Pediatric Salmonella Infection Clinical Presentation

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 27, 2010
 

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.
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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.
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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.[3]

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 milk, and eggs that have been contaminated by infected animals or an infected human.[1]

Recent Salmonella outbreaks have been attributed to commercially produced items, such as peanut butter, frozen pot pies, puffed vegetable snacks, and dry dog food.[10, 11, 12, 13, 14] 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.[1] Travelers visiting friends and relatives in typhoid-endemic countries may be at more risk than tourists because of a lack of precautionary measures.[15] Historically, Salmonella paratyphi (A) has been the cause of a smaller proportion of the cases of enteric fever. However, China and India are experiencing a substantial increase in enteric fever caused by Sparatyphi (A).[16]

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.[17]

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Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine O'Keefe, DNP, APRN  Assistant Professor of Nursing and Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

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, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: phamaceutical companies Honoraria Speaking and teaching; phamaceutical companies Grant/research funds clinical trials

Specialty Editor Board

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, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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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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