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Salmonella

Epidemiology: - most common bacterial cause of foodborne illness in U.S. - associated with animal reservoirs, especially poultry & eggs - in 2004-2011, 316 cases in 43 states - 81% from a mail order hatchery involving live poultry [3] - 10 outbreaks of Salmonella linked to backyard poultry in 2017 - 961 sickened, 215 hospitalized,1 death [9] (U.S) - transmission to children following handling of pet reptiles [6] - asymptomatic shedding of the bacteria in the stool occurs for weeks even after appropriate antibiotic therapy - a contaminant of 7% of imported spices [5] - outbreak of Salmonella adelaide linked to pre-cut mellon distributed to Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, & Ohio in 2018 [10] - outbreak of multidrug-resistant Salmonella tied to human contact with pig ear treats for dogs [12] - multistate outbreak of Salmonella dublin infection linked to ground beef, 10 cases in 6 states [13] - outbreak in 2012 associated with a sushi variety called "spicy tuna" Clinical manifestations: - Salmonella gastroenteritis indistinguishable from gastroenteritis caused by other organisms - typically, non-bloody diarrhea - fever/chills, abdominal cramping, myalgia Laboratory: - Salmonella identified by culture - stool culture may take up to 72 hours to become positive [1] - Salmonella/Shigella culture from stool - blood cultures positive in 10-25% - bone marrow & duodenal cultures may be helpful (enteric fever) - lactose -; H2S +; gas +; indole -; methyl red +; Voges-Proskauer -; urease -; motility +; lysine +; ornithine decarboxylase +; malonate -; KCN - - Salmonella identified in isolate - antibiotic susceptibility testing indicated [1] - Salmonella DNA - Salmonella serology Complications: - 5% of patients may develop complications of bacteremia a) endocarditis or other endovascular infection b) osteomyelitis [1] - reactive arthritis - erythema nodosum - irritable bowel syndrome Management: 1) supportive a) hygiene, contact precautions b) infected food handlers should remain at home until asymptomatic c) most infections in patients <50 years resolve spontaneously within 1 week [1] 2) antibiotics generally not indicated a) no evidence of benefit for diarrhea [8] b) may prolong duration of the carrier state (shedding) c) do NOT affect the course of the disease 2) indications for antibiotics: a) blood cultures are positive b) patients < 2 years of age & > 50 years of age c) severe infection requiring hospitalization d) known or suspected atheromas or bone prosthesis because of possible seeding during bacteremia e) immunosuppressed patients 3) duration of therapy a) 7-10 days in immunocompetent patients b) minimum of 2 weeks in immunosuppressed patients 4) empiric antibiotic therapy a) fluoroquinolones are 1st line [1]; - add ceftriaxone for bacteremia (sepsis) [1] b) Bactrim c) amoxicillin 5) antibiotic susceptibility testing indicated

Related

salmonellosis

Specific

Salmonella arizonae Salmonella dublin Salmonella enterica serotype Typhi Salmonella enteritidis Salmonella gallinarum Salmonella hirschfeldii Salmonella newport Salmonella paratyphi Salmonella poona Salmonella schottmuelleri Salmonella typhi Salmonella typhimurium

General

Enterobacteriaceae

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
  2. Vearrier D 8 Cases of Food Poisoning: Find the Pathogen Responsible. Medscape. March 22, 2021 https://reference.medscape.com/slideshow/food-poisoning-6009621
  3. Gaffga NH et al Outbreak of Salmonellosis Linked to Live Poultry from a Mail-Order Hatchery N Engl J Med 2012; 366:2065-2073May 31, 2012 PMID: 22646629 http://www.nejm.org/doi/full/10.1056/NEJMoa1111818
  4. Valdez Y, Ferreira RB, Finlay BB. Molecular mechanisms of Salmonella virulence and host resistance. Curr Top Microbiol Immunol. 2009;337:93-127 PMID: 1981298
  5. Harris G for the New York Times. August 27, 2013 Salmonella in Spices Prompts Changes in Farming http://www.nytimes.com/2013/08/28/world/asia/farmers-change-over-spices-link-to-food-ills.html
  6. Murphy D, Oshin F Reptile-associated salmonellosis in children aged under 5 years in South West England. Arch Dis Child. Dec 22, 2014 PMID: 25538189 http://adc.bmj.com/content/early/2014/12/18/archdischild-2014-306134
  7. Centers for Disease Control and Prevention (CDC) The 2013 NARMS Annual Human Isolates Report. CDC NARMS tracks antimicrobial resistance in Salmonella and other enteric (intestinal) bacteria that may cause mild or severe diarrhea or bloodstream infection. http://www.cdc.gov/narms/reports/annual-human-isolates-report-2013.html
  8. Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev. 2012 Nov 14;11:CD001167. Review. PMID: 23152205
  9. Centers for Disease Control and Prevention (CDC) Multistate Outbreaks of Human Salmonella Infections Linked to Live Poultry in Backyard Flocks, 2017. Salmonella Homepage. Outbreak Advisory Posted August 21, 2017 https://www.cdc.gov/salmonella/live-poultry-06-17/index.html
  10. Centers for Disease Control and Prevention (CDC) Multistate Outbreak of Salmonella Adelaide Infections Linked to Pre-Cut Melon. Salmonella Homepage. Outbreak Advisory Posted June 8, 2018 https://www.cdc.gov/salmonella/adelaide-06-18/index.html
  11. Mermin J, Hutwagner L, Vugia D et al Reptiles, amphibians, and human Salmonella infection: a population-based, case-control study. Clin Infect Dis. 2004 Apr 15;38 Suppl 3:S253-61. PMID: 15095197
  12. Centers for Disease Control & Prevention (CDC), July 31, 2019 Outbreak of Multidrug-Resistant Salmonella Infections Linked to Contact with Pig Ear Dog Treats. https://www.cdc.gov/salmonella/pet-treats-07-19/index.html
  13. Centers for Disease Control & Prevention (CDC), CDC Investigation Notice: CDC investigating outbreak of Salmonella infections linked to ground beef. News Release. Media Statement. Nov 1, 2019 https://www.cdc.gov/media/releases/2019/s1101-ground-beef.html - Centers for Disease Control & Prevention (CDC Outbreak of Salmonella Infections Linked to Ground Beef Investigation Notice. Nov 1, 2019 https://www.cdc.gov/salmonella/dublin-11-19/index.html