1. Salmonella Infections an update
Dr.T.V.Rao MD
Dr.T.V.Rao MD

2. Salmonella Causes Infections in Humans and vertebrates,
Enteric Fever ( Typhoid fever )
Gastroenteritis
Septicemias,
Carrier state a concern
Dr.T.V.Rao MD

3. Salmonella A Very complex group Contains more > 2,000 spp
Typed on the basis of Serotyping, and species typing
Divided into two groups
1 Enteric fever group
2 Food poisoning group – Septicemias.
Dr.T.V.Rao MD

4. Key points
There are more than 2000 different antigenic types of Salmonella; those pathogenic to man are serotypes of S. enterica.
Most serotypes of S. enterica cause food-borne gastroenteritis and have animal reservoirs.
S. enterica serotypes Typhi and Paratyphi cause typhoid fever.
Dr.T.V.Rao MD

5. Enteric Fever Typhoid Fever
Caused by Salmonella typhi, and other Groups called as Paratyphoid A, B, C
Salmonella typhi - Causes Typhoid
Salmonella Paratyphi A,B,C Causes Paratyphoid fevers.
Food Poison group
Spread from Animals – Humans
Causes Gastroenteritis – Septicemias, Localized Infection
Dr.T.V.Rao MD

6. Typhoid fevers are prevalent in many regions in the World

7. Typhoid Mary Most Dangerous Woman in America
Dr.T.V.Rao MD

8. Typhoid Mary
A famous example is “Typhoid” Mary Mallon, who was a food handler responsible for infecting at least 78 people, killing 5. These highly infectious carriers pose a great risk to public health.

9. Typhoid Mary
"Typhoid Mary," real name Mary Mallon, worked as a cook in New York City in the early 1900s. Public health pioneer Sara Josephine Baker, MD, PhD tracked her down after discovering that she was the common link among many people who had become ill from typhoid fever She was traced to typhoid outbreaks a second time so she was put in prison again where she lived until she died.

10. Morphology of Salmonella
Gram negative bacilli
1-3 / 0.5 microns,
Motile by peritrichous flagella
Dr.T.V.Rao MD

11. S.typhi with Flagella
Dr.T.V.Rao MD

12. Bacteriology –Typhoid fever
The Genus Salmonella belong to Enterobacteriaceae
Facultative anaerobe
Gram negative bacilli
Distinguished from other bacteria by Biochemical and antigen structure
Dr.T.V.Rao MD

13. Different types of Salmonella
I - enterica II - salamae IIIa -arizonae IIIb -diarizonae IV - houtenae V - bongori VI - indica

14. Cultural Characters On MacConkey medium appear Colorless ( NLF )
Aerobic / Facultatively anaerobic
Grows on simple media – Nutrient agar,
Temp 15 – 41ºc / 37º c
Colonies appear as large 2 -3 mm, circular, low convex,
On MacConkey medium appear
Colorless ( NLF )
Selective Medium - Wilson Blair Bismuth sulphide medium. Produce Jet black colonies
H2 S produced by Salmonella typhi
Dr.T.V.Rao MD

15. Enrichment Medium Liquid Medium
Selenite F medium
Tetrathionate broth
Above medium are used for isolation of Salmonella from contaminated specimens
Particularly stool specimens..
Dr.T.V.Rao MD

16. Identifying Enteric Organisms
Isolates which are Non lactose fermenting
Motile, Indole positive
Urease negative
Ferment Glucose,Mannitol,Maltose
Do not ferment Lactose, Sucrose
Typhoid bacilli are anaerogenic
Some of the Paratyphoid form acid and gas
Further identification done by slide agglutination tests
Dr.T.V.Rao MD

17. Biochemical Characters
Glucose ,Mannitol ,Maltose produce A/G
Salmonella typhi do not produce gas
Lactose/Salicin/sucrose not fermented.
Indole –
Methyl Red +
V P -
Citrate +
Urea –
H2S – produced by Salmonella typhi
Paratyphi A do not produce H2S
Dr.T.V.Rao MD

