View source for Non-typhoidal Salmonella

{{DISPLAYTITLE:Non-typhoidal ''Salmonella''}}

==Background==

*Serotypes of [[Salmonella enterica]] that exclude Typhi and Paratyphi, which cause [[Enteric fever|typhoid fever]]

===Epidemiology===

*Numerous animal reservoirs
*May be transmitted by animal products (especially eggs, poultry, undercooked ground meat, dairy, or contaminated fresh produce), contaminated water exposure, and contact with animals and their environment (including pet hedgehogs)

==Clinical Manifestations==

===Gastroenteritis===

*One of the most common causes of foodborne illness
*Incubation period [[Usual incubation period::6 to 48 hours]] (range [[Incubation period range::up to 7 days]])
*Diarrhea, abdominal pain, nausea and vomiting, fevers and chillds
**Stools are usually loose but can be profuse and watery ("cholera-like") or small volume but with tenesmus ("dysentery-like")
*May have headaches and myalgias
*Can mimic [[appendicitis]] (from [[mesenteric adenitis]]) and [[inflammatory bowel disease]]
*Self-limited, lasting 3 to 7 days

===Extraintestinal Manifestations===

====Bacteremia====

*Most common extraintestinal site, in up to 8% of cases of NTS gastroenteritis
*More common in older patients >65 years, immunocompromised hosts, and patients with [[hemoglobinopathies]] (particularly [[sickle cell disease]])

====Endovascular Infection====

*More common in people with atherosclerosis, aortic aneurysms, prosthetic vascular grafts, valvular heart disease, and prosthetic heart valves
**Most common include [[aortitis]] (particularly infrarenal abdominal aorta), [[vascular graft infection]], and [[endocarditis]]
**Other endovascular sources are possible; pathophysiology appears to involve infection of atherosclerosis
*Complicates up to 25% of bacteremia
*Endovascular infection can be predicted by the [[NTSVI score]][[CiteRef::chen2012a]]
**+1 point for each of: male sex, [[hypertension]], [[coronary artery disease]], and serogroup C1 infection
**−1 point for each of: immunosuppression and malignancy
**≤1 is low-risk and effectively rules out endovascular infection

====Bone and Joint Infection====

*Can cause [[osteomyelitis]], especially in [[sickle cell disease]], as well as [[septic arthritis]]
*Can also cause a [[reactive arthritis]] characterized by lower-limb [[acute arthritis]], [[urethritis]], and [[conjunctivitis]]

====Genitourinary Infection====

*Can rarely cause [[urinary tract infection]]
*May be secondary to [[bacteremia]]

====Meningitis====

*More common in infants

===Asymptomatic Carriage===

*Asymptomatic shedding following treatment continues for a median of 5 weeks
**Possibly longer in patients who have been treated with antibiotics
**Some people chronically shed bacteria in stool for >1 year
*Occurs in less than 1% of cases

==Management==

=== Gastroenteritis ===
*'''Mild to moderate gastroenteritis:''' rehydration and supportive care
*'''Severe gastroenteritis:''' antibiotics
*Other indications for antibiotics include: older age >50 years, prosthetic joints, valvular heart disease, prosthetic heart vales, endovascular stents, severe atherosclerosis, active malignancy, uremia, [[sickle cell disease]], severe joint disease, immunosuppression, advanced or untreated HIV, infants <3 months
*Options include:
**[[Ceftriaxone]] 1-2 g IV q24h
**[[Ciprofloxacin]] 500 mg PO bid
**[[Azithromycin]] 1000 mg PO on day 1 followed by 500 mg PO on days 2 to 7
**[[TMP-SMX]] DS 1 tablet PO bid
*Duration depends on immune status and bacteremia
**Immunocompetent without bacteremia: 3 to 7 days
**Immunocompetent with bacteremia alone: 7 to 14 days
**Advanced HIV/AIDS: 2 to 6 weeks
**Other immunosuppressed host: 14 or more days

=== Bacteremia ===

* [[Ceftriaxone]] 2 g IV q24h for 7 to 14 days

*Alternatives include [[cefotaxime]] or high-dose [[ciprofloxacin]]

=== Other Foci ===

* [[Vascular graft infection]] or vascular prosthesis infection: as for bacteremia, for 6 weeks; remove prosthesis or graft, or do lifelong suppressive therapy
* [[Aortitis]]: [[CiteRef::soravia‐dunand1999ao]]
* [[Osteomyelitis]]: as for bacteremia, for 4+ weeks
* [[Septic arthritis]]: as for bacteremia, for 4 to 6 weeks
* [[Endocarditis]]: as for bacteremia, for 6 weeks
* [[Urinary tract infection]]: intravenous therapy for 1 to 2 weeks followed by oral therapy to complete 6 weeks
** IV: [[ceftriaxone]], [[cefotaxime]], [[ciprofloxacin]] IV/PO
** PO: [[ciprofloxacin]] or [[TMP-SMX]]

=== Asymptomatic Carriage ===

* No treatment, since it does not eradicate carriage but does promote resistance
* Encourage hand hygiene

[[Category:Gram-negative bacilli]]