Salmonellosis natural history, complications and prognosis
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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
Salmonellosis symptoms begin between 6 to 72 hours after ingestion of contaminated food. Symptoms include nausea, vomiting, crampy abdominal pain, diarrhea, and fever. Uncomplicated infection often affects only the gastrointestinal tract, and resolves within 5 to 7 days. Infants, elderly and immunocompromised patients may experience severe forms of the disease, and are more prone for the development of complications, such as: bacteremia, endovascular, and focal infections. Focal infections may be located in the abdomen, CNS, lungs, urinary and genital tracts, or in the bones and joints.
Natural History
Salmonellosis may occur at any age, and start with symptoms that are indistinguishable from those caused by other gastrointestinal pathogens. These typically develop after 6 to 72 hours after ingestion of the contaminated food and 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 stool. 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 duration of symptoms.[1]
Complications
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. In some cases complications may occur. These include:[4]
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-typhi, bacteremia is most common among patients infected with the serotypes Choleraesuis and Dublin.[5]
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:[6]
- Atherosclerotic vascular disease
- Preexisting valvular heart 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.[7]
In rare cases (<1%) arteritis and endocarditis may complicate into severe, often fatal, complications, such as:[8]
- Valve perforation
- Endomyocardial abscess
- Mycotic aneurysms
- Infected mural thrombus
- Aortoenteric fistula
- Aneurysm rupture
- Pericarditis
Focal Infections
Of the 8% of patients who develop bacteremia, 5-10% progress into localized infections. These may include:[9]
Intra-abdominal Infections
Rare complications that when present, manifest as cholecystitis, splenic or hepatic abscesses. Common risk factors for their development include:
- Splenic abscesses from sickle cell disease
- Hepatobiliary anatomic abnormalities
- Abdominal malignancy
Central Nervous System Infections
Non-typhoid salmonella may lead to different CNS infections, such as:[10]
Pulmonary Infections
Pulmonary infections caused by non-typhoid salmonella commonly lead to lobar pneumonia. Complications may include:[11]
Urinary and Genital Tract Infections
Non-typhoid salmonella may complicate into urinary and genital tract infections, such as:[12]
- Cystitis
- Pyelonephritis
- Ovarian abscess
- Testicular abscess
- Prostatitis
- Epididymitis
Joint Infection
Non-typhoid salmonella may lead to Reiter's syndrome[13]
Prognosis
The prognosis of salmonellosis is good for most patients. Persons with diarrhea usually recover completely, although in some cases, it may take several months until their bowel habits become entirely normal. The development of a severe form of the disease, or complications, is associated with bad prognosis.[14]
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.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ "Salmonella (non-typhoidal)".