18. Resistance of Salmonella
55º c – 1 hour
60º c – 15 MT
Boiling ,Chlorination, Pasteurization Destroy the Bacilli.
Dr.T.V.Rao MD

19. Antigenic structure of Salmonella
Two sets of antigens
Detection by serotyping
1 Somatic or 0 Antigens contain long chain polysaccharides ( LPS ) comprises of heat stable polysaccharide commonly.
2 Flagellar or H Antigens are strongly immunogenic and induces antibody formation rapidly and in high titers following infection or immunization. The flagellar antigen is of a dual nature, occurring in one of the two phases.
Dr.T.V.Rao MD

20. Salmonella Antigenic Structure
H – Flagellar antigens
O – Somatic antigen,
Vi – Surface antigen in some species only
H antigens also called flagellar antigens, heat labile protein,
Boiling destroys antigenicity
When mixed with Antiserum produces agglutination and fluffy clumps are produced
H antigens are strongly immunogenic Induces antibodies rapidly,
Dr.T.V.Rao MD

21. Antigens – Salmonella ( cont )
O Antigens
Forms integral part of Cell wall,
Like Endotoxin
0 Antigens unaffected by boiling.
When mixed with antiserum produce chalky clumps are formed, take more time reaction, at high temp 50º – 55º c
O antigens are less immunogenic. than H antigens
Dr.T.V.Rao MD

22. Antigen (Vi) – Salmonella ( contd )
Vi antigens
Many strains in S.typhi covers the O antigens- prevents agglutination.
Resembles like K antigens
Destroyed after boiling at 60º c / 1 hour.
Vi a polysaccharide
Acts as virulence factor, protects the bacilli against Phagocytosis and activity of Complement
Poorly immunogenic
Low titer of antibodies are produced, Not diagnostic
Dr.T.V.Rao MD

23. Classification of Salmonella
Classified on the basis of Kauffmann-White Scheme
Structure of 0 and H antigens are taken into consideration,
More than 2000 species characterized.
Dr.T.V.Rao MD

24. Kauffmann – White scheme
Serotype antigens H antigens
Phase
1.Typhi ,12,(Vi) d ,2
2 Paratyphi A 1, a
3 Paratyphi B 1,4,5, b ,2
4 Typhimuruim 1,4,5, I ,7
5 Enteritidis 1,9, g m 1,2
Dr.T.V.Rao MD

25. Antigenic Variation in Salmonella
May be phenotypic / Genotypic
H to O = loss of Flagella
May be phase variation from I to II
V to W variation
S to R variation
Dr.T.V.Rao MD

26. Pathogenicity Salmonella are definite parasites to humans. Eg S.typhi.
S.paratyphi A, B ,C
Other groups Salmonella
The important clinical syndromes
1. Enteric fever, Septicemias, gastroenteritis.
Dr.T.V.Rao MD

27. Enteric Fever: S. typhi Ileocecal penetration
intraluminal multiplication
mononuclear response (macrophages)
Salmonella remains alive
2nd week - lymphoid hyperplasia (mesenteric lymph nodes)
back to bowel

28. Typhoid – caused by S.typhi Paratyphoid Caused by Paratyphi A,B,C
Enteric Fever Typhoid
Typhoid – caused by S.typhi
Paratyphoid Caused by Paratyphi A,B,C
Typhoid Like Typhus
Infective dose ID50 / 107,
Dr.T.V.Rao MD

29. Fever
All the events coincides with Fever and other signs of clinical illness
From Gall bladder further invasion occurs in intestines
Involvement of peyr’s patches, gut lymphoid tissue
Lead to inflammatory reaction, and infiltration with monocular cells
Leads to Necrosis, Sloughing and formation of chacterstic typhoid ulcers

30. Rashes in Typhoid
May present with rash, rose spots 2 -4 mm in diameter raised discrete irregular blanching pink maculae's found in front of chest
Appear in crops of upto a dozen at a time
Fade after 3 – 4 days

