Salmonella Infection in Emergency Medicine Workup

  • Author: Michael D Owens, DO, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 23, 2012
 

Laboratory Studies

  • Serologic testing for Salmonella lacks overall sensitivity and specificity and varies with the stage of infection.[3, 24]
  • 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.[25]
  • 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.[21] 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.[26]
    • Culture sensitivity decreases after the first week of illness and antibiotic therapy.[3, 24]
    • Bone marrow evaluation is considered the criterion standard for enteric fever and has a sensitivity of 90% but is rarely performed. Bone marrow aspirates have approximately 10 times the concentration of viable organisms versus blood and continue to have high sensitivity with prior antimicrobial treatment and regardless of duration of disease.[23]
    • Blood culture results in enteric fever are positive in 50-70% of cases and often considered practical first choice.
    • PCR sensitivity on blood is 84.5% and is as high as 95% when performed in the first 5 days.[24]
    • PCR evaluations on urine and feces are 69% and 47% sensitive, respectively.[24]
    • Duodenal string culture is an additional option.[23]
    • Three serially collected urine samples for suspected enteric fever patients have reported sensitivities of 92% and specificities of 71%.[23]
    • Antibody assays are commonly used to detect nontyphoid Salmonella in veterinary and food sectors, but this has not extended to standardized testing in human salmonellosis.[27]
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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 in neonates).
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Procedures

  • A rectal examination is needed to assess for bleeding. A blood transfusion is rarely required.
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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 and American College of Emergency Physicians

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; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape 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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

Additional Contributors

The authors and editors of Medscape Reference 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.

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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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