Salmonellosis natural history, complications and prognosis: Difference between revisions
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===Endovascular Infection=== | ===Endovascular Infection=== | ||
In the presence of persistent bacteremia, endovascular infection should be suspected. Previous conditions that are prone to the development of endovascular infection include: | |||
*Preexisting valvular heart disease | |||
*Atherosclerotic vascular disease | |||
*Prosthetic vascular graft | |||
*Aortic aneurysm | |||
In elder patients presenting with prolonged [[chest pain|chest]], [[back pain|back]] or [[abdominal pain]], and prolonged [[fever]], subsequently to an episode of [[gastroenteritis]], [[arteritis]] should be suspected. | |||
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Endocarditis and arteritis are rare (<1% of cases) but are associated with potentially fatal complications, including valve perforation, endomyocardial abscess, infected mural thrombus, pericarditis, mycotic aneurysms, aneurysm rupture, aortoenteric fistula, and vertebral osteomyelitis. In some areas of sub-Saharan Africa, NTS may be among the most common causes—or even the most common cause—of bacteremia in children. NTS bacteremia among these children is not associated with diarrhea and has been associated with nutritional status and HIV infection. | |||
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===Localized Infections=== | ===Localized Infections=== | ||
Of the 8% of patients who develop bacteremia, 5-10% progress into localized infections. | Of the 8% of patients who develop [[bacteremia]], 5-10% progress into localized [[infections]]. | ||
====Intra-abdominal Infections==== | ====Intra-abdominal Infections==== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]
Overview
Natural History
The symptoms of salmonellosis may occur at any age, and typically develop after 6 to 72 hours after ingestion of the contaminated food. The inoculum responsible for the disease is often greater 50000 bacteria.
Salmonellosis may occur at any age, and start with symptoms that are indistinguishable from those caused by other gastrointestinal pathogens. These include acute onset of nausea, vomiting, crampy abdominal pain, fever (38-39ºC) and diarrhea. Diarrhea may be simply nonbloody, loose stools, in moderate volume, or may be a large volume of watery, bloody stools. Children with enterocolitic infection often present with severe inflammatory disease, with bloody diarrhea, increased symptom duration and risk of complications.[1]
Commonly salmonellosis affects the ileum, however, it may also occur in the large bowel (non-typhoyd). The stomach, duodenum and jejunum are commonly spared of inflammation.[1][2][3]
For the infections limited to the gastrointestinal tract, in the absence of treatment, symptoms commonly have a spontaneous resolution within 5 to 7 days.[1]
For adults, antibiotic treatment is only indicated in certain conditions, mentioned in medical therapy. For these cases, the treatment does not decrease severity nor the duration of symptoms.[1]
Complications
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. However, in some cases complications may occur. These include:
Bacteremia
About 8% of patients develop bacteremia. This progress is more common in children, elderly and immunocompromised patients. Of the different serotypes of salmonella enterica non-tiphy, bacteremia is most common among patients infected with the serotypes Choleraesuis and Dublin.
Endovascular Infection
In the presence of persistent bacteremia, endovascular infection should be suspected. Previous conditions that are prone to the development of endovascular infection include:
- Preexisting valvular heart disease
- Atherosclerotic vascular disease
- Prosthetic vascular graft
- Aortic aneurysm
In elder patients presenting with prolonged chest, back or abdominal pain, and prolonged fever, subsequently to an episode of gastroenteritis, arteritis should be suspected.
Localized Infections
Of the 8% of patients who develop bacteremia, 5-10% progress into localized infections.
Intra-abdominal Infections
Central Nervous System Infections
Pulmonary Infections
Urinary and Genital Tract Infections
Bone, Joint, and Soft Tissue Infections
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.[4]
References
- ↑ 1.0 1.1 1.2 1.3 Coburn B, Grassl GA, Finlay BB (2007). "Salmonella, the host and disease: a brief review". Immunol Cell Biol. 85 (2): 112–8. doi:10.1038/sj.icb.7100007. PMID 17146467.
- ↑ McGovern VJ, Slavutin LJ (1979). "Pathology of salmonella colitis". Am J Surg Pathol. 3 (6): 483–90. PMID 534385.
- ↑ Boyd JF (1985). "Pathology of the alimentary tract in Salmonella typhimurium food poisoning". Gut. 26 (9): 935–44. PMC 1432849. PMID 3896961.
- ↑ http://www.cdc.gov/ncidod/dbmd/diseaseinfo/salmonellosis_g.htm