The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Salmonellosis is an acute infectious disease caused by bacteria of the genus Salmonella, with a fecal-oral mechanism of transmission, occurring primarily in the gastrointestinal tract. The nature of the course of the disease differs in each case, from asymptomatic lesions to severe forms with toxic and dehydration shock. Pathogenic pathogens enter the body, most often, after eating contaminated food, due to improper culinary processing of food.
Salmonellosis has its own disease code according to the ICD 2010 (International Classification of Diseases of 2010) - A02.
Prevalence and poor outcome
It should be noted that not only sick animals with bright symptoms of salmonellosis are dangerous for people, but also outwardly healthy carriers without pronounced clinical symptoms. As soon as the body is exposed to stress or hypothermia, weakens and can no longer restrain the development of salmonella, active inflammation begins in the intestines with a generalization of the process by blood flow throughout the body, where salmonella invades various organs and tissues.
Salmonellosis is a ubiquitous intestinal infection. Over the past 10 years, there has been a trend towards an increase in the incidence in various groups of patients. Often, intestinal infections are considered diseases that are more typical for disadvantaged areas, for disadvantaged and polluted settlements. This does not apply to salmonellosis, since it is equally common in large comfortable cities and in less civilized areas, that is, wherever there are animals or food of animal origin.
The increase in the prevalence of the disease is facilitated by the intensification of animal husbandry, when the cultivation, slaughter and sale of poultry and cattle increases every year. An important role for the development of the disease is played by active migration processes, urbanization, globalization and the resulting increase in the volume of movement of food products across the borders of states.
Salmonellosis is dangerous because it quickly acquires the character of an epidemic, it is recorded as sporadic cases and epidemic outbreaks, and deciphering their origin is usually quite difficult.
Cases of disease associated with oral infection in the body from poultry meat, from eggs, as well as from products and dishes prepared from them, are especially often recorded. If the infection enters the poultry farm, most of the livestock is infected already on the first day due to the ability of the pathogen to transovarial transmission. Adults are more likely to be infected through food, young children are also sensitive to the household route of infection.
The epidemiological danger of outbreaks increases in warm seasons: late spring and summer are considered the most suitable times for the active spread of the pathogen.
In addition, salmonellosis can be nosocomial, that is, spread among patients in medical institutions. The spread of infection in hospitals is facilitated by overcrowding of wards, unreasonable movement of patients from ward to ward, lack of necessary auxiliary facilities, reuse of disposable instruments, and poor-quality bedding. In infectious diseases hospitals, contact-household transmission of antibiotic-resistant strains of S. typhimurium or S. haifa occurs. Due to the fact that these pathogens exist in hospitals, they develop resistance to disinfectants and antibiotics. In general, outbreaks of nosocomial salmonellosis are typical for children's hospitals.
A child can become infected with salmonellosis from a sick mother in utero, during childbirth, and also through breast milk.
Salmonellosis is a dangerous infectious disease that can lead to death. The overall mortality rate from salmonellosis is 1-3%. Children get sick with it somewhat more often and endure more severely, therefore, among babies under the age of 2-3 years, the percentage of deaths reaches 3-5%. In addition, in the acute form of the disease, death occurs in 1-2% of patients, while up to 20% of those infected die from an asymptomatic course.
Classification according to the type of salmonellosis
Depending on the degree and direction of the lesion in the body, on the external manifestations of the disease, all forms and types of the course are displayed in the following classification:
- localized (gastrointestinal): occurs in the gastritis, gastroenteritis, or gastroenterocolitis variant;
- generalized in a typhoid-like or septic variant;
- carriage (bacterioexcretion): can be acute, chronic or transient.
