eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Salmonella Infection: Follow-up

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
Coauthor(s): Catherine O'Keefe, DNP, APRN, Assistant Professor of Nursing, Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University School of Nursing; Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine
Contributor Information and Disclosures

Updated: Jan 9, 2009

Follow-up

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.

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.20

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.
  • 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

Complications

  • 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

Prognosis

  • 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.21

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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider S typhi as a differential diagnosis because the patient does not initially present with diarrhea and may have constipation
  • Failure to ask about foreign travel and, therefore, not considering S typhi as a differential diagnosis
  • Failure to aggressively treat infants younger than 3 months, patients with sickle cell disease, and patients who are immunocompromised and thus avoid potentially serious complications and poor outcome

Special Concerns

  • Salmonella infections in day care
    • When a child or a staff member in a daycare setting has been diagnosed with S typhi infection, stool specimens from all children and staff members of the daycare should be obtained. All infected individuals should be excluded from the center until results from 3 consecutive stool culture results are negative for children younger than 5 years. Children older than 5 years can return to group care if diarrhea has resolved for 24 hours.
    • When a child or adult contracts a case of Salmonella gastroenteritis (species other than S. typhi), children or staff members should not be allowed to return to the day care center until they are asymptomatic. Asymptomatic individuals do not need to give stool specimens.
  • Salmonella infections among food handlers and health care workers: Infected individuals should be excluded from handling and preparing food and providing health care until asymptomatic.
 


More on Salmonella Infection

Overview: Salmonella Infection
Differential Diagnoses & Workup: Salmonella Infection
Treatment & Medication: Salmonella Infection
Follow-up: Salmonella Infection
References
[ CLOSE WINDOW ]

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. 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].

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

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. 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].

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

  23. 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].

  24. 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].

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

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

  27. 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].

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

  29. 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].

  30. 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].

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

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

  33. 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].

  34. 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].

  35. Yates J. Traveler's diarrhea. Am Fam Physician. Jun 1 2005;71(11):2095-100. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Salmonella infection, bacterial gastroenteritis, infectious colitis, Salmonella typhi, S typhi, enteric fever, typhoid fever, Salmonella enteritidis, S enteritidis, nontyphoidal Salmonella, NTS, bacteremia, meningitis, food-borne gastroenteritis, osteomyelitis, cell disease, AIDS, neoplasms, appendicitis, hepatosplenomegaly, bradycardia

[ CLOSE WINDOW ]

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: GlaxosmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi-Pasteur Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; GlaxoSmithKline Grant/research funds Other; MedImmune  Other; Merck Grant/research funds Other; Novartis Grant/research funds Other; Sanofi-Pasteur Grant/research funds Other

Coauthor(s)

Catherine O'Keefe, DNP, APRN, Assistant Professor of Nursing, Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University School of Nursing
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, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine
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

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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 Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare 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: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.