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Salmonella Infection

Salmonella Infection is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Infection caused by any serotype of the bacterial genus Salmonella, a gram-negative anaerobic bacillus
  • Nontyphoidal Salmonella typically causes gastroenteritis via foodborne infection and sporadic outbreaks; less commonly causes infection outside the gastrointestinal tract
  • Clinical syndromes
    • Enteric fever (see “Typhoid Fever”)
    • Nontyphoidal gastroenteritis
      • Chronic carrier state (>1 year)
    • Nontyphoidal invasive disease
      • Bacteremia
        • Endovascular complications
        • Localized infection outside GI tract

Geriatric Considerations
Patients >65 years have increased risk of invasive disease with bacteremia and endovascular complications due to higher prevalence of comorbidities (atherosclerotic endovascular lesions, prostheses, etc.).

Pediatric Considerations
Neonates (<3 months) are more susceptible to invasive disease and complications.

Epidemiology

Incidence
  • Global incidence of nontyphoidal Salmonella enteritidis ~94 million/year
    • Wide variation by region from 40 to 3,980 estimated cases per 100,000
  • Global incidence of invasive nontyphoidal Salmonella infection estimated to be 2.1 to 6.5 million
    • Wide variation by region from ~0.8 to 227 estimated cases per 100,000
  • Most commonly identified foodborne illness in the United States and a common cause of traveler’s diarrhea; annual incidence in the United States—15 illnesses per 100,000 individuals
  • Second most common bacteria (following Campylobacter) isolated from diarrheal stool cultures in the United States
  • Highest incidence in children <5 years old
  • Hospitalization rates higher in patients >50 years old
  • Peak frequency from July to November

Etiology and Pathophysiology

  • Salmonella enterica
    • Most pathogenic species in humans
    • 2,500 different serotypes
  • Etiology
  • ~95% of cases are foodborne.
  • Most other cases are from direct or indirect fecal–oral contact human (or animal) carriers.
  • Iatrogenic seeding (e.g., blood transfusion, endoscopy) is rare.
  • Pathophysiology
  • Typical infectious dose in immunocompetent patients is 1 million bacteria.
  • Ingested bacteria invade the distal ileum and proximal colon to produce an inflammatory and cytotoxic mucosal response.
  • Bacteria enter the mesenteric lymphatic system and systemic circulation to cause disseminated disease.

Risk Factors

  • Recent travel
  • Consumption of undercooked meat, egg, or unpasteurized dairy products. Nonanimal products have been implicated in outbreaks.
  • Contact with live reptiles or poultry
  • Contact with human carrier (Salmonella fecal shedding)
  • Impaired gastric acidity: H2 receptor blockers, antacids, proton pump inhibitors (PPIs), gastrectomy, achlorhydria, pernicious anemia, infants
  • Recent antibiotic use
  • Reticuloendothelial blockade: sickle cell disease, malaria, bartonellosis
  • Immunosuppression: HIV, diabetes, corticosteroid or other immunosuppressant use, chemotherapy
  • Iron overload, chronic granulomatous disease
  • Age <5 years or >50 years

General Prevention

  • Proper food hygiene production, transport, and storage (e.g., refrigeration during food storage and thorough cooking prior to consumption)
  • Control of animal reservoirs: Avoid contact with high-risk animals, animal feces, and polluted waters.
  • Hand hygiene
  • CDC Web site (http://www.cdc.gov/salmonella/): outbreak tracking

Commonly Associated Conditions

  • Gastroenteritis
  • Bacteremia: immunocompromised patients or those with underlying comorbidities that predispose to Salmonella (e.g., cholelithiasis, prostheses)
  • Osteomyelitis: higher incidence in sickle cell disease
  • Abscesses: higher incidence with malignant tumors
  • Reactive arthritis

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Citation

Stephens, Mark B., et al., editors. "Salmonella Infection." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116542/all/Salmonella_Infection.
Salmonella Infection. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116542/all/Salmonella_Infection. Accessed April 20, 2019.
Salmonella Infection. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116542/all/Salmonella_Infection
Salmonella Infection [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116542/all/Salmonella_Infection.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Salmonella Infection ID - 116542 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116542/all/Salmonella_Infection PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -