salmonella poisoning

Salmonella poisoning: description

Salmonella poisoning (salmonellosis) is generally an infection with salmonella, ie certain bacteria. It can vary, depending on the type of salmonella and the condition of the person affected. On the one hand, Salmonella poisoning can manifest as an intestinal inflammation and on the other hand systemically (ie in the whole body) (typhoid illness).

What are Salmonella?

Salmonella are motile, rod-shaped bacteria that can invade cells. There are two types: Salmonella enterica and S. bongori. The first species, Salmonella enterica, is divided into six subspecies and more than 2,000 so-called serovars, some of which cause different diseases. Some of these serovars have proper names like:

• Salmonella typhi: typhoid fever
• Salmonella parathyphi (A, B, C): Paratyphus pathogen
• Salmonella enteritidis (and Salmonella typhimurium): Enteritisers

The pathogens of typhus and paratyphoid cause disease only in humans. They penetrate from the intestine into the blood, spread over the bloodstream throughout the body (systemic infection) and can cause dangerous blood poisoning (sepsis).

The enteritis pathogens occur both in humans and animals and usually do not leave the intestine. They trigger vomiting diarrhea.

Salmonella can survive for several months (even in the freezer) and adapt to their environment very well. This is especially important for salmonella enteritis: Salmonella enteritidis is common in poultry. Thawed poultry as well as thawing water can contain a large number of salmonella and can easily lead to salmonella poisoning.

Salmonella poisoning: frequency

Salmonella poisoning, which was already known in antiquity, gained importance in the 19th and 20th centuries. By improving the water supply, sanitation and hygiene as well as the introduction of antibiotics such infections could be contained.

The Salmonella enteritis is the second most notifiable food-borne bowel disease in Germany after Campylobacter infection. This form of Salmonella poisoning occurs especially in infants and in summer. In Germany, approximately 65 out of 100,000 people develop Salmonella enteritis every year. Worldwide, around 94 million people are affected each year, of which 150,000 die.

At typhus An estimated 22 million people worldwide die each year, 200,000 of them die. The greatest risk is the disease in India and Pakistan. Most cases occurring in Europe occur after travel to (sub) tropical areas. In Germany less than 100 cases of typhus are recorded each year. paratyphoid, a typhoid-like disease, occurs similarly rare in Germany and occurs mostly as a result of trips to India and Turkey.

Salmonellosis is notifiable

Any suspicion of Salmonella enteritis, typhus or paratyphoid must be reported to the health department (mandatory), because Salmonella are contagious. Also notifiable are the detected disease and death by salmonella poisoning.

Anyone working in schools, kindergartens or similar community facilities or in food businesses may in certain cases no longer work in cases of suspected salmonella poisoning. The public health office oversees sick people and will not allow work until three salmonellae can no longer be detected in three stool samples.

Salmonella poisoning: symptoms

After ingestion of the pathogens it takes either only hours to days (enteritis) or weeks (typhoid fever) until first salmonella symptoms appear. The exact duration of this salmonella incubation period depends on the type and amount of bacteria ingested.

How severe the symptoms are is very variable. Some infected people (especially strong-defense people) even show no salmonella symptoms (“silent salmonella infection”).

enteritis

The pathogen, Salmonella enteritidis, preferentially settles in the small intestine and secretes toxins (toxins). They trigger the first symptoms five to 72 hours after the Salmonella poisoning: acute vomiting diarrhea with severe abdominal cramps, fever and headache. A dangerous consequence of vomiting diarrhea is dehydration (loss of water), as much fluid and electrolytes are lost. Salmonella symptoms usually improve after a few days. Sometimes the bacteria can also be detected in the blood (bacteremia) and settle in organs, especially in at-risk patients with a weakened immune system.

Typhoid & Paratyphoid

In contrast to enteritis, typhoid fever begins abruptly 3 to 60 days after the actual Salmonella infection. A typical fever, a gray tongue (typhoid tongue), a swollen spleen and a rash are characteristic of typhoid fever. It also shows the transition from initial constipation to pea-sphincter diarrhea – also typical of this type of Salmonella infection.

Signs of paratyphoid fever tend to be weaker: About one to ten days after infection, they often manifest as a gastrointestinal infection with watery diarrhea, vomiting, nausea, and fever. After four to ten days, the salmonella symptoms usually resolve – much faster than with typhoid fever.

Spread of the infection

Salmonella poisoning can spread throughout the body and cause severe inflammation (especially in typhoid fever and paratyphoid fever). After passing into the blood, the bacteria can colonize all organs and cause severe infections. Gallbladder and spleen are particularly common.

A recurrence (recurrence) shortly after a salmonella poisoning is usually due to the fact that the antibiotic therapy was not sufficient.

