Salmonellosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]
Overview
Symptoms of salmonellosis begin between 6 to 72 hours after ingestion of contaminated food. These may include nausea, vomiting, crampy abdominal pain, diarrhea, and fever. Uncomplicated infection often affects only the gastrointestinal tract, and resolves within 5 to 7 days. Infants, elderly and immunocompromised patients may experience severe forms of the disease, and are more prone for the development of complications, such as: bacteremia, and endovascular or focal infections. Focal infections may be located in the abdomen, CNS, lungs, urinary and genital tracts, or in the bones and joints. The prognosis of salmonellosis is good in most cases, however, severe forms of the disease, and presence of complications are associated with poor prognosis.
Natural History
Salmonellosis may occur at any age, and start with symptoms that are indistinguishable from those caused by other gastrointestinal pathogens. Symptoms typically develop 6 to 72 hours after ingestion of contaminated food, and include acute onset of nausea, vomiting, crampy abdominal pain, fever (38-39ºC) and diarrhea. Diarrhea may be mild nonbloody, loose stools, in moderate volume, or may consist of a large volume of watery, bloody stool. Children with enterocolitic infection often present with severe inflammatory disease, with bloody diarrhea, increased symptom duration and risk of complications.[1]
Salmonellosis affects most commonly the ileum, however, the large bowel may also be affect in certain cases. The stomach, duodenum and jejunum are usually spared of inflammation.[1][2][3]
For the infections that are limited to the gastrointestinal tract, in the absence of treatment, symptoms commonly have a spontaneous resolution within 5 to 7 days.[1]
Complications
Persons with diarrhea usually recover completely, although it may take several months before their bowel habits become entirely normal. In some cases complications may occur, including:[4]
Bacteremia
About 8% of patients develop bacteremia. This complication is more common in children, elderly and immunocompromised patients. Of the different serotypes of salmonella enterica non-typhi, bacteremia is most common among patients infected with the serotypes Choleraesuis and Dublin.[5]
Endovascular Infection
In the presence of persistent bacteremia, endovascular infection should be suspected. Previous conditions that are prone to the development of endovascular infection include:[6]
- Atherosclerotic vascular disease
- Preexisting valvular heart disease
- Prosthetic vascular graft
- Aortic aneurysm
In elder patients presenting with prolonged chest, back or abdominal pain, and prolonged fever, that are subsequent to an episode of gastroenteritis, arteritis should be suspected.[7]
In rare cases (<1%) arteritis and endocarditis may complicate and lead to severe, often fatal, complications, such as:[8]
- Valve perforation
- Endomyocardial abscess
- Mycotic aneurysms
- Infected mural thrombus
- Aorto-enteric fistula
- Aneurysm rupture
- Pericarditis
Focal Infections
Of the 8% of patients who develop bacteremia, 5-10% evolve into localized infections. These may include:[9]
Intra-abdominal Infections
Intra-abdominal complications may include cholecystitis, splenic or hepatic abscesses. They may be identified and monitored with abdominal CT, or ultrasound.
These complications are prone to occur in patients with:
- Splenic abscesses from sickle cell disease
- Hepatobiliary anatomic abnormalities
- Abdominal malignancy
Central Nervous System Infections
Non-typhoid salmonella may lead to different CNS infections, such as:[10]
Pulmonary Infections
Pulmonary infections caused by non-typhoid salmonella commonly lead to lobar pneumonia. Complications may include:[11]
Urinary and Genital Tract Infections
Non-typhoid salmonella may complicate into urinary and genital tract infections, such as:[12]
- Cystitis
- Pyelonephritis
- Ovarian abscess
- Testicular abscess
- Prostatitis
- Epididymitis
Joint Infection
Non-typhoid salmonella may lead to Reiter's syndrome[13]
Prognosis
The prognosis of salmonellosis is good for most patients. Persons with diarrhea usually recover completely, although in some cases, it may take several months until their bowel habits become entirely normal. The development of a severe form of the disease, or complications, are associated with poor prognosis.[14]
References
- ↑ 1.0 1.1 1.2 Coburn B, Grassl GA, Finlay BB (2007). "Salmonella, the host and disease: a brief review". Immunol Cell Biol. 85 (2): 112–8. doi:10.1038/sj.icb.7100007. PMID 17146467.
- ↑ McGovern VJ, Slavutin LJ (1979). "Pathology of salmonella colitis". Am J Surg Pathol. 3 (6): 483–90. PMID 534385.
- ↑ Boyd JF (1985). "Pathology of the alimentary tract in Salmonella typhimurium food poisoning". Gut. 26 (9): 935–44. PMC 1432849. PMID 3896961.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
- ↑ "Salmonella (non-typhoidal)".