31. Dr.T.V.Rao MD

32. Events in a Typical typhoid Fever
Dr.T.V.Rao MD

33. Pathology and Pathogenesis
Bacilli enter through ingestion,
Bacilli attach to Microvilli,ileal mucosa, penetrate to Lamina propria and sub mucosa
Phagocytosis by Polymorphs and Macrophages
Enters the mesenteric lymph nodes
Enter the thoracic duct – Blood stream
Dr.T.V.Rao MD

34. Infective Dose
For human infections, the number of bacteria that must be swallowed in order to cause infection is uncertain and varies with the serotype. In most of these the median infective dose for most serotypes, including Typhi, has varied from 106 to 109 viable organisms. However, investigation of outbreaks suggests that in natural infection the infective dose might be fewer than 1000 viable organisms.
Dr.T.V.Rao MD

35. Pathology and Pathogenesis
Bacteremia Spread to Liver, Gall bladder, Spleen, Bone marrow, Lymph nodes, Lungs, Multiply in kidneys
Once again spill into Blood stream
Causes clinical illness.
Dr.T.V.Rao MD

36. Pathology and Pathogenesis
Multiply abundantly in Gall bladder,
Bile rich source of Bacteria
Spill into Intestine, infects payers patches, Lymph follicles
Inflammation – Undergo necrosis, Slough off
Typhoid ulcers
Typhoid ulcers can cause perforation and hemorrhage
Duration of Illness 3 – 4 weeks
Incubation 7 -14, ( 3-56 days )
Dr.T.V.Rao MD

37. What is Enteric Fever Typhoid Fever
Enteric fever is caused by strains of S. Typhi or S. Paratyphi A, B or C; although S. Paratyphi B, which gene sequence analysis suggests is a variant of S. Java, is more likely to cause non-typhoidal diarrhoea. The clinical features tend to be more severe with S. Typhi (typhoid fever). After penetration of the ileal mucosa the organisms pass via the lymphatic's to the mesenteric lymph nodes, whence after a period of multiplication they invade the bloodstream via the thoracic duct.
Dr.T.V.Rao MD

38. Progress in Enteric Fever
The liver, gall bladder, spleen, kidney and bone marrow become infected during this primary bacteraemic phase in the first 7-10 days of the incubation period. After multiplication in these organs, bacilli pass into the blood, causing a second and heavier bacteraemia, the onset of which approximately coincides with that of fever and other signs of clinical illness.
Dr.T.V.Rao MD

39. Progress in Enteric Fever
From the gall bladder, a further invasion of the intestine results. Peyer's patches and other gut lymphoid tissues become involved in an inflammatory reaction, and infiltration with mononuclear cells, followed by necrosis, sloughing and the formation of characteristic typhoid ulcers occurs.
Dr.T.V.Rao MD

40. Immunity in Typhoid Typhoid bacilli are Intracellular pathogens
Cell mediated immunity is crucial
Dr.T.V.Rao MD

41. Symptoms of Salmonellosis
Diarrhea
Nausea
Vomiting
Stomach pain
Headache
Fever
Onset hours after
infection

42. Clinical manifestation
Head ache, malise,anorexia ,coated tongue
Abdominal discomfort,
Constipation / Diarrhea
Step ladder type fever,
Relative bradycardia,
A soft palpable spleen
Hepatomegaly
Rose spots appear
Dr.T.V.Rao MD

43. Events in a Typical typhoid Fever
Dr.T.V.Rao MD

44. Complications of Enteric fever
Intestinal perforation,
Hemorrhage,
Circulatory collapse.
Bronchitis Bronchopneumonia,
Meningitis,
Cholecystitis,
Arthritis,Periostitis / Nephritis,
Osteomyletis,
Dr.T.V.Rao MD

