Salmonella Infection in Emergency Medicine Follow-up

  • Author: Michael D Owens, DO, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 20, 2010
 

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.[32]
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Deterrence/Prevention

Deterrence and prevention methods are listed below.

  • Proper hygiene and food storage
  • Infection rates decrease in parallel with introduction of municipal water treatment, pasteurization of dairy products, and exclusion of human feces from food production.[27]
  • 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.[33]
  • The Food and Drug Administration (FDA) published a rule allowing irradiation of fresh iceberg lettuce and spinach as well as piloting an advanced border screening program in August 2008.[4]
  • Avoid eating raw or undercooked eggs. Salmonella can withstand temperatures as high as 194o F (90o C) for 50 minutes.[13]
    • Control of animal reservoir
    • Vaccine for enteric or typhoid fever
    • Current multidose oral live attenuated Ty21a vaccine (5 years) or single-dose Vi capsular polysaccharide parental vaccine (2 years) with an efficacy of 50-80%[5]
    • Capsules licensed for ≥ 6 years, while parental licensed ≥ 2 years in the United States
    • Trials are underway for a single-dose oral vaccine.[16]
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Complications

Complications of Salmonella infection may include the following:

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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.[15]
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Patient Education

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

Michael D Owens, DO, FACEP, FAAEM  Assistant Professor of Military/Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; 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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; 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.

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

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Coburn B, Grassl GA, Finlay BB. Salmonella, the host and disease: a brief review. Immunol Cell Biol. Feb-Mar 2007;85(2):112-8. [Medline].

  2. Grassl GA, Finlay BB. Pathogenesis of enteric Salmonella infections. Curr Opin Gastroenterol. Jan 2008;24(1):22-6. [Medline].

  3. Chambers HF. McPhee SJ, Papadakis MA, Tierney LM, eds. Current Medical Diagnosis & Treatment. 47th ed. McGraw-Hill Co; 2008:1250-1252.

  4. Centers for Disease Control and Prevention. Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through food--10 States, 2008. MMWR Morb Mortal Wkly Rep. Apr 10 2009;58(13):333-7. [Medline]. [Full Text].

  5. Linam WM, Gerber MA. Changing epidemiology and prevention of Salmonella infections. Pediatr Infect Dis J. Aug 2007;26(8):747-8. [Medline].

  6. Peques DA, Miller SI. Salmonella Species, Including Salmonella Typhi. In: Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 7th ed. Elsevier; 2009:chap. 223.

  7. Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food - 10 states, 2009. MMWR Morb Mortal Wkly Rep. Apr 16 2010;59(14):418-22. [Medline]. [Full Text].

  8. Croswell A, Amir E, Teggatz P, Barman M, Salzman NH. Prolonged impact of antibiotics on intestinal microbial ecology and susceptibility to enteric Salmonella infection. Infect Immun. Jul 2009;77(7):2741-53. [Medline]. [Full Text].

  9. Braden CR. Salmonella enterica serotype Enteritidis and eggs: a national epidemic in the United States. Clin Infect Dis. Aug 15 2006;43(4):512-7. [Medline].

  10. Jones TF, Ingram LA, Fullerton KE, et al. A case-control study of the epidemiology of sporadic Salmonella infection in infants. Pediatrics. Dec 2006;118(6):2380-7. [Medline].

  11. Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2007. MMWR Morb Mortal Wkly Rep. Apr 11 2008;57(14):366-70. [Medline].

  12. Centers for Disease Control and Prevention. Multistate outbreak of human Salmonella infections caused by contaminated dry dog food--United States, 2006-2007. MMWR Morb Mortal Wkly Rep. May 16 2008;57(19):521-4. [Medline]. [Full Text].

  13. Centers for Disease Control and Prevention. Multistate outbreak of Salmonella infections associated with peanut butter and peanut butter-containing products--United States, 2008-2009. MMWR Morb Mortal Wkly Rep. Feb 6 2009;58(4):85-90. [Medline]. [Full Text].

  14. Voetsch AC, Van Gilder TJ, Angulo FJ, et al. FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States. Clin Infect Dis. Apr 15 2004;38 Suppl 3:S127-34. [Medline].

  15. Weinberger M, Keller N. Recent trends in the epidemiology of non-typhoid Salmonella and antimicrobial resistance: the Israeli experience and worldwide review. Curr Opin Infect Dis. Dec 2005;18(6):513-21. [Medline].

  16. Boyle EC, Bishop JL, Grassl GA, Finlay BB. Salmonella: from pathogenesis to therapeutics. J Bacteriol. Mar 2007;189(5):1489-95. [Medline]. [Full Text].

