eMedicine Specialties > Emergency Medicine > Infectious Diseases

Salmonella Infection: Follow-up

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

Follow-up

Further Outpatient Care

  • Follow-up treatment with the patient's primary care physician is highly recommended.
  • Worsening symptoms warrant a return visit to the ED.
  • Antibiotic treatment for a chronic carrier in coordination with the patient’s primary care physician may be indicated. Asymptomatic carriage occurs on average for about 5 weeks, with prolonged duration existing in children younger than 5 years.28

Deterrence/Prevention

  • Proper hygiene and food storage
  • Keep raw meat and poultry away from unprepared foods
  • Clean surfaces, utensils, and hands after contact with raw foods
  • Myrtle leaves oil has shown promise as an alternative disinfectant.29
  • Avoid eating raw or undercooked eggs
    • Salmonella can withstand temperatures as high as 194o F (90o C) for 50 minutes.10
  • Control of animal reservoir
  • Vaccine for enteric or typhoid fever
    • Current multidose oral vaccine (5 years) or single-dose parental vaccine (3 years) with an efficacy of 50-80%5
    • Trials underway for a single-dose oral vaccine13

Complications

Prognosis

  • Nontyphoid Salmonella is generally self-limiting.
    • Most patients are treated on an outpatient basis.
    • Extremes of age and an immunocompromised state increases morbidity and mortality.
  • Typhoid Salmonella generally requires treatment.
    • Mortality rate for treated cases is 2%, while complications occur in 30% of untreated cases.3
    • Morbidity and mortality increases with drug-resistant S typhi.12

Patient Education

  • Emphasize good hand-washing, thorough cleaning of cooking utensils, appropriate food preparation techniques, and adequate cooking temperature for killing the bacteria.

Miscellaneous

Medicolegal Pitfalls

  • Failure to aggressively manage patients who are immunocompromised, extremes of age, or have complicating factors such as sickle-cell disease or prosthetic grafts 
  • Failure to recognize an extraintestinal manifestation
  • Failure to query about recent travel to underdeveloped nations
  • Failure to ask about previous gastric surgery, use of antacids and H2 antagonists, or any predisposition toward reduced stomach acid production
  • Failure to consider alternative diagnoses - Perforated viscous and atypical presentation of appendicitis needs to be considered.
  • Failure to recognize that a sudden outbreak of Salmonella may be secondary to an intentional contamination31
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Robert A Barrali Jr, MD, to the development and writing of this article. We would like to acknowledge the assistance of Michelle Manfredi in researching this topic.



More on Salmonella Infection

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