45. Relapses in Typhoid Fever
Apparent recovery can be followed by relapse in 5-10% of untreated cases. Relapse is usually shorter and of milder character than the initial illness, but can be severe and may be fatal. Severe intestinal haemorrhage and intestinal perforation are serious complications that can occur at any stage of the illness.
Dr.T.V.Rao MD

46. Other complications
Causes relapses in particular to patients treated with chloramphenicol.
S.paratyphi produce septicemias.
Dr.T.V.Rao MD

47. Typhoid carriers
Salmonella enterica causes approximately 16 million cases of typhoid fever worldwide, killing around 500,000 per year. One in thirty of the survivors, however, become carriers. In carriers the bacteria remain hidden inside cells and the gall bladder, causing new infections as they are shed from an apparently healthy host.

48. Carrier Stage in Typhoid Fever
Most people infected with salmonella continue to excrete the organism in their stools for days or weeks after complete clinical recovery, but eventual clearance of the bacteria from the body is usual. A few patients continue to excrete the salmonellae for prolonged periods. The term chronic carrier is reserved for those who excrete salmonellae for a year or more.
Dr.T.V.Rao MD

49. Carrier Stage in Typhoid Fever
Chronic carriage can follow symptomatic illness or may be the only manifestation of infection. It can occur with any serotype, but is a particularly important feature of enteric fever: up to 5% of convalescents from typhoid and a smaller number of those who have recovered from paratyphoid fever become chronic carriers, many for a lifetime.
Dr.T.V.Rao MD

50. Carrier Stage in Typhoid Fever
The bacilli are most commonly present in the gall bladder, less often in the urinary tract, and are shed in faeces and sometimes in urine. The long duration of the carrier state enables the enteric fever bacilli to survive in the community in non-epidemic times and to persist in small and relatively isolated communities.
Dr.T.V.Rao MD

51. Epidemiology Developed countries - Controlled.
Water supply/ Sanitation /Economically poor.
S.typhi and S.paratyphi are prevalent in India
Previously Typhi are more common Paratyphoid A on raise.
Age 5 – 20 years, Sanitation
Dr.T.V.Rao MD

52. Epidemiology Sanitation has great role
Source an active patient or a Carrier shed the Bacilli.
Who are carriers.
Convalescent carrier 3 weeks to 3 months
Temporary carrier 3 months to 1 year
Chronic carrier > 1 year,
Women attain more carrier stage
Dr.T.V.Rao MD

53. Epidemiology (Contd) Bacilli persist in the Gall bladder and kidney
Food handlers spread the infection
Cooks great role
S.typhi and S.paratyphi in humans
S.para B in Animals,
Typhoid spread through
Water, Milk, Food
HIV patients potentially susceptible for Typhoid disease.
Dr.T.V.Rao MD

54. Bacteriological Diagnosis of Typhoid Fever
Selective media, such as Deoxycholate-citrate agar or xylose-lysine Deoxycholate agar, are used for the isolation of salmonella bacteria from faeces. Fluid enrichment media, such as Tetrathionate or selenite broth, are also useful to detect small numbers of salmonellae in faeces, foods or environmental samples.
Dr.T.V.Rao MD

55. Bacteriological Diagnosis of Typhoid Fever
Suspicious colonies from the culture plates are tested directly for the presence of Salmonella somatic (O) antigens by slide agglutination and subcultured to peptone water for the determination of flagellar (H) antigen structure and further biochemical analysis.
Dr.T.V.Rao MD

56. Bacteriological Diagnosis of Typhoid Fever
A presumptive diagnosis of salmonellosis can often be made within 24 h of the receipt of a specimen, although confirmation may take another day, and formal identification of the serotype takes several more days. A negative report must await the result of enrichment cultures - at least 48 h.
Dr.T.V.Rao MD

57. How we Diagnose Typhoid Fever
Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar ). In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and cultures of the blood and stool.
Dr.T.V.Rao MD