Gastrointestinal (localized) form
It is considered a relatively mild type of disease, in which the pathogen practically does not leave the intestines. It occurs in the form of acute gastritis, acute gastroenteritis or gastroenterocolitis. Accompanied by fever, crampy abdominal pain, nausea and vomiting, copious loose stools. In some patients, only fever and signs of general intoxication are noted at first, and changes in the gastrointestinal tract join somewhat later. They are most pronounced by the end of the first and on the second and third days from the onset of the disease. The incubation period does not exceed 72 hours, and in children and persons with a weakened body, the disease manifests itself 2-4 hours after the ingestion of salmonella with food. The severity and duration of the manifestations of the disease depend on the severity of the course.
Less common than the other two forms. It is characterized by an abrupt onset with recurrent vomiting and severe pain in the epigastric region. Intoxication symptoms are weakly expressed, there is no diarrhea, the course of the disease is short-term - up to 3-4 days. The prognosis is favorable - after the start of taking the medication, the pathogen quickly dies, without having time to cause serious harm to the body.
If the process goes into a generalized course, the patient develops a typhoid-like form, similar in clinical picture to a typhoid-paratyphoid lesion, or a septic form.
It develops acutely, signs of the disease appear already a couple of hours after infection with the pathogen. The patient has characteristic symptoms of intoxication, dehydration, fever can reach 40-40.5 degrees. Then spastic pains appear in the epigastric and umbilical zone of the abdomen, nausea and repeated vomiting. After each vomiting, there is no relief, the person continues to feel sick. Diarrhea joins after one and a half to two hours, initially the bowel movements look like characteristic feces, and then they become watery, frothy and acquire a greenish tint. After 2-3 days, the volume of bowel movements decreases, mucus appears in them, sometimes streaks of blood. The large intestine is painful and spasmodic on palpation. In the process of defecation, tenesmus appears - sharp cutting pains in the rectum, not dependent on fecal excretion. Symptoms are similar to acute dysentery.
The most common form, which also begins acutely, 2-3 hours after exposure to the pathogen. Against the background of a violation of the water-electrolyte balance, the patient develops a temperature, nausea and vomiting, cramps and pain in the abdomen, intense diarrhea with a liquid greenish frothy stool appear. The severity of the lesion is determined not by the frequency of acts of defecation and vomiting, but by the loss of fluid in this case. Tenesmus during defecation is absent.
The patient's skin is pale in color, cyanosis is noticeable in complex cases. The tongue is dry, covered with a whitish or yellow coating. The intestines are swollen, palpation responds with soreness and rumbling. With auscultation of the heart, tachycardia is heard, a decrease in blood pressure is determined. Urine output is markedly reduced. With a severe crowbar, clonic convulsions appear.
This form of flow is characterized by the release of the pathogen from the intestine. There is a generalization of the lesion. With the blood stream, salmonella are carried throughout the body and are introduced into various organs and tissues. Infection becomes extensive, which is why such a course is considered severe. It proceeds in a septic and typhoid form.
The most severe variant of the generalized form of salmonellosis. The disease begins acutely, in the first days it has a typhoid-like course. In the future, the condition of patients worsens. Body temperature is characterized by large daily jumps, repeated chills and profuse sweating. The patient is tormented by chills, and during periods when the fever recedes, he feels increased sweating, tachycardia, myalgia. Further, hepatosplenomegaly is formed - a syndrome of pronounced enlargement of the liver and spleen at the same time.
The duration of the course of the disease is long, torpid, the general condition is characterized by weakness, malaise, loss of ability to work.
In some internal organs and tissues, secondary foci of inflammation begin to form, as a result of which the clinical manifestations of this variant of salmonellosis are very diverse, and its diagnosis is difficult. The formed purulent focus in the symptomatology comes to the fore. Purulent foci often develop in the musculoskeletal system: osteomyelitis, arthritis. Septic endocarditis, aortitis with subsequent development of aortic aneurysm are sometimes observed. Relatively often there are cholecysto-cholangitis, tonsillitis, cervical purulent lymphadenitis, meningitis (the latter is usually in children). Less often, purulent foci of other localizations are observed, for example, liver abscess, infection of the ovarian cyst, salmonella strumitis, mastoiditis, abscess in the gluteal region.
