Pediatric Salmonella Infection Follow-up

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

Further Inpatient Care

If admission is necessary in patients with Salmonella infection, monitor the patient's hydration and electrolyte levels, continue intravenous (IV) or oral (PO) antibiotics as needed, and observe for and appropriately treat complications of Salmonella.[21]

Next

Further Outpatient Care

Monitor patient's hydration status as an outpatient. Admission is warranted if the patient has signs and/or symptoms of dehydration. Monitor patients treated for enteric fever for possibility of relapse. Follow up on all blood cultures if the patient is being treated as an outpatient. Monitor for postinfectious functional GI disorders, such as irritable bowel syndrome.[22]

Previous
Next

Deterrence/Prevention

Good personal hygiene, handwashing, and appropriate sanitary practices deter spread of the disease. Standard precautions and contact precautions must be used during the entire hospitalization of patients, especially for children who are in diapers or who are incontinent.

A study of 123 children with laboratory-confirmed Salmonella infections and 139 control children who had not experienced symptoms of GI illness during the month prior to the interviews concluded that after adjusting for race and household income, Salmonella infections were significantly associated with attendance of a daycare center, contact with cats, and contact with reptiles during the 3 days prior to the onset of illness.[23] Thus, exposure to environmental sources may play an important role in sporadic infections with Salmonella.

For patients hospitalized with S typhi infection, precautions must be continued until results of 3 stool cultures are negative 48 hours after stopping antibiotic therapy.[1]

No vaccination is available for nontyphoidal Salmonella (NTS). Typhoid vaccination can help reduce the incidence of typhoid fever (50-75% efficacy). Although vaccinations enhance resistance to infection with S typhi, immunity is overcome by a large bacterial inoculum. Immunization is recommended for the following individuals: (1) those who travel to an endemic area, (2) those with intimate exposure to an individual known to be a carrier of typhoid fever, (3) laboratory workers with frequent contact with S typhi, and (4) individuals living in typhoid-endemic areas outside the United States.[1]

Two vaccinations are available in the United States. PO Ty21a vaccine is a live attenuated vaccination that can be given to children aged 6 years or older. Vaccination should be completed at least 1 week before exposure. A booster dose is recommended after 5 years in the case of continuous or repeated exposure. Vi capsular polysaccharide vaccine can be given to patients aged 2 years or older and consists of one intramuscular injection at least 2 weeks before exposure. A booster is recommended in 2 years.[1, 3]

Previous
Next

Complications

Complications of Salmonella infection include the following:

  • Nontyphoidal salmonellosis
    • Bacteremia
    • Meningitis
    • Pneumonia
    • Endocarditis/pericarditis
    • Osteomyelitis (most common in patients with sickle cell anemia)
    • Hepatic/splenic abscess
  • Typhoid fever (enteric fever)
    • Intestinal perforation and severe hemorrhage (occurs in 1-10% of children)
    • Toxic encephalopathy and cerebral thrombosis
    • Hepatitis, pancreatitis, arthritis, and myocarditis
Previous
Next

Prognosis

Prognosis varies, as follows:

  • Nontyphoidal salmonellosis
    • Prognosis of patients with simple gastroenteritis is excellent except for very young infants or patients with debilitating diseases.
    • The prognosis for Salmonella meningitis or endocarditis is poor.
  • Typhoid fever (enteric fever)
    • Therapy with antibiotics has decreased the mortality rate to 1%; however, prognosis depends on the extent of complications from the disease.
    • Relapse is common after therapy for enteric fever.
  • Chronic carrier state: Patients who continue to shed bacteria for more than 1 year (approximately 1% of patients) are considered chronic carriers.
  • NTS bacteremia: Increased mortality may be associated with a higher magnitude of NTS bacteremia.[24]
Previous
Next

Patient Education

Good personal hygiene and hand washing are essential for all people involved in food handling. All medical personnel must also use standard precautions when treating patients with Salmonella to avoid patient-to-patient transmission.

For excellent patient education resources, visit eMedicine's Public Health Center. Also, see eMedicine's patient education article Foreign Travel and the Centers for Disease Control and Prevention Web site.

Previous
 
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.

References

  1. Pickering L, Baker C, Long S, et al. American Academy of Pediatrics. Salmonella Infections. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:579-87.

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

  3. Reller ME. Salmonella Species. In: Long A, Pickering, L, Prober C (Editors). Principles and Practices of Pediatric Infectious Diseases Elsevier, Inc. 3rd ed. Orlando, FL: Churchill Livingstone; 2008:812-817.

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

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

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

  7. CDC. 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].

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

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

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

  11. CDC. 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].

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

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

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

  15. 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. May 29 2008;[Medline].

  16. 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. Apr 2008;86(4):260-8. [Medline].

  17. 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].

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

  19. 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. Apr 1 2008;46(7):963-9. [Medline].

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

  21. [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.

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

  23. 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. Apr 16 2010;3(1):105. [Medline].

  24. 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. Feb 2008;116(2):147-53. [Medline].

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

  26. CDC. 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. Apr 25 2008;57(16):432-5. [Medline].

  27. Davis MA, Hancock DD, Besser TE. Multiresistant clones of Salmonella enterica: The importance of dissemination. J Lab Clin Med. Sep 2002;140(3):135-41. [Medline].

  28. Fierer J, Guiney DG. Diverse virulence traits underlying different clinical outcomes of Salmonella infection. J Clin Invest. Apr 2001;107(7):775-80. [Medline].

  29. Fleisher, GR, Ludwig, SL, Henretig FM. Infectious Disease Emergencies. In: Textbook of Pediatric Emergency Medicine. 5th ed. Baltimore, Md: 2005:783-851.

  30. 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. Jun 1 2008;46(11):1656-63. [Medline].

  31. Kliegman RM, Behrman RE, Jenson HB, et al. Salmonella. In: Nelson Textbook of Pediatrics. 18th ed. Elsevier Health Sciences; 2007:Ch. 195.

  32. Leonard MK, Murrow JR, Jurado R, et al. Salmonella meningitis in adults infected with HIV: case report and review of the literature. Am J Med Sci. May 2002;323(5):266-8. [Medline].

  33. Lu L, Walker WA. Pathologic and physiologic interactions of bacteria with the gastrointestinal epithelium. Am J Clin Nutr. Jun 2001;73(6):1124S-1130S. [Medline].

  34. Ochiai RL, Wang X, von Seidlein L, et al. Salmonella paratyphi A rates, Asia. Emerg Infect Dis. Nov 2005;11(11):1764-6. [Medline].

  35. Parry CM, Hien TT, Dougan G, et al. Typhoid fever. N Engl J Med. Nov 28 2002;347(22):1770-82. [Medline].

  36. Rooney RM, Bartram JK, Cramer EH, et al. A review of outbreaks of waterborne disease associated with ships: evidence for risk management. Public Health Rep. Jul-Aug 2004;119(4):435-42. [Medline].

  37. Rooney RM, Cramer EH, Mantha S, et al. A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management. Public Health Rep. Jul-Aug 2004;119(4):427-34. [Medline].

  38. Yates J. Traveler's diarrhea. Am Fam Physician. Jun 1 2005;71(11):2095-100. [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 © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.