Pediatric Salmonella Infection Follow-up

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

Further Outpatient Care

Monitor patient's hydration status as an outpatient. Admission is warranted if the patient has signs and/or symptoms of dehydration. Monitor patients treated for enteric fever for possibility of relapse. Follow up on all blood cultures if the patient is being treated as an outpatient. Monitor for postinfectious functional GI disorders, such as irritable bowel syndrome. [35]

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Further Inpatient Care

If admission is necessary in patients with Salmonella infection, monitor the patient's hydration and electrolyte levels, continue intravenous (IV) or oral (PO) antibiotics as needed, and observe for and appropriately treat complications of Salmonella. [36]

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Deterrence/Prevention

Good personal hygiene, handwashing, and appropriate sanitary practices deter spread of the disease. Standard precautions and contact precautions must be used during the entire hospitalization of patients, especially for children who are in diapers or who are incontinent.

A study of 123 children with laboratory-confirmed Salmonella infections and 139 control children who had not experienced symptoms of GI illness during the month prior to the interviews concluded that after adjusting for race and household income, Salmonella infections were significantly associated with attendance of a daycare center, contact with cats, and contact with reptiles during the 3 days prior to the onset of illness. [37] Thus, exposure to environmental sources may play an important role in sporadic infections with Salmonella.

For patients hospitalized with S. typhi infection, precautions must be continued until results of 3 stool cultures are negative 48 hours after stopping antibiotic therapy. [5]

No vaccination is available for nontyphoidal Salmonella (NTS). Typhoid vaccination can help reduce the incidence of typhoid fever (50-75% efficacy). Although vaccinations enhance resistance to infection with S. typhi, immunity is overcome by a large bacterial inoculum. Immunization is recommended for the following individuals: (1) those who travel to an endemic area, (2) those with intimate exposure to an individual known to be a carrier of typhoid fever, (3) laboratory workers with frequent contact with S. typhi, and (4) individuals living in typhoid-endemic areas outside the United States. [5]

Two vaccinations are available in the United States. PO Ty21a vaccine is a live attenuated vaccination that can be given to children aged 6 years or older. Vaccination should be completed at least 1 week before exposure. A booster dose is recommended after 5 years in the case of continuous or repeated exposure. Vi capsular polysaccharide vaccine can be given to patients aged 2 years or older and consists of one intramuscular injection at least 2 weeks before exposure. A booster is recommended in 2 years. [5, 7]

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Complications

Complications of Salmonella infection include the following:

  • Nontyphoidal salmonellosis

    • Bacteremia

    • Meningitis

    • Pneumonia

    • Endocarditis/pericarditis

    • Osteomyelitis (most common in patients with sickle cell anemia)

    • Hepatic/splenic abscess

  • Typhoid fever (enteric fever)

    • Intestinal perforation and severe hemorrhage (occurs in 1-10% of children)

    • Toxic encephalopathy and cerebral thrombosis

    • Hepatitis, pancreatitis, arthritis, and myocarditis

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Prognosis

Prognosis varies, as follows:

  • Nontyphoidal salmonellosis

    • Prognosis of patients with simple gastroenteritis is excellent except for very young infants or patients with debilitating diseases.

    • The prognosis for Salmonella meningitis or endocarditis is poor.

  • Typhoid fever (enteric fever)

    • Therapy with antibiotics has decreased the mortality rate to 1%; however, prognosis depends on the extent of complications from the disease.

    • Relapse is common after therapy for enteric fever.

  • Chronic carrier state: Patients who continue to shed bacteria for more than 1 year (approximately 1% of patients) are considered chronic carriers.

  • NTS bacteremia: Increased mortality may be associated with a higher magnitude of NTS bacteremia. [38]

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Patient Education

Good personal hygiene and hand washing are essential for all people involved in food handling. All medical personnel must also use standard precautions when treating patients with Salmonella to avoid patient-to-patient transmission.

For excellent patient education resources, see eMedicineHealth's patient education article Foreign Travel and the Centers for Disease Control and Prevention Web site.

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