Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Salmonella Infection Clinical Presentation

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 10, 2016
 

History

Carefully obtain the patient's history to determine any potential sources of Salmonella and to help determine if the correct diagnosis has been made.

  • General history
    • Inquire about any recent travel abroad.
    • Inquire about possible animal exposures, including contact with pet iguanas, turtles, tortoises, or other reptiles.
    • Inquire whether any family members have current or recent gastroenteritis.
    • Inquire whether any recent outbreaks have occurred in the community.
  • Salmonella gastroenteritis
    • The incubation period of Salmonella gastroenteritis is 6-72 hours.
    • In most cases, children have cramping abdominal pain, nausea, vomiting, and loose watery stools.
    • Stools may be bloody; however, this is not as common as in infection with Shigella.
    • Fever, which rarely exceeds 39°C, occurs in approximately one half of infected patients.
    • Symptoms usually resolve spontaneously in 2-7 days.
  • Enteric fever (typhoid fever)
    • Enteric fever is caused by S. typhi and several other Salmonella serotypes.
    • The incubation period for enteric fever is 3-60 days, but symptoms typically occur in 1-2 weeks.
    • Patients may present with high fever, which rises in a steplike fashion.
    • Other symptoms include anorexia, abdominal pain, malaise, myalgias, headache, cough, diarrhea or constipation, and delirium.
Next

Physical

Physical findings may include the following:

  • Salmonella gastroenteritis
    • Upon physical examination, patients may have signs of dehydration, such as delayed capillary refill, sunken eyes, dry mucous membranes, or tachycardia.
    • Patients may have tenderness to palpation on abdominal examination, which sometimes can be difficult to differentiate from appendicitis.
    • Rectal examination may reveal heme-positive stools, gross blood, or mucoid stools.
  • Enteric fever (typhoid fever)
    • A typical finding of enteric fever is relative bradycardia for the height of the fever.
    • Hepatosplenomegaly may be found on examination.
    • Patients with enteric fever may develop rose spots; these spots are blanching pink papules most commonly found on the anterior thorax. They usually fade about 3-4 days after appearance, are 2-4 mm in diameter, and occur in groups of 5-20.
Previous
Next

Causes

Salmonella organisms are gram-negative rod-shaped bacilli in the family Enterobacteriaceae. All Salmonella organisms are to be considered a single species (Salmonella enterica) because of their close relationship by DNA hybridization studies.[7]

Differences in lipopolysaccharide (LPS) and flagellar structure generate the antigenic variation that is reflected in the more than 2500 known serotypes that cause human disease.

Nontyphoidal Salmonella (NTS) serotypes are divided into O-antigen groups A through E. Since 1997, Salmonellaenteritidis (D), S. typhimurium (B), and Salmonella newport (C2) account for about half of the culture-confirmed Salmonella isolates. The principal reservoirs for NTS organisms are poultry, livestock, reptiles, and pets. The mode of transmission is ingestion of foods of animal origin, including poultry, red meats, unpasteurized dairy products, and eggs that have been contaminated by infected animals or an infected human.[5, 21]

Recent Salmonella outbreaks have been attributed to commercially produced items, such as peanut butter, frozen pot pies, puffed vegetable snacks, and dry dog food.[22, 23, 24, 25, 26] Contact with infected reptiles, such as iguanas, pet turtles and tortoises, and ingestion of contaminated water are other modes of transmission.

S. typhi (D) is the species known to cause enteric fever (typhoid fever). S. typhi is found only in humans. In the United States, typhoid fever is usually caused by foreign travel to countries with contaminated food and drinking water or by ingestion of food contaminated by a chronic carrier.[5] Travelers visiting friends and relatives in typhoid-endemic countries may be at more risk than tourists because of a lack of precautionary measures.[27] Historically, Salmonella paratyphi (A) has been the cause of a smaller proportion of the cases of enteric fever.[28] However, China and India have experienced a substantial increase in enteric fever caused by S.paratyphi (A).[29]

Excess antibiotic use in the prior year has been associated with a higher incidence of NTS. Disruption of the microflora of the gut has been offered as a possible cause; however, an alternate explanation may be that these individuals are a more medically fragile group, requiring more antibiotics and, in general, are more susceptible to illness.[30]

Previous
 
 
Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Catherine O’Keefe, DNP, APRN-NP Associate Professor of Nursing, Clinician-Educator Track Graduate Curriculum Coordinator, Nurse Practitioner Programs, Creighton University, School of Nursing; Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O’Keefe, DNP, APRN-NP is a member of the following medical societies: American Association of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Diana L Crevi, MD, to the original writing and development of this article.

