Salmonella Infection in Emergency Medicine Treatment & Management

Updated: Mar 08, 2021
  • Author: Michael D Owens, DO, MPH, FACEP, FAAEM; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Treatment

Prehospital Care

Perform a standard evaluation of airway, breathing, and circulation.

Provide intravenous fluids if signs or symptoms of dehydration are present.

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Emergency Department Care

Perform a standard evaluation of airway, breathing, and circulation.

Treat with rehydration and electrolyte replacement via oral or intravenous solutions for an uncomplicated gastroenteritis.

Transfusions should be based on hemoglobin and hematocrit levels.

Symptomatically manage pain, nausea, vomiting, and diarrhea.

Antibiotics are indicated for infants aged up to 2 months, elderly patients, immunocompromised patients, those with a history of sickle cell disease or prosthetic grafts, or patients who have extraintestinal findings.

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Consultations

Admission may be required if the patient exhibits unstable vital signs, harbors significant risk factors, is younger than 2 months or is elderly, is immunocompromised, or shows signs or symptoms of an extraintestinal manifestation.

Appropriate specialty consultation for specific extraintestinal manifestations is indicated.

Arrange for follow-up care on an outpatient basis with the patient’s primary care physician if discharged from the emergency department.

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Prevention

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. [44]

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. [45]

Myrtle leaves oil has shown promise as an alternative disinfectant. [46]

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. [15]

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% [6] Newer conjugate Vi vaccines may offer increased and longer protection against Salmonella Typi [21]

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 [34]

Trials are underway for a single-dose oral vaccine. [24]

Current vaccines do provide any significant protection against the Salmonella Paratyphi strain. [21]

Immunity against typhoid after infection or vaccination is only temporary. [20]

Other measures

Animal reservoirs and flies should be controlled.

Individuals with diarrhea who attend or work in childcare centers, healthcare facilities, food service, or recreational water venues should follow local outbreak reporting and infection-control procedures. [32]

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Long-Term Monitoring

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

Worsening symptoms warrant a return visit to the ED.

Reduced osmolarity oral rehydration solution (ORS) is recommended for mild to moderate dehydration, while breastfeeding should be continued in infants.

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. [47]

Patients with HIV infection who achieve a short-term response to combination antiretroviral therapy (cART) have a lower risk of recurrent nontyphoid Salmonella bacteremia. [48]

Probiotic preparations may be offered and have shown antagonistic properties against Salmonella. [49]

Consider zinc supplementation in children aged 6 months to 5 years who reside in countries with a high prevalence of zinc deficiency or who are malnourished.

Reassessment of fluid and electrolyte balance, nutritional status, and antimicrobial therapy for patients with persistent symptoms is strongly recommended.

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