Non-typhoidal Salmonella: Difference between revisions
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Non-typhoidal Salmonella
(Created page with "{{DISPLAYTITLE:Non-typhoidal ''Salmonella''}} == Background == * Serotypes of Salmonella enterica that exclude Typhi and Paratyphi, which cause Enteric fever|typhoid f...") Â |
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{{DISPLAYTITLE:Non-typhoidal ''Salmonella''}} |
{{DISPLAYTITLE:Non-typhoidal ''Salmonella''}} |
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− | == |
+ | ==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 |
− | == |
+ | ==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==== |
− | * |
+ | *Can cause [[aortitis]], [[vascular graft infection]], and endocarditis |
− | * |
+ | *Complicates up to 25% of bacteremia |
− | * |
+ | *More common in people with atherosclerosis, aortic aneurysms, prosthetic vascular grafts, valvular heart disease, and prosthetic heart valves |
− | * |
+ | *Endovascular infection can be predicted by a scoring system[[CiteRef::chen2012a]] |
− | ** |
+ | **+1 point for each of: male gender, hypertension, coronary artery disease, and serogroup C1 infection |
− | ** |
+ | **−1 point for each of: immunsuppression and malignancy |
− | ** |
+ | **≤1 is low-risk and ≥2 is high-risk, giving a sensitivity of 95% and specificity 45% |
− | ==== |
+ | ====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=== |
− | * |
+ | *Some people chronically shed bacteria in stool for >1 year |
− | * |
+ | *Less than 1% |
− | == |
+ | ==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, and [[TMP-SMX]] SD 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]] |
− | * |
+ | *Vascular prosthesis infection: as for bacteremia, for 6 weeks |
− | ** |
+ | **Either remove prosthesis or consider lifelong suppressive therapy |
− | * |
+ | *[[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]] |
[[Category:Gram-negative bacilli]] |
Revision as of 21:58, 9 January 2021
Background
- Serotypes of Salmonella enterica that exclude Typhi and Paratyphi, which cause 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
Clinical Manifestations
Gastroenteritis
- One of the most common causes of foodborne illness
- Incubation period 6 to 48 hours (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
- Can cause aortitis, vascular graft infection, and endocarditis
- Complicates up to 25% of bacteremia
- More common in people with atherosclerosis, aortic aneurysms, prosthetic vascular grafts, valvular heart disease, and prosthetic heart valves
- Endovascular infection can be predicted by a scoring system1
- +1 point for each of: male gender, hypertension, coronary artery disease, and serogroup C1 infection
- −1 point for each of: immunsuppression and malignancy
- ≤1 is low-risk and ≥2 is high-risk, giving a sensitivity of 95% and specificity 45%
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
- Some people chronically shed bacteria in stool for >1 year
- Less than 1%
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, and TMP-SMX SD 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
- Vascular prosthesis infection: as for bacteremia, for 6 weeks
- Either remove prosthesis or consider lifelong suppressive therapy
- 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
References
- ^ P.-L. Chen, C.-C. Lee, C.-Y. Li, C.-M. Chang, H.-C. Lee, N.-Y. Lee, C.-J. Wu, H.-I. Shih, H.-J. Tang, W.-C. Ko. A Simple Scoring Algorithm Predicting Vascular Infections in Adults With Nontyphoid Salmonella Bacteremia. Clinical Infectious Diseases. 2012;55(2):194-200. doi:10.1093/cid/cis381.