Salmonella poisoning: causes and risk factors

Salmonella is preferably infected by eating contaminated food or by contact with patients. By definition, Salmonella infection is possible until three negative stool samples are detected.

Infection with salmonella enteritis

Salmonella enteritidis is particularly common raw eggs and in insufficiently heated meat (especially poultry meat, mussels, Mett). Cross-contamination is also possible, ie the transmission of the pathogens from such contaminated foods to other products such as vegetables. Therefore, potentially contaminated food must be processed and stored separately.

Only rarely does Salmonella poisoning take place via animals (especially pets like reptiles) or excrements. Dauerausscheider are rare. Salmonella enteritidis usually does not leave the intestine and therefore rarely causes inflammation of other organs.

Infection with typhus and paratyphoid

The pathogens of typhoid fever and paratyphoid fever are usually caused by ingestion of water and food contaminated with infectious feces (urine, stool). Often, the infection is also by hand contact with patients or (unrecognized) Salmonella-Dauerausscheidern – people who carry permanent salmonella in the body even after an infection (without showing any other symptoms) and excrete them with the stool.

The typhoid salmonella enter the small intestine through oral ingestion. There they penetrate into the intestinal cells and – after passing into the blood – also into the phagocytes (macrophages) floating in them. In the wall of the small intestine there are accumulations of white blood cells called Peyer’s plaques. Especially in this area it comes to an inflammation, which can also cell death result (necrotic inflammation). This can explain the diarrhea.

risk groups

In risk groups such as infants, infants, elderly or immunocompromised persons, salmonella poisoning can be severe. At risk are, for example, people with sickle cell anemia, systemic lupus erythematosus, HIV infection or other immune deficiencies. In these patients, the stomach acid or the defense system is not strong enough to effectively kill the bacteria. In addition, people who take stomach acid inhibitors are often affected by a salmonella disease.

Salmonella poisoning: examinations and diagnosis

The specialists for salmonella poisoning are gastroenterologists and travel medical specialists. If you suspect a mild Salmonella poisoning, you can first contact his family doctor. In severe cases, a hospital should be visited. First, the doctor will ask for the collection of medical history (anamnesis), inter alia, the following questions:

• Do you have fever?
• What is your bowel movement?
• Have you been away lately?
• Have you been in contact with people who have or have had salmonella?
• Do you take any medicine?

Physical examination

This is followed by the physical examination. The doctor will examine the abdomen particularly well. In addition, it is very important in salmonella poisoning to recognize signs of dehydration (exsiccosis, dehydration) and to assess the severity. This dehydration results from the high fluid and salt loss due to vomiting and diarrhea.

Salmonella detection

In order to confirm Salmonella poisoning, the patient’s stool and blood samples are usually examined in the laboratory. Salmonella is also found in vomit, rectal swabs and contaminated food. In addition, typhoid salmonella can detect bone marrow, small intestinal secretions and urine. The stool is often positive for Salmonella only in the second to third week of illness, but can also remain negative throughout. As proof, Salmonella are either grown in the laboratory or a rapid test (such as MUCAP test) is performed.

For the exact typing of Salmonella there are different methods (lysotypy, biochemical and genetic methods). These investigations are carried out at the National Reference Center at the Robert Koch Institute (RKI). This way, the path of Salmonella poisoning can be traced back. In epidemic salmonella poisoning, the results of those affected and the potential triggers can be compared.

In many cases of Salmonella poisoning, it is additionally tested whether the causative Salmonella are resistant to certain antibiotics.

blood test

If typhoid suspicion, the blood should first be examined. In salmonella enteritis, stool is more important. In the blood can after antibodies against salmonella (Widal test). However, the antibody detection is often not successful in salmonella poisoning. Typhoid and paratyphoid salmonella may also be detected in the blood (bacteremia); This is rarely the case with salmonella enteritis.

The blood test also serves to increase the inflammatory markers demonstrated. In case of fever, one should blood culture In Salmonella poisoning, the number of white blood cells is reduced (leukopenia), and one of its subgroups, the eosinophils, is totally absent (aneosinophilia). In addition, many white blood cells are immature (left shift). In paratyphoid fever the number of white blood cells is increased.

imaging

Computed tomography (CT) of the abdomen can show a thickened intestinal wall, especially at the transition from the small to large intestine. Before this section, the bowel may be dilated. However, these signs are not specific to Salmonella poisoning – they may be similar to those of a so-called pseudomembranous colitis (caused by Clostridia bacteria).

differential diagnoses

Some symptoms of Salmonella poisoning also occur in other diseases. So the doctor will check for something else Food poisoning (especially a Staphylococcus) causes the discomfort. Typhoid-like symptoms may also be present malariaHeart inflammation (endocarditis), tuberculosis (especially in the stage of miliary tuberculosis) and other intestinal infections and inflammations (such as ulcerative colitis) occur.