References
  1. Chen HM, Wang Y, Su LH, Chiu CH. Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy. Pediatr Neonatol. 2013 Jun. 54(3):147-52. [Medline].

  2. Fleisher GR, Sieff CA. Infectious Disease Emergencies. Fleisher, GR, Ludwig, SL. Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2010. Ch. 92.

  3. Bhutta ZA. Salmonella. Kliegman RM, Stanton B, St. Geme J, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011. 948-59/Ch. 190.

  4. Schneider L, Ehlinger M, Stanchina C, Giacomelli MC, Gicquel P, Karger C, et al. Salmonella enterica subsp. arizonae bone and joints sepsis. A case report and literature review. Orthop Traumatol Surg Res. 2009 May. 95(3):237-42. [Medline].

  5. Brady MT, et al. Salmonella infections. Pickering L. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 635-41.

  6. Chiu CH, Chuang CH, Chiu S, et al. Salmonella enterica serotype Choleraesuis infections in pediatric patients. Pediatrics. 2006 Jun. 117(6):e1193-6. [Medline].

  7. Reller ME. Salmonella Species. Long A, Pickering, L, Prober C (Editors). Principles and Practices of Pediatric Infectious Diseases Elsevier, Inc. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2012. 814-819.

  8. CDC. Vital signs: incidence and trends of infection with pathogens transmitted commonly through food--foodborne diseases active surveillance network, 10 U.S. sites, 1996-2010. MMWR Morb Mortal Wkly Rep. 2011 Jun 10. 60(22):749-55. [Medline].

  9. Sánchez-Vargas FM, Abu-El-Haija MA, Gómez-Duarte OG. Salmonella infections: an update on epidemiology, management, and prevention. Travel Med Infect Dis. 2011 Nov. 9(6):263-77. [Medline].

  10. Miller MA, Sentz J, Rabaa MA, et al. Global epidemiology of infections due to Shigella, Salmonella serotype Typhi, and enterotoxigenic Escherichia coli. Epidemiol Infect. 2008 Apr. 136(4):433-5. [Medline].

  11. CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food - 10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010 Apr 16. 59(14):418-22. [Medline].

  12. Walters MS, Simmons L, Anderson TC, et al. Outbreaks of Salmonellosis From Small Turtles. Pediatrics. 2016 Jan. 137 (1):[Medline].

  13. Tsai MH, Huang YC, Chiu CH, et al. Nontyphoidal Salmonella bacteremia in previously healthy children: analysis of 199 episodes. Pediatr Infect Dis J. 2007 Oct. 26(10):909-13. [Medline].

  14. Boggild AK, Castelli F, Gautret P, et al. Vaccine preventable diseases in returned international travelers: results from the GeoSentinel Surveillance Network. Vaccine. 2010 Oct 28. 28(46):7389-95. [Medline].

  15. Johnson KJ. Crossing borders: one world, global health: CDC updates recommendations for typhoid vaccination. Clin Infect Dis. 2012 Apr. 54(7):v-vi. [Medline].

  16. Johnson KJ, Gallagher NM, Mintz ED, et al. From the CDC: new country-specific recommendations for pre-travel typhoid vaccination. J Travel Med. 2011 Nov-Dec. 18(6):430-3. [Medline].

  17. Galanakis E, Bitsori M, Maraki S, et al. Invasive non-typhoidal salmonellosis in immunocompetent infants and children. Int J Infect Dis. 2007 Jan. 11(1):36-9. [Medline].

  18. Shkalim V, Amir A, Samra Z, Amir J. Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children. Infection. 2012 Jun. 40(3):285-9. [Medline].

  19. Jones TF, Ingram LA, Cieslak PR, et al. Salmonellosis outcomes differ substantially by serotype. J Infect Dis. 2008 Jul 1. 198(1):109-14. [Medline].