  17. Sethuraman U, Kamat D. Management of child with fever after international travel. Clin Pediatr (Phila). Apr 2007;46(3):222-7. [Medline].

  18. Heymann DL. Control of Communicable Diseases Manual. 18th ed. American Public Health Association; 2004:469-473.

  19. Hedican E, Hooker C, Jenkins T, et al. Restaurant Salmonella Enteritidis outbreak associated with an asymptomatic infected food worker. J Food Prot. Nov 2009;72(11):2332-6. [Medline].

  20. Hatta M, Smits HL. Detection of Salmonella typhi by nested polymerase chain reaction in blood, urine, and stool samples. Am J Trop Med Hyg. Jan 2007;76(1):139-43. [Medline].

  21. Bottieau E, Clerinx J, Van den Enden E, et al. Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions. Medicine (Baltimore). Jan 2007;86(1):18-25. [Medline].

  22. Abubakar I, Irvine L, Aldus CF, et al. A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food. Health Technol Assess. Sep 2007;11(36):1-216. [Medline].

  23. Sirinavin S, Garner P. Antibiotics for treating salmonella gut infections. Cochrane Database Syst Rev. 2000;CD001167. [Medline].

  24. Wistrom J, Jertborn M, Ekwall E, et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med. Aug 1 1992;117(3):202-8. [Medline].

  25. Centers for Disease Control and Prevention. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS): Human Isolates Final Report, 2004. [Full Text].

  26. Grady R. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J. Dec 2003;22(12):1128-32. [Medline].

  27. Crump JA, Mintz ED. Global trends in typhoid and paratyphoid Fever. Clin Infect Dis. Jan 15 2010;50(2):241-6. [Medline]. [Full Text].

  28. Threlfall EJ, de Pinna E, Day M, Lawrence J, Jones J. Alternatives to ciprofloxacin use for enteric Fever, United kingdom. Emerg Infect Dis. May 2008;14(5):860-1. [Medline]. [Full Text].

  29. Mølbak K. Human health consequences of antimicrobial drug-resistant Salmonella and other foodborne pathogens. Clin Infect Dis. Dec 1 2005;41(11):1613-20. [Medline].

  30. [Best Evidence] Thaver D, Zaidi AK, Critchley JA, Azmatullah A, Madni SA, Bhutta ZA. Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst Rev. Oct 8 2008;CD004530. [Medline].

  31. Parry CM, Threlfall EJ. Antimicrobial resistance in typhoidal and nontyphoidal salmonellae. Curr Opin Infect Dis. Oct 2008;21(5):531-8. [Medline].

  32. Buchwald DS, Blaser MJ. A review of human salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella. Rev Infect Dis. May-Jun 1984;6(3):345-56. [Medline].

  33. Gündüz GT, Gönül SA, Karapinar M. Efficacy of myrtle oil against Salmonella Typhimurium on fresh produce. Int J Food Microbiol. Mar 31 2009;130(2):147-50. [Medline].

  34. Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. Jul 8 2006;333(7558):78-82. [Medline]. [Full Text].

  35. Torok TJ, Tauxe RV, Wise RP, et al. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. Aug 6 1997;278(5):389-95. [Medline].

  36. Adhikari B, Besser TE, Gay JM, et al. Introduction of new multidrug-resistant Salmonella enterica strains into commercial dairy herds. J Dairy Sci. Sep 2009;92(9):4218-28. [Medline].

  37. Amieva MR. Important bacterial gastrointestinal pathogens in children: a pathogenesis perspective. Pediatr Clin North Am. Jun 2005;52(3):749-77, vi. [Medline].

  38. Connor BA, Schwartz E. Typhoid and paratyphoid fever in travellers. Lancet Infect Dis. Oct 2005;5(10):623-8. [Medline].

  39. Hoffman SL, Punjabi NH, Kumala S, et al. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med. Jan 12 1984;310(2):82-8. [Medline].

  40. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. Nov 28 2002;347(22):1770-82. [Medline].

  41. Perera N, Geary C, Wiselka M, Rajakumar K, Andrew Swann R. Mixed Salmonella infection: case report and review of the literature. J Travel Med. Mar-Apr 2007;14(2):134-5. [Medline].

  42. Punjabi NH, Hoffman SL, Edman DC, et al. Treatment of severe typhoid fever in children with high dose dexamethasone. Pediatr Infect Dis J. Aug 1988;7(8):598-600. [Medline].

 
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Under a moderately high magnification of 8000X, this colorized scanning electron micrograph (SEM) revealed the presence of a small grouping of gram-negative Salmonella typhimurium bacteria that had been isolated from a pure culture. Image courtesy of the Centers for Disease Control and Prevention, Bette Jensen, and Janice Haney Carr.
 
 
 
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