritidis infection; S. typhimurium infection;
INCUBATION
12-36 hours; range of 6-72 hours; [CCDM]
INITIAL SYMPTOMS
Acute gastroenteritis for 3-7 days with fever, vomiting, diarrhea (no blood), and abdominal cramping; [Harrisons, p. 411] Diarrhea is usually watery, and rarely is blood present. [Merck Manual]
PRECAUTIONS
Standard; "Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks." [CDC 2007 Guideline for Isolation Precautions] "Depending on the serotypes, approximately 1% of infected adults and 5% of children younger than 5 years, may excrete the organism for up to 1 year." [CCDM, p. 535]
COMMENTS
Fever, if present, usually resolves in 2-3 days, and diarrhea usually resolves in 3-7 days. The stool is usually positive for leukocytes and sometimes positive for blood. Complications include pseudoappendicitis (infrequent) and toxic megacolon (rare). [PPID, p. 2732] Septicemia may lead to skin infection, septic arthritis, cholecystitis, endocarditis, meningitis, osteomyelitis, pericarditis, pyelonephritis, or pneumonia. Salmonellosis is commonly transmitted by food of animal origin (milk, eggs, meat, and poultry) and also by contaminated processed foods. Fruits and vegetables may be contaminated by slicing on a cutting board used for meat or poultry. Contaminated pet foods may be an under-recognized source of transmission. Person-to-person, fecal-oral transmission occurs; also transmitted by contaminated water and pets (e.g., turtles, iguanas, dogs, cats, guinea pigs, and chicks). Risk factors include HIV infection or other immunosuppressed state, achlorhydria, and sickle-cell disease. [CCDM, p. 532-9] Patients with nontyphoidal salmonellosis: up to 8% have bacteremia; 5-10% of these have localized infections. [PPID, p. 2732] Other reservoirs are fish/shellfish, horses, rabbits, and primates. [PPID 7th Ed., p. 4002] Pus and occult blood in stool are common findings. [ID, p. 624] Complications include bacteremia (8%), and 5-10% of these patients develop localized infections (hepatosplenic abscesses, meningitis, pneumonia, and osteomyelitis). Also reactive arthritis; [Harrisons, p. 411] E. coli O157:H7, salmonella, and shigella are possible agents of bioterrorism. [www.bt.cdc.gov] Transmission may occur by sexual contact (fecal-oral). [Cecil, p. 1940] Fever and splenomegaly are associated with bacteremia. [Guerrant, p. 131] May cause myocarditis; [ABX Guide: Myocarditis] See "Multistate Outbreak of Multidrug-Resistant Salmonella Heidelberg Infections Linked to Contact with Dairy Calves" at https://www.cdc.gov/salmonella/heidelberg-11-16/index.html.
DIAGNOSTIC
Culture (stool, blood, and other); [Harrisons, p. 411]
SIGNS & SYMPTOMS
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>fever
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>myalgia
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G abdominal pain
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G blood in stool
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G diarrhea
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G fecal leukocytes
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G hepatomegaly
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G nausea, vomiting
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H leukocytosis
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H splenomegaly
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N headache
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S pustule
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U pyuria
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X pleural effusions
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*arthritis
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*brain abscess or lesion
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*endocarditis
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*epididymo-orchitis
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*erythema nodosum
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*meningitis
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*myocarditis
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*osteomyelitis
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*parotitis
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*pericarditis
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*pneumonia
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*sepsis
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*weight loss
ENTRY
Ingestion, Swimming, Sexual Contact
SOURCE
Person-to-Person, Human Fecal-Oral, Animal Excreta, Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Dogs, Fish and Shellfish, Horses, Monkeys, Rabbits, Rodents, Swine, Human, Wild Animals
RISK FACTORS
- AIDS patients
- Asplenic patients
- Cancer patients
- Care for patients (fecal-oral pathogens)
- Consume unpasteurized milk/cheese
- Eat undercooked meat or fish
- Handle domestic animals
- Handle infected chickens or birds
- Have dog or cat contact (fecal-oral)
- Ingest infectious agents in food/water
- Swim in contaminated water (ingestion or inhalation)
- Victim--water/food release
TREATMENT
Antibiotics not indicated for uncomplicated enterocolitis with the following exceptions: infants, elderly, immunocompromised, sickle-cell disease, HIV infection, continued high fever, and extraintestinal infection; [CCDM, p. 538]
REFERENCES FOR CASES/YEAR
1. (US) 14.86 cases/100,000 in 2007; [Gorbach, p. 10] Calculate 14.86 for population of 300 million = 44,580; CDC 2011 estimated cases = 1,027,561; [http://www.cdc.gov/foodborneburden/2011-foodborne-estimates.html]
2. (Global) 10s of millions of cases/yr; [Fact sheets from WHO 2013] Estimated global cases/yr = 20 X US cases/yr;