  20. CDC. Trends in incidence of frequently identified non-typhoidal Salmonella serotypes. FoodNet News. 2008. 2(3):

  21. Centers for Disease Control and Prevention. Outbreak of multidrug-resistant Salmonella enterica serotype Newport infections associated with consumption of unpasteurized Mexican-style aged cheese--Illinois, March 2006-April 2007. MMWR Morb Mortal Wkly Rep. 2008 Apr 25. 57(16):432-5. [Medline].

  22. CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2006. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):336-9. [Medline].

  23. CDC. Multistate outbreak of human Salmonella infections caused by contaminated dry dog food--United States, 2006-2007. MMWR Morb Mortal Wkly Rep. 2008 May 16. 57(19):521-4. [Medline].

  24. CDC. Multistate outbreak of human Salmonella infections associated with exposure to turtles--United States, 2007-2008. MMWR Morb Mortal Wkly Rep. 2008 Jan 25. 57(3):69-72. [Medline].

  25. CDC. Salmonella Litchfield outbreak associated with a hotel restaurant--Atlantic City, New Jersey, 2007. MMWR Morb Mortal Wkly Rep. 2008 Jul 18. 57(28):775-9. [Medline].

  26. CDC. Salmonella typhimurium infection associated with raw milk and cheese consumption--Pennsylvania, 2007. MMWR Morb Mortal Wkly Rep. 2007 Nov 9. 56(44):1161-4. [Medline].

  27. Nguyen TQ, Reddy V, Sahl S, et al. Importance of Travel in Domestically Acquired Typhoid Fever Infections: Opportunities for Prevention and Early Detection. J Immigr Minor Health. 2008 May 29. [Medline].

  28. Gupta SK, Medalla F, Omondi MW, et al. Laboratory-based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance. Clin Infect Dis. 2008 Jun 1. 46(11):1656-63. [Medline].

  29. Ochiai RL, Acosta CJ, Danovaro-Holliday MC, et al. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organ. 2008 Apr. 86(4):260-8. [Medline]. [Full Text].

  30. Gradel KO, Dethlefsen C, Ejlertsen T, et al. Increased prescription rate of antibiotics prior to non-typhoid Salmonella infections: a one-year nested case-control study. Scand J Infect Dis. 2008. 40(8):635-41. [Medline].

  31. Rahman M, Siddique AK, Shoma S, et al. Emergence of multidrug-resistant Salmonella enterica serotype Typhi with decreased ciprofloxacin susceptibility in Bangladesh. Epidemiol Infect. 2006 Apr. 134(2):433-8. [Medline].

  32. Gordon MA, Graham SM, Walsh AL, et al. Epidemics of invasive Salmonella enterica serovar enteritidis and S. enterica Serovar typhimurium infection associated with multidrug resistance among adults and children in Malawi. Clin Infect Dis. 2008 Apr 1. 46(7):963-9. [Medline].

  33. Egorova S, Timinouni M, Demartin M, et al. Ceftriaxone-resistant salmonella enterica serotype Newport, France. Emerg Infect Dis. 2008 Jun. 14(6):954-7. [Medline].

  34. Crump JA, Medalla FM, Joyce KW, et al. Antimicrobial resistance among invasive nontyphoidal Salmonella enterica isolates in the United States: National Antimicrobial Resistance Monitoring System, 1996 to 2007. Antimicrob Agents Chemother. 2011 Mar. 55(3):1148-54. [Medline].

  35. Saps M, Pensabene L, Di Martino L, et al. Post-infectious functional gastrointestinal disorders in children. J Pediatr. 2008 Jun. 152(6):812-6, 816.e1. [Medline].

  36. [Guideline] National Institute for Health and Clinical Excellence (NICE). National Collaborating Centre for Women's and Children's Health. Diarrhoea and vomiting in children. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. Apr 2009.

  37. Younus M, Wilkins MJ, Davies HD, et al. Case-control study of disease determinants for non-typhoidal Salmonella infections among Michigan children. BMC Res Notes. 2010 Apr 16. 3(1):105. [Medline].

  38. Gradel KO, Dethlefsen C, Schonheyder HC, et al. Magnitude of bacteraemia is associated with increased mortality in non-typhoid salmonellosis: a one-year follow-up study. APMIS. 2008 Feb. 116(2):147-53. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.