Salmonella Infection (Salmonellosis) Follow-up

Updated: Jul 24, 2017
  • Author: Alena Klochko, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

Deterrence/Prevention

Salmonella bacteria are primarily transmitted orally. Disease prevention consequently includes proper sanitation and hygiene, as well as the avoidance of insufficiently cooked or mishandled food.

To reduce the incidence of Salmonella infections, concerted efforts are needed throughout the food supply chain, from farm to processing plant to kitchen. Recognizing the need to prevent Salmonella contamination of poultry products and other meats, the US Department of Agriculture's Food Safety and Inspection Service (USDA FSIS) launched a Salmonella initiative in 2006, with enhancements in 2008. [18]

Recent Salmonella outbreaks associated with exposure to small turtles highlight the importance of enforcing a 1975 prohibition on their sale and distribution in the United States. [18]

Persons should be aware that dry dog and cat food can be contaminated with Salmonella and should not be handled or stored in areas where human food is prepared or consumed. [20]

Washing hands is the most important step to prevent illness, especially after handling pet food or cleaning up after pets. [20]

Two typhoid vaccines are commercially available: Ty21a (oral) and Vi polysaccharide (parenteral). Both are moderately effective, with a cumulative efficacy of approximately 70%. Protection may be much poorer in individuals who are frequently exposed to high inocula of S typhi. The new and unlicensed modified conjugated Vi vaccine (Vi-rEPA) is equally efficacious and may confer longer immunity. Neither of the available vaccines is currently registered for administration to children younger than 2 years. [44]

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Complications

Bacteremia

Approximately 5-8% of individuals with nontyphoidal Salmonella gastrointestinal illness develop bacteremia, which is more likely to occur in immunodeficient patients. Most healthy hosts clear the bacteremia without complication, but some patients develop a septic or typhoidal picture. Metastatic infection may follow bacteremia. [2]

Cardiovascular

Endocarditis, pericarditis, valve perforation, and arteritis may occur. Prosthetic valves and grafts may become infected. A feared complication of Salmonella bacteremia is endarteritis, especially with involvement of abdominal aorta. Although data are limited, the prognosis with medical therapy alone is typically grim. [2] .

A simple scoring algorithm can be used to identify adults older than 50 years with nontyphoid Salmonella bacteremia with a high risk of vascular infections. The 4 risk factors significantly associated with vascular infections (ie, male sex, hypertension, coronary arterial disease, and serogroup C1 infection) are each assigned +1 point. In contrast, malignancy and immunosuppressive therapy were each assigned -1 point. Based on proposed nontyphoid Salmonella vascular infection scoring, the prevalence of vascular infections in patients with fewer than 0, 1, 2, 3, or 4 points was 2.2%, 10.6%, 39.4%, 55.2%, and 100%, respectively (P < .0001). [45]

CNS infection

Meningitis, ventriculitis, and abscess may develop. CNS complications are more common in infants and young children.

Pulmonary

Pneumonia, abscess, empyema, and bronchopleural fistula are possible pulmonary complications of Salmonella infection.

Bone/joints

Septic arthritis and osteomyelitis are possible. Salmonella osteomyelitis affects the long bones and typically occurs in patients with sickle cell disease. Severe prolonged polyarticular reactive joint disease can occur after intestinal salmonellosis and is not altered by long-term antibiotic therapy. [46]

Gastrointestinal

Bowel perforation and gastrointestinal bleeding are potential gastrointestinal complications of Salmonella infection. However, bowel perforation is now rare (< 1%). [17]

Hepatobiliary

Hepatic abscess, cholecystitis, and peritonitis may occur.

Splenic

Abscess may occur.

Urinary

Cystitis, pyelonephritis, and renal abscess may occur.

Genital

Ovarian abscess, testicular abscess, prostatitis, and epididymitis may occur.

Soft tissue

Abscess may occur.

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Prognosis

Nontyphoidal salmonellosis is generally self-limiting, with symptoms typically lasting 3-7 days.

Patients occasionally require hospitalization, but death is rare (< 1%).

After resolution of symptoms, the mean duration of fecal shedding of Salmonella organisms is 4-5 weeks, depending on the strain.

In the absence of risk factors for severe disease, limit treatment for enterocolitis to symptomatic care and fluid and electrolyte repletion. Indeed, some studies suggest that antibiotics actually prolong the carrier state.

In the preantibiotic era, approximately 15% of patients with typhoid fever died. More recently, mortality rates as high as 30% have been reported in certain developing countries. The mortality rate in patients with typhoid fever who are appropriately treated is less than 1%.

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Patient Education

Because salmonellae are ubiquitous, their eradication is unlikely. Consequently, a mainstay of disease prevention and control is public education.

Because transmission primarily occurs through ingestion of contaminated foods, information about the importance of sanitary food handling, proper food preparation, and personal hygiene is pivotal.

Notably, the emergence of drug-resistant salmonellae illustrates the importance of responsible antibiotic use in medicine and animal husbandry.

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