Salmonellosis
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| Salmonellosis Classification and external resources | |
| ICD-10 | A02.0 |
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| ICD-9 | 003.0 |
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Salmonellosis is an infection with Salmonella bacteria. Most persons infected with Salmonella develop diarrhea, fever, vomiting, and abdominal cramps 6 to 72 hours after infection. In most cases, the illness lasts 3 to 7 days—most affected persons recover without treatment. However, in some persons the diarrhea may be so severe that the patient becomes dangerously dehydrated and must be taken to a hospital. At the hospital, the patients will receive intravenous fluids to treat their dehydration and medications may be given to provide symptomatic relief, like fever reduction. In severe cases, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. Some people afflicted with Salmonellosis later experience reactive arthritis, which can have long-lasting, disabling effects.
The type of salmonella usually associated with infections in humans is called Non-Typhoidal Salmonella. It is usually contracted by ingesting raw or undercooked eggs, or from sources such as:
- Poultry and cattle, if the meat is prepared incorrectly or somehow becomes infected with the bacteria.
- Infected eggs and milk, as well as egg products, when not prepared, handled, or refrigerated properly.
- Reptiles such as turtles, lizards, and snakes, as they can carry the bacteria on their skin.
- Pet rodents
Cannabis contaminated with Salmonella muenchen was positively correlated with dozens of cases of salmonellosis in 1981.[1]
A rarer form of salmonella called Typhoidal Salmonella can lead to typhoid fever. It is only carried by humans and is usually contracted through direct contact with the fecal matter of an infected person. It therefore mainly occurs in countries that do not have proper systems for handling human waste.
Etymology
Both Salmonellosis and the Salmonella type of microorganisms derive their names from a modern Latin coining after Daniel E. Salmon 1850–1914, an American Veterinary surgeon. He had help from Theobald Smith, and together they found the bacterium in pigs.
Epidemiology and Demographics
Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common in the United States. Salmonella has been known to cause illness for over 100 years. They were discovered by a American scientist named Salmon, for whom they are named.
How do people catch Salmonella?
Salmonella live in the intestinal tracts of humans and other animals, including birds. Salmonella are usually transmitted to humans by eating foods contaminated with animal feces. Contaminated foods usually look and smell normal. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables may become contaminated. Many raw foods of animal origin are frequently contaminated, but fortunately, thorough cooking kills Salmonella. Food may also become contaminated by the unwashed hands of an infected food handler, who forgot to wash his or her hands with soap after using the bathroom.
Salmonella may also be found in the feces of some pets, especially those with diarrhea, and people can become infected if they do not wash their hands after contact with these feces. Reptiles are particularly likely to harbor Salmonella and people should always wash their hands immediately after handling a reptile, even if the reptile is healthy. Adults should also be careful that children wash their hands after handling a reptile. [1]
How common is salmonellosis?
Every year, approximately 40,000 cases of salmonellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be thirty or more times greater. Salmonellosis is more common in the summer than winter. Children are the most likely to get salmonellosis. Young children, the elderly, and the immunocompromised are the most likely to have severe infections. It is estimated that approximately 600 persons die each year with acute salmonellosis. [1]
Trends
Half of salmonellosis cases are caused by 2 serotypes: S. Enteritidis (SE) and S. Typhimurium (ST). The proportion of salmonellosis caused by SE increased markedly from 1980 to 1995, but has decreased 22% since 1996. The incidence of ST decreased 24% since 1996, but an increasing proportion of isolates show resistance to multiple antimicrobial agents. S. Newport has increased 32% from 1996 to 2001 to become the third most frequent serotype, with many isolates resistant to >9 antimicrobial drugs. [1]
Risk Factors
Affects all age groups. Groups at greatest risk for severe or complicated disease include infants, the elderly, and persons with compromised immune systems.
Pathophysiology & Etiology
Etiologic agent:
Enterobacteriaceae of the genus Salmonella, a gram-negative rod-shaped bacilli. Approximately 2000 serotypes cause human disease.
Salmonellosis is an infection with a bacteria called Salmonella. The Salmonella germ is actually a group of bacteria that can cause diarrheal illness in humans. They are microscopic living creatures that pass from the feces of people or animals, to other people or other animals. There are many different kinds of Salmonella bacteria.[1]
Diagnosis
Many different kinds of illnesses can cause diarrhea, fever, or abdominal cramps. Determining that Salmonella is the cause of the illness depends on laboratory tests that identify Salmonella in the stools of an infected person. These tests are sometimes not performed unless the laboratory is instructed specifically to look for the organism. Once Salmonella has been identified, further testing can determine its specific type, and which antibiotics could be used to treat it.[1]
Symptoms
Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. [1]
After bacterial infections, reactive arthritis (aka Reiters Syndrome) can develop.[1] In sickle-cell anemia, osteomyelitis due to Salmonella infection is much more common than in the general population.
