Salmonella Infection in Emergency Medicine Follow-up

Updated: Apr 10, 2017
  • Author: Michael D Owens, DO, MPH, FACEP, FAAEM; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Follow-up

Further Outpatient Care

Follow-up treatment with the patient's primary care physician is highly recommended.

Worsening symptoms warrant a return visit to the ED.

Antibiotic treatment for a chronic carrier in coordination with the patient’s primary care physician may be indicated. Asymptomatic carriage occurs on average for about 5 weeks, with prolonged duration existing in children younger than 5 years. [45]

Patients with HIV infection who achieve a short-term response to combination antiretroviral therapy (cART) have a lower risk of recurrent nontyphoid Salmonella bacteremia. [46]

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Deterrence/Prevention

Deterrence and prevention methods are listed below.

  • Proper hygiene and food storage
    • Infection rates decrease in parallel with introduction of municipal water treatment, pasteurization of dairy products, and exclusion of human feces from food production. [38]
    • Keep raw meat and poultry away from unprepared foods.
    • Clean surfaces, utensils, and hands after contact with raw foods. Commonly used disinfectants have limited efficacy on mature Salmonellaenterica biofilm strains in food processing environments. [47]
    • Myrtle leaves oil has shown promise as an alternative disinfectant. [48]
    • The Food and Drug Administration (FDA) published a rule allowing irradiation of fresh iceberg lettuce and spinach as well as piloting an advanced border screening program in August 2008.
    • Avoid eating raw or undercooked eggs. Salmonella can withstand temperatures as high as 194o F (90o C) for 50 minutes. [14]
  • Control of animal reservoir
  • Control of flies
  • Vaccine for enteric or typhoid fever
    • Current multidose oral live attenuated Ty21a vaccine (5 years) or single-dose Vi capsular polysaccharide parental vaccine (2 years) with an efficacy of 50-80% [5] Newer conjugate Vi vaccines may offer increased and longer protection against Salmonella Typi [18]
    • Capsules licensed for ≥6 years, while parental licensed ≥2 years in the United States
    • Antibody and cell-mediated immunity responses occur after infection and immunization with live oral vaccines but may not be specific to the infecting organism [27]
    • Trials are underway for a single-dose oral vaccine. [19]
    • Current vaccines do provide any significant protection against the Salmonella Paratyphi strain [18]
    • Immunity against typhoid after infection or vaccination is only temporary [17]
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Complications

Complications of Salmonella infection may include the following:

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Prognosis

Nontyphoid Salmonella is generally self-limiting. Most patients are treated on an outpatient basis. Extremes of age and an immunocompromised state increases morbidity and mortality.

Typhoid Salmonella generally requires treatment. Mortality rate for treated cases is 2%, while complications occur in 30% of untreated cases. [3] Morbidity and mortality increases with drug-resistant S typhi. [16]

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Patient Education

Emphasize good hand-washing, thorough cleaning of cooking utensils, appropriate food preparation techniques, and adequate cooking temperature for killing the bacteria.

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