The disease often begins acutely. In some patients, the first symptoms of the disease may be signs of gastroenteritis. Further, nausea, vomiting and diarrhea gradually stop, while the body temperature rises, constantly or in waves. In most patients, the onset and course of the disease is similar to typhoid fever and paratyphoid fever A and B. Symptoms of intoxication increase - severe headache, insomnia, and a general feeling of weakness. The duration of the fever is 1-3 weeks.
By the end of the first week from the onset of the disease, the patient has a simultaneous enlargement of the liver and spleen (hepatolienal syndrome). Arterial pressure is low, there is a noticeable bradycardia. Due to the fact that the pattern of the course resembles typhoid fever in its signs, there is some difficulty in differential diagnosis. Without a laboratory determination of the pathogen, it is quite difficult to make a correct diagnosis.
After suffering salmonellosis, especially after manifest forms, some convalescents become bacteria carriers. With this form, there are no clinical symptoms, and it is detected by bacteriological and serological studies. Salmonella carriers are divided into the following categories: acute carrier, chronic carrier, transient carrier.
Acute carriage is characterized by salmonella shedding lasting from 15 days to 3 months. If salmonella is excreted 3 or more months after recovery, we are talking about chronic carriage. Carriage is called transient, in which the sowing of Salmonella from the secretions occurs once or twice, while the clinical manifestations of the disease are not detected, and the formation of significant antibody titers is not observed.
The diagnosis of “carriage of Salmonella” is relevant only if any symptoms of the disease have completely disappeared. The carrier period is counted from the day of disappearance of clinical manifestations, or from the day of the first detection of Salmonella during the examination.
Transient carriage is the most unstable condition, since the pathogen can be isolated periodically in acute and chronic bacterial carriage, as well as in the asymptomatic form of salmonellosis, which need to be differentiated by a specialist from each other.
Etiology of the disease
Infection of people occurs when caring for animals, during slaughter in meat processing plants, and also when eating meat infected in vivo or posthumously. Also, the source of infection is milk, dairy products.
Approximately 10% of cats and dogs are carriers of salmonellosis. In synanthropic rodents, this figure is higher - up to 40%. Among wild street birds (starlings, pigeons, sparrows, gulls), the disease is widespread. Polluting environmental objects with their droppings, birds thus contribute to the spread of the pathogen.
Over the past 30 years, scientists have observed an increase in the number of outbreaks of salmonellosis in poultry, primarily in chickens.
Humans are a source of some pathogens, S. typhimurium and S. haifa, especially in hospital settings. Contagious infection is most dangerous for children under the age of one, who are especially susceptible to salmonella. The duration of the period of contagiousness in a patient directly determines the nature of the course and the duration of the disease. In animals, it can last for months, and in humans - from 2-3 days to 3 weeks. Convalescent, that is, hidden carriage, sometimes lasts for years.
The most dangerous in terms of salmonellosis are chicken eggs. The disease is observed during improper cooking, when infected products, mainly meat (minced meat, products from it, jelly, meat salads, boiled sausages), were in conditions favorable for the reproduction of Salmonella.
The water way of infection is typical for the infection by the pathogen of animals in special livestock complexes and farms, poultry farms. In hospitals, especially in children's medical institutions and maternity hospitals, the contact-household method of spreading the disease prevails.
In urban areas, there is an air-dust distribution pathway, in which wild birds play the main role, polluting habitats and feeding areas with droppings.
Regardless of the state of the organism, age and gender, the natural level of human susceptibility to Salmonella is very high, that is, the defeat will develop in almost 98% of cases of contact with the pathogen. With regard to the duration and severity of the course, it may differ in people with strong immunity, adults and healthy people, or in small children, premature babies, the elderly. Immunity is type-specific, short-lived (5-6 months).
Symptoms of the disease
Noticeable external manifestations of salmonellosis determine its type of course, and differentiate the disease from other infectious lesions. The most common variant is gastroenteric, which is accompanied by dehydration, general intoxication, and fever. Signs of intoxication develop progressively, reaching headaches and muscle aches, weakness and disability.