58. Laboratory Diagnosis of Typhoid Fever
1 Isolation of Bacilli. A Gold standard
2 Diagnosis for presence of Antibodies,
Positive Blood culture – A gold standard
Isolation from Feces and Urine ?
Detection of Antibodies Inconclusive.
Newer methods
Detection of antigen in Blood and Urine
Dr.T.V.Rao MD

59. Blood Culture
1 st week Positive in 90 % 2 nd week Positive in 75 % 3 rd week Positive in 60 % > 3 weeks positive in 25 % Draw 5 – 10 cc of Blood by venipuncture. ADD to ml of Bile broth. Incubate at 37 c /Subculture in MacConkey At regular intervals
Dr.T.V.Rao MD

60. Blood Cultures in Typhoid Fevers
Bacteremia occurs early in the disease
Blood Cultures are positive in
1st week in 90%
2nd week in 75%
3rd week in 60%
4th week and later in 25%
Dr.T.V.Rao MD

61. Castaneda’s method of Blood Culture
Double medium used Solid/Liquid medium in the same Bottle.
Bottle contains Bile broth/agar slant,
For subculture the bottle is merely tilted.
A subculture into MacConkey at regular intervals,
Reduces the chances of contamination
Increases the chances of isolation.
Dr.T.V.Rao MD

62. Salmonella on Mac Conkey's agar
Dr.T.V.Rao MD

63. Salmonella on XLD agar
Dr.T.V.Rao MD

64. Clot culture
Clot cultures are more productive in yielding better results in isolation.
A blood after clotting, the clot is lysed with Streptokinase ,but expensive to perform in developing countries.
Dr.T.V.Rao MD

65. Bactec and Radiometric based methods are in recent use
Bactek methods in isolation of Salmonella is a rapid and sensitive method in early diagnosis of Enteric fever.
Many Microbiology Diagnostic Laboratories are upgrading to Bactek methods
Dr.T.V.Rao MD

66. Biochemical Characters
Non Lactose fermenter,
Motile
Indole – MR VP - Citrate +
Ferment Glu/Mal/Man
Do not ferment Lactose/Sucrose
Dr.T.V.Rao MD

67. Slide agglutination tests
In slide agglutination tests a known serum and unknown culture isolate is mixed, clumping occurs within few minutes
Commercial sera are available for detection of A, B,C1,C2,D, and E.
Dr.T.V.Rao MD

68. Culturing other Specimens
Feces Enrichment in Tetrathionate broth and Selenite broth
Culturing in MacConkey/DCA/Wilson Blair medium – Large black colonies.
Urine Culture – positive in 25 %
Other samples
Bone Marrow,Bile,CSF/Sputum
Dr.T.V.Rao MD

69. Serology WIDAL Test – Tube agglutination test.
Detects O and H antibodies
Diagnosis of Typhoid and Paratyphoid
Testing for H agglutinins in Dryers tubes, a narrow tube floccules at the bottom
Testing for O agglutinins in Felix tubes, Chalky
Incubated at 37º c overnight
Dr.T.V.Rao MD

70. Widal Test
In 1896 Widal A professor of pathology and internal medicine at the University of Paris (1911–29), he developed a procedure for diagnosing typhoid fever based on the fact that antibodies in the blood of an infected individual cause the bacteria to bind together into clumps (the Widal reaction).
Dr.T.V.Rao MD

71. Widal test S.typhi O and H tubes Paratyphi A/B H agglutinins only
Common antigens O in all Factor sharing 12
Significance
I st week negative.
Titers raise in 2nd week Raise of titers diagnostic
Dr.T.V.Rao MD

72. Diagnosis of Enteric Fever Widal test
Serum agglutinins raise abruptly during the 2nd or 3rd week
The Widal test detects antibodies against O and H antigens
Two serum specimens obtained at intervals of 7 – 10 days to read the raise of antibodies.
Serial dilutions on unknown sera are tested against the antigens for respective Salmonella
False positives and False negative limits the utility of the test
The interpretative criteria when single serum specimens are tested vary
Cross reactions limits the specificity

