Pediatric Salmonella Infection 

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

Background

Infections due to Salmonella species represent a major public health problem in many countries. In the United States, nontyphoidal Salmonella (NTS) is the most common pathogen implicated in food-borne gastroenteritis. In most cases, NTS is a self-limiting disease that causes mild gastroenteritis; however, it can lead to a wide spectrum of complications including bacteremia, enterocolitis, and severe local infections such as meningitis and osteomyelitis. Salmonella serotype typhi can cause serious and prolonged bacteremic illness referred to as enteric fever or typhoid fever.[1]

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Pathophysiology

The extension of the disease to various organs depends on the serotype, the size of the inoculum, and the status of the host. If large enough numbers of bacteria are ingested, they can survive in the normally lethal acidic pH of the stomach.Once ingested, Salmonella can gain access to the small intestine, producing diffuse mucosal inflammation, edema, and microabscesses. Generally, most NTS do not extend beyond the lamina propria and lymphatics of the gut. Exceptions include Salmonellacholeraesuis and Salmonelladublin, which can cause bacteremia with little intestinal involvement.[2] In individuals with S typhi, areas of intestinal necrosis can ulcerate and result in perforation. In addition, this mucosal penetration allows uptake into the draining lymph nodes, contributing to blood stream infections (BSI) and subsequent invasion of the liver, spleen, and bone marrow. This process explains the delayed onset of symptoms in Styphi.[3]

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Epidemiology

Frequency

United States

From 1996-2006, more than 50,000 laboratory-confirmed cases of NTS infections occurred annually, an average of 14.7 infections per 100,000 persons per year.[4, 5] Approximately 400 cases of typhoid fever are reported per year. More than two thirds of cases are acquired from foreign travel. From 1985-1994, travel to Mexico and India accounted for most cases of typhoid fever. However, over the last 10 years, US travelers to Asia, Africa, and Latin America have been especially at risk.[6]

The preliminary data from the Foodborne Diseases Active Surveillance Network (FoodNet) of the Centers for Disease Control and Prevention's (CDC's) Emerging Infections Program for 2009 noted a sustained decline in the reported incidence of Salmonella infections in the 10 US states in which active, population-based surveillance is performed.[7]

International

The past 2 decades have seen an increase in the incidence of NTS in Europe and North America.[4] Typhoid fever is endemic in many developing areas of the world. Five Asian countries are considered to be endemic for typhoid: China, India, Indonesia, Pakistan, and Vietnam.[1] Annually, the World Health Organization (WHO) estimates 16-33 million cases of typhoid fever worldwide and 500,000-600,000 deaths.

Mortality/Morbidity

Enteric infections account for significant morbidity and mortality in young children (aged 1-4 y). Morbidity and mortality rates are highest in infants (most dangerous in infants < 3 mo with bacteremia), elderly patients, and patients with sickle cell disease, acquired immunodeficiency syndrome (AIDS), neoplasms, or other immunosuppressive conditions.[1, 8] Substantial differences in outcomes have been noted based on varying serotypes.[5]

Race

The incidence of infection for all serotyped NTS is almost twice as high in blacks and Latinos, Salmonella typhimurium is the most common pathogen.[9]

Sex

No sex differences are noted.[9]

Age

Attack rates are highest in persons younger than 5 years or older than 70 years.[9, 1]

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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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