Incidents of salmonellosis
In June 2006, the BBC reported that the Cadbury chocolate manufacturer withdrew a number of products when products contaminated with salmonella caused up to 56 cases of Salmonellosis.[1] The problems had been traced to a leaking pipe at a Cadbury plant in Herefordshire in January 2006, though the announcement was not made until June.
The U.S. Government reported that 16.3% of all chickens were contaminated with salmonella in 2005, and in the late 1990s as many as 20% were contaminated.[1] In the mid to late twentieth century, Salmonella enterica serovar Enteritidis was a common contaminant of eggs. This is much less common now with the advent of hygiene measures in egg production and the vaccination of laying hens to prevent salmonella colonization. Many different salmonella serovars also cause severe diseases in animals other than human beings.
In February 2007, the U.S. FDA issued a warning to consumers not to eat certain jars of Peter Pan peanut butter or Great Value peanut butter due to risk of contamination with 'Salmonella Tennessee'. [3]
In March 2007, around 150 people were diagnosed with salmonella-poisoning after eating tainted food at a governor's reception in Krasnoyarsk, Russia. Over 1,500 people attended the ball on March 1 and fell ill as a consequence of ingesting salmonella-tainted sandwiches.
In December 2007, about 150 people were sickened by salmonella-tainted chocolate cake produced by a major bakery chain in Singapore. [4]
Four-Inch Law
The Four-Inch Law refers to a regulation passed by the U.S. Food and Drug Administration in 1975 outlawing the sale of turtles with a carapace length of less than four inches. Exceptions are present for scientific and educational use, export, and private sale.[1]
The law was enacted, according to the FDA, "because of the public health impact of turtle-associated salmonellosis". There had been reported cases of young children placing small turtles in their mouths, which led to the size-based restriction.
Prognosis
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons who are infected with Salmonella, will go on to develop pains in their joints, irritation of the eyes, and painful urination. This is called Reiter's syndrome. It can last for months or years, and can lead to chronic arthritis which is difficult to treat. Antibiotic treatment does not make a difference in whether or not the person later develops arthritis.[1]
Treatment
Salmonella infections usually resolve in 5-7 days and often do not require treatment unless the patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhea may require rehydration, often with intravenous fluids. Antibiotics are not usually necessary unless the infection spreads from the intestines, then it can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.[1]
Primary Prevention
What can I do to prevent salmonellosis?
- Cook poultry, ground beef, and eggs thoroughly before eating. Do not eat or drink foods containing raw eggs, or raw unpasteurized milk.
- If you are served undercooked meat, poultry or eggs in a restaurant, don't hesitate to send it back to the kitchen for further cooking.
- Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
- Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
- Wash hands with soap after handling reptiles or birds, or after contact with pet feces.
- Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons.
- Don't work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time.
- Mother's milk is the safest food for young infants. Breast-feeding prevents salmonellosis and many other health problems. [1]
There is no vaccine to prevent salmonellosis. Since foods of animal origin may be contaminated with Salmonella, people should not eat raw or undercooked eggs, poultry, or meat. Raw eggs may be unrecognized in some foods such as homemade hollandaise sauce, caesar and other homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings. Poultry and meat, including hamburgers, should be well-cooked, not pink in the middle. Persons also should not consume raw or unpasteurized milk or other dairy products. Produce should be thoroughly washed before consuming.
Cross-contamination of foods should be avoided. Uncooked meats should be keep separate from produce, cooked foods, and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after handling uncooked foods. Hand should be washed before handling any food, and between handling different food items.
People who have salmonellosis should not prepare food or pour water for others until they have been shown to no longer be carrying the Salmonella bacterium.
People should wash their hands after contact with animal feces. Since reptiles are particularly likely to have Salmonella, everyone should immediately wash their hands after handling reptiles. Reptiles (including turtles) are not appropriate pets for small children and should not be in the same house as an infant.[1]
Secondary Prevention
What else can be done to prevent salmonellosis?