Salmonella poisoning: treatment

Salmonella treatment depends on the type of pathogen and the form and severity of the disease. While a typhoid disease is usually treated immediately with antibiotics, this is not always necessary for salmonella enteritis. In all cases of salmonella poisoning special hygiene regulations must be adhered to.

Treatment of salmonella enteritis

The sudden diarrhea in this form of salmonella poisoning requires careful control of the water and electrolyte balance. To compensate for the large loss of water and salts, patients can drink electrolyte or glucose solutions and adjust the diet accordingly. For infants and toddlers, glucose and electrolytes should be injected into the vein.

Antibiotics are given when enteritis is severe or people with impaired immunity (such as infants, the elderly, patients with immune deficiencies and heart disease). They hardly influence the course of Salmonella poisoning, but they ensure a longer salmonella excretion in the stool. Because the number of antibiotic resistances increases with salmonella poisoning, it is advisable to test for existing resistance beforehand.

typhus

This salmonella poisoning is with antibiotics fought. At the moment, ciprofloxacin (and a broad-spectrum cephalosporin) is recommended for a two-week salmonella treatment. But there are other antibiotics that can be used. In addition, strict hygiene rules must be observed.

Resistance to common antibiotics against typhus is becoming increasingly common in Asia. Therefore, a test for antibiotic resistance should also be carried out in cases of suspected typhoid fever.

After discharge from the hospital, patients continue to be monitored by the health department until three consecutive stool samples no longer have Salmonella.

Salmonella Dauerausscheider

Those who continue to excrete salmonella after salmonella poisoning must be specially treated. The antibiotic salmonella treatment with ciprofloxacin or ceftriaxone (with gentamicin) must be continued for one month or two weeks. In so-called small intestinal excretors lactulose is often added. Once the salmonella has settled in the gallbladder, it can be removed surgically. But this is rarely done.

Salmonella poisoning: disease course and prognosis

Salmonella poisoning, if properly treated, usually heals without consequences. The prognosis for each individual case depends on many factors such as age and constitution of the patient. Serious complications are common in people with low deficiency (especially young children and the elderly). Deaths due to complications of Salmonella poisoning are rare in Germany. For typhoid fever, 15 to 20 percent of patients are left untreated. On the other hand, if treatment is given, the mortality rate is less than one percent.

Complications of salmonellosis

Especially because of the high fluid loss, a collapse or even a circulatory failure can occur. This in turn can cause kidney or heart failure. Other possible consequences of Salmonella poisoning include intestinal bleeding, ulcers and intestinal perforations. A strong suspicion of a bowel fracture results when the body temperature suddenly drops in the course of the disease.

When the salmonella circulate in the blood, the risk of transmission of Salmonella poisoning increases: The inflammation can affect the lungs, gallbladder (cholecystitis), liver (hepatitis), bone (osteomyelitis), brain (meningitis), heart (endocarditis) and other organs expand. In severe cases there is a risk of sepsis. Another possible complication is a so-called reactive arthritis, a joint disease.

Salmonella Dauerausscheider

Salmonella permanent excrements are people who, after recovering, further excrete the pathogens via the stool. In typhoid fever, about two to five percent of patients become permanent ones. In Salmonella enteritis, however, this is very rare. The typhoid Dauerausscheider is subdivided into so-called Galleausscheider (salmonella are delivered with the bile) and small intestine. Gall separator have an increased risk of gallbladder cancer.

Salmonella poisoning: prevention

The most important measure to protect against Salmonella poisoning is adequate drinking water and food hygiene. Foods that may contain salmonella (such as meat) should be stored separately from other foods and at below ten degrees. Their preparation should also be done separately so as not to transfer salmonella to raw food, for example. The thawing water should not come into contact with other foods. Poultry, fish and other meats should be well cooked. So you can kill contained salmonella. Minced meat should not be stored for more than one day. Foods that contain raw egg should be consumed as soon as possible. Especially in risky areas the rule is: “Cock it, peel it, boil it or leave it!”

The hands should be washed regularly and also disinfected.

Salmonella permanent excretors and acutely ill persons are obliged in Germany to observe special hygiene measures and may not work in contact with food. Special precautions also apply to work in community facilities.

vaccinations

When traveling in high-risk areas, in epidemics and natural disasters can be vaccinated against the typhoid pathogen. Similar to a disease that has passed through, there is some immunity after a typhoid vaccine – but it does not protect 100% from infection. The vaccine can either be given as a dose (taking three capsules two days apart). Or the vaccine against the typhoid salmonella poisoning is administered as a syringe.