In addition, salmonellosis manifests itself as pain in the umbilical region and upper abdomen, along the large intestine. The pains are spasmodic, undulating, from mild to very intense attacks. Worried about nausea and repeated vomiting, which does not bring relief.
Diarrhea is a characteristic symptom of salmonellosis, and the appearance of stools (watery, fetid, frothy, with a greenish color), as well as their quantity, attracts attention. Against the background of vomiting and diarrhea, dehydration syndrome develops.
On examination, paleness of the skin, bloating, dry mouth attracts attention. The tongue is heavily coated. Auscultation of the heart revealed tachycardia, the pulse was softly filled. Severe dehydration is accompanied by cramps in the lower extremities.
Further, the symptoms begin to differ depending on which variant of the course is observed in the diseased.
The gastroenterocolitic type of salmonellosis is accompanied by a decrease in the volume of feces by 2-3 days from the onset of the disease. Mucus appears in the feces, blood impurities. The intestine is spasmodic, responds to palpation with pain, tenesmus is present. The gastritis form passes without tenesmus and diarrhea. The temperature ranges from subfebrile to high values.
Symptoms of the generalized form have characteristic differences. For example, a typhoid-like course is very similar to the typhoid fever clinic, when, along with nausea, vomiting and diarrhea, a wave-like or stable fever appears. In this case, there is a noticeable increase in the spleen and liver, a hemorrhagic rash appears on the skin. Blood pressure is low, bradycardia is present.
In a septic course, in addition to the typical gastrointestinal clinic, the patient has a prolonged relapsing fever, chills, tachycardia, severe sweating, enlargement of the spleen and liver. There may be noticeable inflammation of the iris, which determines electrolyte disturbances in the body.
Course of the disease
The onset of the disease is clinically counted from the moment the first symptoms appear, however, the disease actually begins from the incubation period, when it still doesn't show up. Further, after the appearance of the first clinical symptoms, the stage of active development of the infectious process begins. After the concentration of the pathogen in the body begins to decrease, and the acute symptoms gradually subside, we can talk about the beginning of the patient's recovery, but this statement is not true for all forms of salmonellosis.
In children, the course and duration of the incubation period depend on the endurance of the organism. Usually this stage lasts from several hours in case of food infection, up to 3-4 days if the pathogen enters the body by contact-household way. The higher the concentration of the infectious agent and microbiological toxins enters the body, the shorter the incubation period of the pathogen, and the more severe the course of the disease is expected.
In adults, the incubation period also lasts from several hours to several days. In general, this category of patients is less susceptible to contact-household infection.
Period of development
The age of the child and the state of the immune system determine the severity of the development of salmonellosis in children. In addition, the course of the disease is influenced by the route of infection, the number and type of Salmonella that have entered the children's body. The main impact of microorganisms falls on the gastrointestinal tract, where microbes enter by breaking the barrier in the stomach (hydrochloric acid).
In infants, development is gradual: at first, the baby becomes lethargic and capricious, his appetite disappears, and the temperature rises. Next comes vomiting and loose stools. At first, the discharge has a normal color, defecation occurs 5-6 times a day. Further, the condition worsens, the increase in body temperature reaches more than 38 degrees. The child has frequent diarrhea (more than 10 times a day), while the stools are greenish in color and have a frothy texture. By the 7th day of the course, mucus and streaks of blood appear in them. If during diarrhea there is no replenishment of lost fluid reserves, dehydration begins in the baby, which is noticeable by the dryness of the mucous membranes of the mouth, dryness of the tongue, sinking of the fontanel, the appearance of severe thirst, and reduced urine output.
In newborns, the general symptoms of salmonellosis most often prevail over the gastrointestinal clinic. The temperature may remain normal, but the child refuses to eat, stops gaining weight. He shows anxiety, suffers from frequent regurgitation, the skin looks pale. The abdomen is swollen.