It is important for the public health department to know about cases of salmonellosis. It is important for clinical laboratories to send isolates of Salmonella to the City, County, or State Public Health Laboratories so the specific type can be determined and compared with other Salmonella in the community. If many cases occur at the same time, it may mean that a restaurant, food or water supply has a problem which needs correction by the public health department.
Some prevention steps occur everyday without you thinking about it. Pasteurization of milk and treating municipal water supplies are highly effective prevention measures that have been in place for many years. In the 1970s, small pet turtles were a common source of salmonellosis in the United States, and in 1975, the sale of small turtles was halted in this country. Improvements in farm animal hygiene, in slaughter plant practices, and in vegetable and fruit harvesting and packing operations may help prevent salmonellosis caused by contaminated foods. Better education of food industry workers in basic food safety and restaurant inspection procedures, may prevent cross-contamination and other food handling errors that can lead to outbreaks. Wider use of pasteurized egg in restaurants, hospitals, and nursing homes is an important prevention measure. In the future, irradiation or other treatments may greatly reduce contamination of raw meat. [1]
What is the government doing about salmonellosis?
The Centers for Disease Control and Prevention (CDC) monitors the frequency of Salmonella infections in the country and assists the local and State Health Departments to investigate outbreaks and devise control measures. CDC also conducts research to better identify specific types of Salmonella. The Food and Drug Administration inspects imported foods, milk pasteurization plants, promotes better food preparation techniques in restaurants and food processing plants, and regulates the sale of turtles. The FDA also regulates the use of specific antibiotics as growth promotants in food animals. The US Department of Agriculture monitors the health of food animals, inspects egg pasteurization plants, and is responsible for the quality of slaughtered and processed meat. The US Environmental Protection Agency regulates and monitors the safety of our drinking water supplies.[1]
Acknowledgements
The content on this page was first contributed by: C. Michael Gibson M.S., M.D.
List of contributors:
Pilar Almonacid
References
External links
- CDC website, Division of Bacterial and Mycotic Diseases, Disease Listing: Salmonellosis
- CFIA Website: Salmonellae
See also
cs:Salmonelóza de:Salmonellosefr:Salmonellose gl:Salmonelose it:Salmonellosi lt:Salmoneliozėsk:Salmonelová enteritída sh:Salmoneloza
WikiDoc Research Resources for Salmonellosis | |
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| Articles on Salmonellosis | Most recent articles on Salmonellosis • Most cited articles on Salmonellosis • Review articles on Salmonellosis • Articles on Salmonellosis in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Salmonellosis | Powerpoint slides on Salmonellosis • Images of Salmonellosis • Photos of Salmonellosis • Podcasts & MP3s on Salmonellosis • Videos on Salmonellosis |
| Evidence Based Medicine Regarding Salmonellosis | Cochrane Collaboration on Salmonellosis • Bandolier on Salmonellosis • TRIP on Salmonellosis |
| Cost Effectiveness of Salmonellosis | Cost Effectiveness of Salmonellosis |
| Clinical Trials Involving Salmonellosis | Ongoing Trials on Salmonellosis at Clinical Trials.gov • Trial results on Salmonellosis • Clinical Trials on Salmonellosis at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Salmonellosis | US National Guidelines Clearinghouse on Salmonellosis • NICE Guidance on Salmonellosis • NHS PRODIGY Guidance • FDA on Salmonellosis • CDC on Salmonellosis |
| Textbook Information on Salmonellosis | Books and Textbook Information on Salmonellosis |
| Pharmacology Resources on Salmonellosis | Dosing of Salmonellosis • Drug interactions with Salmonellosis • Side effects of Salmonellosis • Allergic reactions to Salmonellosis • Overdose information on Salmonellosis • Carcinogenicity information on Salmonellosis • Salmonellosis in pregnancy • Pharmacokinetics of Salmonellosis • |
| Genetics, Pharmacogenomics, and Proteinomics of Salmonellosis | Genetics of Salmonellosis • Pharmacogenomics of Salmonellosis • Proteomics of Salmonellosis |
| Newstories on Salmonellosis | Salmonellosis in the news • Be alerted to news on Salmonellosis • News trends on Salmonellosis |
| Commentary on Salmonellosis | Blogs on Salmonellosis |
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| Healthcare Provider Resources on Salmonellosis | Symptoms of Salmonellosis • Causes & Risk Factors for Salmonellosis • Diagnostic studies for Salmonellosis • Treatment of Salmonellosis |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
