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| __NOTOC__
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| {{Salmonellosis}}
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| {{CMG}}; {{AE}} {{JS}} {{JM}}
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| ==Overview==
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| Symptoms of salmonellosis are indistinguishable from those caused by other gastrointestinal pathogens. Salmonella must therefore by identified with diagnostic studies identified in stool cultures e appropriate culture media, such as blood and MacConkey.
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| ==Other Diagnostic Studies==
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| ===Stool Cultures===
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| [[Stool culture]]s in adequate [[culture media]], allow the correct identification of the [[pathogen]] responsible for [[infectious diarrhea]]. The organism should be isolated from fresh stool. The sample should be planted in different selective and nonselective culture agar media, such as:<ref name=NCBI>{{cite web | title = Salmonella | url = http://www.ncbi.nlm.nih.gov/books/NBK8435/ }}</ref>
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| *[[Blood]]
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| *MacConkey
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| *Bismuth sulfite
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| *Eosin-methylene blue
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| *Salmonella-Shigella
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| In cases where there is reduced number of pathogens, enrichment broths, such as tetrathionate or selenite, may be used prior to culture of the bacteria.<ref name=NCBI>{{cite web | title = Salmonella | url = http://www.ncbi.nlm.nih.gov/books/NBK8435/ }}</ref>
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| The identification of the organism allows specific treatment of the disease, as well as appropriate follow-up recommendations.<ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref><ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
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| However, this test is not routinely performed due to its elevated cost, when compared with the accuracy of the results. Results from fecal cultures are often delayed and show an elevated rate of false-negatives.<ref name="pmid8815110">{{cite journal| author=Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL| title=To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. | journal=J Clin Microbiol | year= 1996 | volume= 34 | issue= 4 | pages= 928-32 | pmid=8815110 | doi= | pmc=PMC228919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8815110 }} </ref>
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| [[Stool culture]] may remains positive during 4 to 5 weeks, and in rare cases (chronic) for more than 1 year.<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref>
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| ===Serologic Tests===
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| After identification of Salmonella in [[stool culture]]s, the identification of the [[serologic]] type of the [[pathogen]] is given by serologic testing. Polyvalent and specific [[antisera]] should be used.<ref name=NCBI>{{cite web | title = Salmonella | url = http://www.ncbi.nlm.nih.gov/books/NBK8435/ }}</ref>
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| For this classification the following bacterial structures are considered:<ref>{{cite book | last = Murray | first = Patrick | title = Medical microbiology | publisher = Elsevier/Saunders | location = Philadelphia | year = 2013 | isbn = 0323086926 }}</ref>
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| *Capsular [[antigen]]
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| *[[Polysaccharide]] O antigens
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| *Flagellar [[antigens]]
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| ===Microscopic Examination===
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| The examination of stool samples, after staining with methylene blue, helps in the [[diagnosis]] of acute [[diarrhea]]. This test allows the identification of [[leukocytes]] in feces, suggesting an [[inflammatory]] etiology for the [[diarrhea]]. When the results indicate a serious form of the disease, further studies, such as [[stool culture]]s are indicated.<ref name="pmid8815110">{{cite journal| author=Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL| title=To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. | journal=J Clin Microbiol | year= 1996 | volume= 34 | issue= 4 | pages= 928-32 | pmid=8815110 | doi= | pmc=PMC228919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8815110 }} </ref> Limitations of this test include:
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| *Smear must be obtained from a fresh specimen, preferably collected in a cup (sensitivity 95%) <ref name="pmid507279">{{cite journal| author=Korzeniowski OM, Barada FA, Rouse JD, Guerrant RL| title=Value of examination for fecal leukocytes in the early diagnosis of shigellosis. | journal=Am J Trop Med Hyg | year= 1979 | volume= 28 | issue= 6 | pages= 1031-5 | pmid=507279 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=507279 }} </ref>
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| *The result is dependent on the experience of the operator
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| ====Lactoferrin Testing====
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| Some studies advocate the importance to test for [[fecal]] [[lactoferrin]]. This test is considered more sensitive than simple [[microscopic]] examination of [[PMN]]. The Lactoferrin Latex Agglutination (LFLA) is an [[in vitro]] test able to detect a highly sensitive [[leukocyte]] marker, indicative of the presence of [[PMN]].<ref name="pmid8815110">{{cite journal| author=Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL| title=To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. | journal=J Clin Microbiol | year= 1996 | volume= 34 | issue= 4 | pages= 928-32 | pmid=8815110 | doi= | pmc=PMC228919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8815110 }} </ref>
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| Its cost and high rate of [[false-positive]]s in breast-fed children, limit its application.<ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref><ref name="pmid8953074">{{cite journal| author=Hines J, Nachamkin I| title=Effective use of the clinical microbiology laboratory for diagnosing diarrheal diseases. | journal=Clin Infect Dis | year= 1996 | volume= 23 | issue= 6 | pages= 1292-301 | pmid=8953074 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8953074 }} </ref><ref name="pmid8815110">{{cite journal| author=Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL| title=To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. | journal=J Clin Microbiol | year= 1996 | volume= 34 | issue= 4 | pages= 928-32 | pmid=8815110 | doi= | pmc=PMC228919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8815110 }} </ref><ref name="pmid7993149">{{cite journal| author=Miller JR, Barrett LJ, Kotloff K, Guerrant RL| title=A rapid test for infectious and inflammatory enteritis. | journal=Arch Intern Med | year= 1994 | volume= 154 | issue= 23 | pages= 2660-4 | pmid=7993149 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7993149 }} </ref>
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| ===Colonoscopy===
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| For some cases of [[bloody diarrhea]] of unknown origin, a [[colonoscopy]] is indicated. It contributes to the [[diagnosis]] by confirming or ruling out conditions such as [[ulcerative colitis]] or [[malignancy]].<ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref>
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| ===Imaging Studies===
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| For patients with complications, such as abscesses, CT and ultrasound may be used to identify and monitor these structures.
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| ==References==
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| {{Reflist|2}}
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| [[Category:Bacterial diseases]]
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| [[Category:Foodborne illnesses]]
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| [[Category:Zoonoses]]
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| [[Category:Disease]]
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| [[Category:Infectious disease]]
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| [[Category:Emergency medicine]]
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| [[Category:Intensive care medicine]]
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