History

Carefully obtain the patient's history to determine any potential sources of Salmonella and to help determine if the correct diagnosis has been made.

General history
- Inquire about any recent travel abroad.
- Inquire about possible animal exposures, including contact with pet iguanas, turtles, tortoises, or other reptiles.
- Inquire whether any family members have current or recent gastroenteritis.
- Inquire whether any recent outbreaks have occurred in the community.
Salmonella gastroenteritis
- The incubation period of Salmonella gastroenteritis is 6-72 hours.
- In most cases, children have cramping abdominal pain, nausea, vomiting, and loose watery stools.
- Stools may be bloody; however, this is not as common as in infection with Shigella.
- Fever, which rarely exceeds 39°C, occurs in approximately one half of infected patients.
- Symptoms usually resolve spontaneously in 2-7 days.
Enteric fever (typhoid fever)
- Enteric fever is caused by S. typhi and several other Salmonella serotypes.
- The incubation period for enteric fever is 3-60 days, but symptoms typically occur in 1-2 weeks.
- Patients may present with high fever, which rises in a steplike fashion.
- Other symptoms include anorexia, abdominal pain, malaise, myalgias, headache, cough, diarrhea or constipation, and delirium.

Physical Examination

Physical findings may include the following:

Salmonella gastroenteritis
- Upon physical examination, patients may have signs of dehydration, such as delayed capillary refill, sunken eyes, dry mucous membranes, or tachycardia.
- Patients may have tenderness to palpation on abdominal examination, which sometimes can be difficult to differentiate from appendicitis.
- Rectal examination may reveal heme-positive stools, gross blood, or mucoid stools.
Enteric fever (typhoid fever)
- A typical finding of enteric fever is relative bradycardia for the height of the fever.
- Hepatosplenomegaly may be found on examination.
- Patients with enteric fever may develop rose spots; these spots are blanching pink papules most commonly found on the anterior thorax. They usually fade about 3-4 days after appearance, are 2-4 mm in diameter, and occur in groups of 5-20.

Differential Diagnoses

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Media Gallery

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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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)

Catherine OKeefe, 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 OKeefe, 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.

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: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer, Sanofi<br/>Received research grant from: Merck; MedImmune; Regenron; Pfizer;Novartis; Sanof; GSK<br/>Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

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, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

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.

Pediatric Salmonella Infection Clinical Presentation

History

Physical Examination

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