Pediatric Salmonella Infection Follow-up
- Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD more...
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.
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.
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. 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.
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.
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.[5, 7]
Complications of Salmonella infection include the following:
- 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
Prognosis varies, as follows:
- 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. 
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.
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].
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.
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.
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].
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.
Chiu CH, Chuang CH, Chiu S, et al. Salmonella enterica serotype Choleraesuis infections in pediatric patients. Pediatrics. 2006 Jun. 117(6):e1193-6. [Medline].
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.
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].
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].
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].
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].
Walters MS, Simmons L, Anderson TC, et al. Outbreaks of Salmonellosis From Small Turtles. Pediatrics. 2016 Jan. 137 (1):[Medline].
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].
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].
Johnson KJ. Crossing borders: one world, global health: CDC updates recommendations for typhoid vaccination. Clin Infect Dis. 2012 Apr. 54(7):v-vi. [Medline].
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].
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].
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].
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].
CDC. Trends in incidence of frequently identified non-typhoidal Salmonella serotypes. FoodNet News. 2008. 2(3):
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
[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.
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].
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].