73. Widal Test Single test not diagnostic. Paired samples tests
O > 1 in 80
H > 1in 160
H agglutinins appear first
False positives in Unapparent infection,
Immunization
Previously infected
Dr.T.V.Rao MD

74. Widal test
Anamnestic response previous infection and responding to unrelated infection
Other Diagnostic tests
CIE and ELISA
Detection of Circulating antigens
Co agglutination test.
Dr.T.V.Rao MD

75. Limitation of Widal Test
The Widal test is time consuming and often times when diagnosis is reached it is too late to start an antibiotic regimen.
In spite of several limitation many Physicians depend on Widal Test
Dr.T.V.Rao MD

76. False Positive and Negative Reactions with WIDAL Test
The Widal test should be interpreted in the light of baseline titers in a healthy local population. This is especially important when there is a high local prevalence of non-typhoid salmonellosis The Widal test may be falsely positive in patients who have had previous vaccination or infection with S typhi.
Dr.T.V.Rao MD

77. False Positive and Negative Reactions with WIDAL Test
Widal titers have also been reported in association with the dysgammaglobulinaemia of chronic active hepatitis and other autoimmune diseases.64 '8 '9 False negative results may be associated with early treatment, with "hidden organisms" in bone and joints, and with relapses of typhoid fever. Occasionally the infecting strains are poorly immunogenic.
Dr.T.V.Rao MD

78. Diagnosis of Carriers and Environments
Fecal carriers by isolation from specimens. or Bile aspirated.
Sewer swabs
Bacteriophage typing
Dr.T.V.Rao MD

79. Prophylaxis TAB vaccine S.typhi 1,000 millions
S Paratyphi A,B 750 millions.
Injected subcutaneously 0.5 ml
at 4 – 6 weeks.
Live Oral Vaccine Typhoral
Mutant S.typhi strain Ty 2 1a Lacking enzyme UDP galctose 4 epimerase 10 to9
Viable bacilli
Given orally 1 – 3 – 5 days
Dr.T.V.Rao MD

80. Key points
Antibiotics have no place in the management of salmonella gastroenteritis unless invasive complications are suspected.
Clean water, sanitation and hygienic handling of foodstuffs are the keys to prevention.
Dr.T.V.Rao MD

81. Prevention Vi Polysaccharide vaccine
Administered subcutaneously or intramuscular
Confers protection seven days after injection
Approximately 50% efficacy after three years
Ty 21 vaccine
Live attenuated strain of S. typhi
Administered orally in capsule form
Also available in liquid form which can be taken by children as young as two years of age

82. Vaccines An Inject able vaccine Typhium Vi
Contains purified Vi polysaccharide antigen from S.typhi strain Ty2
A single dose, subcutaneous route
Given to children > 5 years
Immunity lasts for 2- 3 years.
Follow a booster
Dr.T.V.Rao MD

83. Treatment Chloramphenicol 1948 /1970 resistance. Other Important drugs
Ampicillin
Amoxicillin,
Furazolidine
Cotromoxazole
Chloramphenical resistance /Mexico
Kerala
Dr.T.V.Rao MD

84. Antimicrobial Therapy in Typhoid
With prompt antibiotic therapy, more than 99% of the people with typhoid fever are cured, although convalescence may last several months. The antibiotic chloramphenicol Some Trade Names CHLOROMYCETIN is used worldwide, but increasing resistance to it has prompted the use of other antibiotics BACTRIM SEPTRAN or ciprofloxacin

85. Other Drugs Fluroquinolones
Ciprofloxacillin, Pefloxacillin Ofloxacillin
Ceftazidime Ceftriaxone / Cefotoxaime
Dr.T.V.Rao MD

86. Coalition against Typhoid
Since May 2011, the Coalition against Typhoid (CaT) has featured monthly articles in the WHO’s Global Immunization Newsletters (GIN). The articles, written by CaT members from around the world, highlight important work being done to accelerate adoption of typhoid vaccines.
Dr.T.V.Rao MD

