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Pediatric Salmonella Infection Workup

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 10, 2016
 

Laboratory Studies

The following tests are indicated in Salmonella infection:

  • CBC count with differential
    • CBC count is often 10,000-15,000/μ L in simple gastroenteritis.
    • Patients with enteric fever commonly have anemia, thrombocytopenia, or neutropenia, although a shift to more immature forms can be seen on the differential count.
  • Cultures
    • Isolation of Salmonella from cultures of stool, blood, urine, or bone marrow is diagnostic (see the image below).
      Under a moderately-high magnification of 8000X, thUnder 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.
    • Cultures of rose spots and/or bone marrow aspirate may be positive in enteric fever even when stool culture findings are negative for Salmonella.
  • Stool examination: Stool may be Hemoccult positive and may have positive findings for fecal polymorphonuclear cells.
  • Chemistry
    • Electrolyte tests may reveal metabolic acidosis or other abnormalities consistent with dehydration.
    • Patients with enteric fever may have mild hepatitis.
  • Serologic tests: Tests for Salmonella agglutinins (febrile agglutinins, Widal test) may suggest infection with S. typhi; however, they are not recommended because of the number of false-positive and false-negative results.
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Imaging Studies

Imaging studies are not necessary for most patients with simple gastroenteritis and enteric fever without any severe complications.

Consider chest radiography if pneumonia is suggested as the result of bacteremia. Perform abdominal radiography if the patient presents with peritoneal signs on physical examination. Consider intestinal perforation as a complication of enteric fever.

Perform a bone scan if osteomyelitis is considered as a complication of bacteremia. MRI, which is more sensitive, is preferred to evaluate osteomyelitis.

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Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Catherine O’Keefe, DNP, APRN-NP Associate Professor of Nursing, Clinician-Educator Track Graduate Curriculum Coordinator, Nurse Practitioner Programs, Creighton University, School of Nursing; Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O’Keefe, DNP, APRN-NP is a member of the following medical societies: American Association of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

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, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Diana L Crevi, MD, to the original writing and development of this article.

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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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