Salmonellosis (patient information)

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Salmonellosis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Salmonellosis?
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Laura Linnemeier; João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]

Overview

Salmonellosis is one of the most common and widely distributed foodborne diseases and is caused by the bacteria salmonella. Salmonella is a group of bacteria that can cause the diarrheal illness known as salmonellosis 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. Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common in the United States. Salmonella germs have been known to cause illness for over 100 years. They were discovered by an American scientist named Salmon, for whom they are named.

What are the symptoms of Salmonellosis?

The onset of disease symptoms occurs 6 - 72 hours (usually 12-36 hours) after ingestion of salmonella. It is usually characterized by acute onset of:

• Fever
• Abdominal pain
• Diarrhea
• Nausea
• Vomiting

The illness usually lasts 2 to 7 days. Symptoms of salmonellosis are relatively mild and patients make a recovery without specific treatment in most cases. However, in some cases, particularly in the very young and in the elderly patients, the associated dehydration can become severe and life-threatening. 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. Unless the person is treated promptly with antibiotics, death may occur.

What causes Salmonellosis?

Salmonellosis is caused by salmonella. For salmonella species, over 2 500 different strains (called "serotypes" or "serovars") have been identified to date. Salmonella is a ubiquitous and hardy bacteria that can survive several weeks in a dry environment and several months in water. The bacteria live in the intestinal tract of humans and other animals, including birds.

Transmission

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 any food, including vegetables, may become contaminated.

Food may become contaminated by the hands of an infected food handler who did not wash 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 pets or pet feces. Reptiles, such as turtles, lizards, and snakes, are particularly likely to harbor Salmonella. Many chickens and young birds carry Salmonella in their feces.

Who is at highest risk?

Children are at highest risk to get salmonellosis. The rate of diagnosed infections in children less than five years old is about five times higher than the rate in all other persons.

Persons at risk of severe disease or complications, include:

• Children
• Elderly
• Immunocompromised persons

Salmonellosis is more common in the summer than winter.

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 stool of an infected person. Once Salmonella has been identified, further testing can determine its specific type.

When to seek urgent medical care?

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.

Treatment options

Salmonella infections usually resolve in 5-7 days and often do not require treatment other than oral fluids and electrolyte replacement. Persons with severe diarrhea may require rehydration with intravenous fluids.

Antibiotic therapy can prolong the duration of excretion of non-typhoidal Salmonella and is recommended only for patients with severe illness (e.g., those with severe diarrhea, high fever, bloodstream infection, or who need hospitalization) or those at risk of severe disease or complications, including young infants, older adults (over 65 years old) and immunocompromised persons. Antibiotics may include, ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin.

Some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of food animals, therefore, susceptibility testing can help guide appropriate therapy.

Where to find medical care for Salmonellosis?

Directions to Hospitals Treating Salmonellosis

Prevention of Salmonellosis

There is no vaccine to prevent salmonellosis. Because 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. Cross-contamination of foods should be avoided. Uncooked meats should be kept separate from produce, cooked foods, and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after touching uncooked foods. Hand should be washed before handling food, and between handling different food items. People who have salmonellosis should not prepare food or pour water for others until their diarrhea has resolved. Many health departments require that restaurant workers with Salmonella infection have a stool test showing that they are no longer carrying the Salmonella bacterium before they return to work. People should wash their hands after contact with animal feces. Because reptiles are particularly likely to have Salmonella, and it can contaminate their skin, 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. Salmonella carried in the intestines of chicks and ducklings contaminates their environment and the entire surface of the animal. Children can be exposed to the bacteria by simply holding, cuddling, or kissing the birds. Children should not handle baby chicks or other young birds. Everyone should immediately wash their hands after touching birds, including baby chicks and ducklings, or their environment. Again, what can be done everyday to prevent the spread of salmonellosis?

• Cook poultry, ground beef, and eggs thoroughly. 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, birds, or baby chicks, and 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. Breastfeeding prevents salmonellosis and many other health problems.

Thorough cooking kills Salmonella.

People should always wash their hands immediately after handling a reptile or bird, even if the animal is healthy. Adults should also assure that children wash their hands after handling a reptile or bird, or after touching its environment.

What to expect (Outlook/Prognosis)?

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. Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons with Salmonella develop pain 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 develops arthritis.

Resources

• Centers for Disease Control and Prevention