87. Food Poisoning
The laboratory diagnosis of bacterial food poisoning depends on isolation of the causal organism from samples of faeces or suspected foodstuffs. The more common food-poisoning serotypes, such as Enteritidis or Typhimuruim, may be characterized more fully by phage typing and antibiotic resistance typing (see above). Strains can be differentiated further by plasmid and pulsed-field gel electrophoresis typing so that the isolates from patients may be matched with those from the infected food and from a suspected animal source.
Dr.T.V.Rao MD

88. Salmonella Gastroenteritis
Zoonotic disease
S.enteritidis
S.typhimurium
S.halder
S. agana
S.indiana
Contaminated poultry, Meat Milk, Milk products.
Enters the shells of the Intact eggs – Chicken feed, and Fecal droppings.
Dr.T.V.Rao MD

89. Nontyphoidal Salmonella
General Incubation: 6 hrs-10 days; Duration: 2-7 days
Infective Dose = usually millions to billions of cells
Transmission occurs via contaminated food and water
Reservoir:
a) multiple animal reservoirs
b) mainly from poultry and eggs (80% cases from eggs)
c) fresh produce and exotic pets are also a source of contamination (> 90% of reptile stool contain salmonella bacterium); small turtles ban.
General Symptoms: diarrhea with fever, abdominal cramps, nausea and sometimes vomiting
Dr.T.V.Rao MD

90. Mechanism of Pathogenicity Gastroenteritis
ingestion
absorbed to brush border of epithelial cells of small intestine and colon
migrate to lamina propria, Ileocecal
multiply in lymphoid follicles
Reticuloendothelial hyperplasia and hypertrophy

91. Nontyphoidal Salmonella: Gastroenteritis
Incubation: 8-48 hrs ; Duration: 3-7 days for diarrhea & 72 hrs. for fever
Inoculum: large
Limited to GI tract
Symptoms include: diarrhea, nausea, abdominal cramps and fevers of ºF. Also accompanied by loose, bloody stool; Pseudo appendicitis (rare)
Stool culture will remain positive for 4-5 weeks
< 1% will become carriers
Dr.T.V.Rao MD

92. Nontyphoidal Salmonella: Bacteremia and Endovascular Infections
5% develop septicemia; 5-10% of septicemia patients develop localized infections
Endocarditis: Salmonella often infect vascular sites; preexisting heart valve disease risk factor
Arteritis: Elderly patients with a history of back/chest + prolonged fever or abdominal pain proceeding gastroenteritis are particularly at risk.
- Both are rare, but can cause complications that may lead
to death
Dr.T.V.Rao MD

93. Salmonella Gastroenteritis
Can occur as cross infection
24 hours
Manifest with Diarrhea, omitting
Abdominal pain mucous and blood in stools
Last for 2 – 4 days
Some times may lead to septicemias
Dr.T.V.Rao MD

94. Diagnosis and Treatment
Isolation by culturing
Rarely need antibiotics.
More frequent in Developed nations.
Dr.T.V.Rao MD

95. Salmonella septicemias
S.cholera suis
Deep abscess, Endocarditis
Isolation from Blood and Pus.
Chloramphenicol highly effective
Dr.T.V.Rao MD

96. Don’t eat raw or undercooked food
How to Prevent Salmonellosis
Don’t eat raw or undercooked food
Cross-contamination of foods should be avoided
Do not prepare food or pour water if you are infected with the bacteria

97. How to Prevent Salmonellosis
Wash hands, kitchen surfaces, and utensils with soap and water after they have come in contact with raw meat or poultry
Wash hands after contact with animal feces
Avoid direct/indirect contact between reptiles and infants

98. Simple hand hygiene and washing can reduce several cases of Typhoid

99. Email doctortvrao@gmail.com
The Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World
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100. Reference: www.Slideshare.com
Dr.T.V.Rao MD