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Salmonella
From WikEM
Contents
Background
- Salmonella enteritidis is a common cause of food borne disease outbreaks
- Infection commonly from foodborne transmission
- Associated with poultry/hen eggs, peanut butter
- Seen in infants often due to cross-contamination in household
Clinical Features
- Severity dependent on dose ingested
- Symptoms within 8-72 hours
- Nausea
- Vomiting
- Fever
- Diarrhea
- Cramping
- Course: Fever resolves within 48-72 hours; diarrhea resolves within 4-10 days
- < 5% of patients develop bacteremia that is rarely complicated by endocarditis, osteomyelitis, or mycotic aneurysm.
- Mortality < 0.5-1%
Differential Diagnosis
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (nontyphi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
Evaluation
- Stool culture
Management
Supportive care
- IVF
Antibiotics
- Have not been shown to reduce duration of symptoms and not recommended in:[2][3]
- Mild-moderate infection
- Immunocompetent
- Patients aged 2-50 years old
- Antibiotics may have a role in patients with:[4]
- Severe illness
- IBD
- Immunocompromised
- Steroid use
- < 3 months or > 65 years old
- On hemodialysis
- Sickle cell disease
- Recommended regimens:[5]
- Adults:
- Levofloxacin (or other fluoroquinolone) 500mg daily x 7-10 days
- Azithromycin 500mg daily x 7 days
- Duration should be 14 days in immunocompromised
- Children:
- Ceftriaxone 100mg/kg/day divided into two doses x 7-10 days
- Azithromycin 20mg/kg/day daily x 7 days
- Adults:
Antibiotic Sensitivities[6]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
Table Overview
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See Also
References
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- ↑ Onwuezobe, I. A., Oshun, P. O., & Odigwe, C. C. (2012). Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. The Cochrane database of systematic reviews, , CD001167.
- ↑ DuPont, H. L. (2014). Acute infectious diarrhea in immunocompetent adults. The New England journal of medicine, 16, 1532–1540.
- ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
- ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
- ↑ Sanford Guide to Antimicrobial Therapy 2014
Authors
Ross Donaldson, Brian Gilberti, Neil Young, Daniel Ostermayer
