Salmonella Infections in Childhood

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Key points

  • Salmonella are gram-negative bacilli within the family Enterobacteriaceae. They are the cause of significant morbidity and mortality worldwide.

  • Animals (pets) are an important reservoir for nontyphoidal Salmonella, while humans are the only natural host and reservoir for Salmonella Typhi.

  • Salmonella infections are a major cause of gastroenteritis worldwide. They account for an estimated 2.8 billion cases of diarrheal disease each year.

  • The transmission of Salmonella is frequently associated with

Microbiology and nomenclature

The organisms that belong to the genus Salmonella are motile, gram-negative, facultative anaerobic bacilli and are classified within the family Enterobacteriaceae. Salmonella organisms are not difficult to identify in the laboratory. These bacteria grow under both aerobic and anaerobic conditions. They ferment glucose but not lactose, are oxidase-negative, are indole-negative, and reduce nitrate to nitrite. Most Salmonella species produce hydrogen sulfide, a property commonly used for easy

Epidemiology

Salmonella infections are a major cause of acute gastroenteritis worldwide, accounting for an estimated incidence of 2.8 billion cases of diarrheal disease each year. Because of the self-limited nature of most intestinal Salmonella infections, the data collected by public health authorities usually represent a fraction of the total cases. The WHO established the Foodborne Disease Burden Epidemiology Reference Group for the purpose of obtaining more accurate and representative data for these

Pathogenesis

Multiple risk factors present in a host may predispose to Salmonella infections, and in addition to the dose of organisms ingested, may determine the incubation period, symptoms, and severity of an acute Salmonella infection. Gastric acidity is the first defensive barrier to the ingested organism, and any situation that decreases the degree of acidity facilitates the survival of Salmonella. Neonates are particularly vulnerable to symptomatic salmonellosis because of their hypochlorhydria and

Nontyphoidal Salmonella

Nontyphoidal Salmonella generally causes a self-limited gastroenteritis in immunocompetent hosts in industrialized countries. However, a small percentage of individuals may present with invasive disease and extra-intestinal infections, such as meningitis and osteomyelitis, depending on special characteristics of the host and serotypes of the pathogen. Immunocompromised individuals are more susceptible to severe illness, and individuals with pre-existing anatomic abnormalities are prone to

Diagnosis

Because Salmonella infections are clinically indistinguishable from similar illnesses caused by other pathogens, confirmatory cultures are required for a definitive diagnosis. Clinical manifestations and type of exposure may suggest the diagnosis, but the inflammatory diarrhea with fever caused by Salmonella can also be associated with enteric pathogens, such as Shigella, enteroinvasive or enterohemorrhagic Escherichia coli, Campylobacter jejuni, Yersinia enterocolitica, and Clostridium

Nontyphoidal Salmonella

General supportive care is the mainstay in managing uncomplicated gastroenteritis in healthy adults and children with NTS infection. Antimicrobials are not recommended for treatment of immunocompetent adults or children more than 1 year of age who present with mild to moderate gastroenteritis caused by Salmonella. This recommendation is supported by a meta-analysis of 12 trials that found no significant benefit from antibiotic therapy on the duration of illness, diarrhea, or fever [57].

Nontyphoidal Salmonella

In general, the most important measures to prevent spread and outbreaks of Salmonella infections are adequate sanitation protocols for food transport and preparation, sanitation of water supplies and sewage disposal, appropriate hand hygiene, isolation of infected patients, and restriction of exposure of children younger than 5 years of age and immunocompromised hosts to reptile pets and rodents. Breast-feeding in young infants remains an important measure for protection from Salmonella

Summary

  • Salmonella are gram-negative bacilli within the family Enterobacteriaceae. They are the cause of significant morbidity and mortality worldwide.

  • Animals (pets) are an important reservoir for nontyphoidal Salmonella, whereas humans are the only natural host and reservoir for Salmonella Typhi.

  • Salmonella infections are a major cause of gastroenteritis worldwide. They account for an estimated 2.8 billion cases of diarrheal disease each year.

  • The transmission of Salmonella is frequently associated with

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