eMedicine Specialties > Emergency Medicine > Infectious Diseases

Salmonella Infection: Differential Diagnoses & Workup

Author: Michael D Owens, DO, FACEP, FAAEM, Clinical Faculty, Emergency Medicine Residency, Naval Medical Center Portsmouth; Consulting Staff, Department of Emergency Medicine, Chesapeake Emergency Physicians, Inc, Chesapeake Regional Medical Center
Coauthor(s): Dirk A Warren, MD, Emergency Medicine Resident, Naval Medical Center Portsmouth
Contributor Information and Disclosures

Updated: Apr 3, 2009

Differential Diagnoses

Abdominal Trauma, Blunt
Pediatrics, Gastroenteritis
CBRNE - Botulism
Toxicity, Shellfish
Diverticular Disease
Gastritis and Peptic Ulcer Disease
Gastroenteritis

Other Problems to Be Considered

Workup

Laboratory Studies

  • Serologic testing for Salmonella lacks overall sensitivity and specificity and varies with the stage of infection.6,17,3
  • Complete blood cell count
    • Anemia is a result of blood loss and inflammation.
    • The white blood cell (WBC) count in enteric or typhoid fever is often low.
    • Leukocytosis is common in the first 10 days in children and may also result from bacteremia, localized infection, bowel perforation, or other extraintestinal complications.
    • Reversible thrombocytopenia may occur.
  • Liver function tests may be mildly elevated. Elevated alanine aminotransferase level (>70 IU/L) can be seen in enteric fever.18
  • A reversible form of a mild disseminated intravascular coagulopathy (DIC) may occur.
  • Cultures
    • The diagnosis of Salmonella infection is based on isolation of the infecting organism.
    • Stool culture results can take 3-7 days. 
      • Three to ten grams collected over several days are preferred.15
      • Due to the time involved with stool culture detection, treatment decisions should be based on the patient’s presentation. 
      • Rapid testing technologies, such as polymerase chain reaction (PCR), have not yet been proven feasible.19
    • Culture sensitivity decreases after the first week of illness and antibiotic therapy.17,3
    • Bone marrow evaluation has a sensitivity of 90% but is rarely performed.
    • Blood culture results in enteric fever are positive in 50-70% of cases.
    • PCR sensitivity on blood is 84.5% and is as high as 95% when performed in the first 5 days.17
    • PCR evaluations on urine and feces are 69% and 47% sensitive, respectively.17

Imaging Studies

  • A focused ultrasonographic examination or CT scan should be performed if an extraintestinal manifestation is of concern. This should include muscle/soft tissue, hepatobiliary, spleen, urinary, genital, and bone.
  • An acute abdominal series for free air under the diaphragm may be needed to rule out intestinal perforation.
  • A CT scan of the brain should be performed if central nervous system complications arise (more commonly neonates).

Procedures

  • A rectal examination is needed to assess for bleeding. A blood transfusion is rarely required.

More on Salmonella Infection

Overview: Salmonella Infection
Differential Diagnoses & Workup: Salmonella Infection
Treatment & Medication: Salmonella Infection
Follow-up: Salmonella Infection
Multimedia: Salmonella Infection
References
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References

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Further Reading

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Keywords

Salmonella, salmonella infection, salmonella gastroenteritis, salmonellosis, typhi, typhoid fever, enteric fever, typhimurium, enteritidis, choleraesuis, Salmonella infection, severe diarrhea, food-borne illness

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Contributor Information and Disclosures

Author

Michael D Owens, DO, FACEP, FAAEM, Clinical Faculty, Emergency Medicine Residency, Naval Medical Center Portsmouth; Consulting Staff, Department of Emergency Medicine, Chesapeake Emergency Physicians, Inc, Chesapeake Regional Medical Center
Michael D Owens, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dirk A Warren, MD, Emergency Medicine Resident, Naval Medical Center Portsmouth
Dirk A Warren, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Emergency Physicians, and Society of United States Naval Flight Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital
Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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