Pathogen
- Enteric fever is caused by Salmonella typhi and Salmonella paratyphi
- Nontyphoidal salmonellae is most commonly caused by types include S. Enteritidis, S. Newport, and S. Typhimurium
Clinical presentation
Salmonellae cause a number of clinical infections in humans; these include:
- Gastroenteritis
- Enteric fever (typhoid and paratyphoid)
- Bacteremia and endovascular infection
- Focal metastatic infections such as osteomyelitis or abscess
- An asymptomatic chronic carrier state
Nontyphoidal Salmonella
Epidemiology
- Nontyphoidal salmonellae are a major cause of diarrhea worldwide.
- In the United States, nontyphoidal salmonellosis is a leading cause of foodborne disease
- Salmonella is most commonly associated with the ingestion of poultry, eggs, and milk products. Other associations include fresh produce, meats, and other foods, as well as contact with pets (including reptiles) and other animals
Clinical presentation
- Gastroenteritis typically occur within 8 to 72 hours following exposure
- Diarrhea, nausea, vomiting, fever, and abdominal cramping
- Usually self-limiting
Management
- Supportive care
- No routine use of antibiotics
- In high risk patients or in patients with severe illness treatment with antibiotics is appropriate
Enteric fever
Typhoid Mary” (Mary Mallon), a historical case where a woman was an asymptomatic carrier of S. typhi in her gallbladder and unknowingly spread the disease to many people through food handling
Epidemiology
- Enteric fever is an invasive bacterial infection acquired through consumption of contaminated food or water.
- Humans are the only reservoir for S. Typhi and S. Paratyphi A.
- In resource-rich settings, most cases of enteric fever occur in patients who have traveled to endemic regions, particularly south-central Asia.
Clinical presentation
- Enteric fever usually presents with abdominal pain, fever, and chills approximately 5 to 21 days after ingestion of the causative microorganism.
- Classic manifestations include relative bradycardia, pulse-temperature dissociation, and “rose spots” (faint salmon-colored macules on the trunk and abdomen).
- Hepatosplenomegaly, intestinal bleeding, and perforation may occur, leading to secondary bacteremia and peritonitis.
- Laboratory findings may include anemia, leukopenia, leukocytosis, and abnormal liver function tests.
Management
- Antibiotics treatment
- Vaccination for prevention