In children with a weakened body, for example, bottle-fed, premature babies, babies with congenital pathologies, the disease quickly takes a generalized course like sepsis, leading to damage to various internal organs:
The course is very severe, with high fever and enlargement of the liver and spleen.
In older children, the disease strikes suddenly - the process begins with a high temperature (over 38 degrees), followed by headache with dizziness, severe and recurrent vomiting, loss of appetite and weakness. Abdominal pains and diarrhoea, with thin, offensive, greenish stools, are next. If you do not start treatment during this period, there is a generalization of the process, with the involvement of the large intestine, with the appearance of mucus and blood in the stool. Pain in the abdomen at the same time acquire a cramping character. The process is accompanied by severe dehydration, toxic shock and renal failure may occur.
Older children usually recover after 1-3 weeks, young children, especially newborns, take longer to get sick - up to several months. Accordingly, their recovery process is longer, and a few months after recovery, salmonella still continues to be excreted in urine and feces.
Digestive disorders in children persist up to 3 months due to pancreatic insufficiency. In children with an unfavorable allergic background, the manifestations of food allergies may increase. Symptoms may be mild or accompanied by stool instability, bloating, and abdominal pain, especially associated with dairy foods.
The development of the disease in adults can take place in several ways, the intensity of which depends on the general condition of the body, and the concentration of the pathogen in it. Initially, salmonellosis is manifested by intoxication, headache, fever, aches and chills. The next stage of reproduction of microbes is accompanied by the appearance of nausea and repeated vomiting, pain in the abdomen. Frequent diarrhea leads to dehydration, the discharge quickly turns into a greenish, watery foam with an unpleasant odor. This course is characteristic of the gastrointestinal form of the disease. The described symptoms last up to a week, after which there is an improvement in well-being.
If salmonellosis becomes generalized, the patient develops weakness, possibly undulating fever, insomnia, headache, pale skin, muffled heart tones. Relapsing fever, chills, tachycardia and increased sweating signal the transition of the disease to a typhoid-like form. The duration of this stage is usually at least several weeks. The disease is severe, complications may occur.
Forms of the course
The chronic course of the disease is possible if a person has a certain concentration of the pathogen in the body, but there are no obvious external expressions of defeat. The chronic form is also called bacteriocarrier. On average, the period of isolation of bacteria in a person who has had salmonellosis lasts about 3 months, sometimes longer. Transient chronic carriage in a patient is observed if the pathogen is sown from the feces once or twice, after which further test results are negative. At the same time, the subject does not have serological, clinical and colposcopic signs of damage.
Chronic transient carriage results from the ingestion of a very small number of weakly virulent pathogens. In this case, only with an in-depth specific examination, most transient carriers show signs of infectious, subclinical salmonellosis.
At the same time, an infectious disease is the result of the interaction of the host organism with the pathogen in specific environmental conditions. If the response of the carrier's body is absent, then doctors have no reason to talk about an infectious process or disease.
Most often, salmonellosis occurs in the form of an acute disease, with corresponding clear and sharp manifestations. The duration of the pathological process, taking into account the right treatment, normally does not exceed 1.5 months. However, recently, especially in industrialized regions, there has been an increase in the number of cases of salmonellosis with a protracted course of up to 3 months. The question of whether such a long course of the disease can be considered chronic cannot be decided unambiguously, since in each case the degree of manifestation of the symptoms of the lesion is different.
An increase in the duration of the disease is associated with a sharp decrease in the resistance of the human body, changes in its immunological processes, as well as a decrease in adaptive abilities under the influence of harmful external factors, in particular, environmental pollution.
Thus, carriage is considered acute, in which the release of the pathogen lasts from 2 weeks to 3 months. The chronic form of salmonellosis lasts from 3 months or longer.
The classic form of salmonellosis is precisely an acute course with characteristic signs and symptoms that constantly, clearly and intensely disturb the patient.
Depending on whether the infection extends beyond the gut or not, acute salmonellosis occurs as a localized or generalized process. In the localized form of salmonellosis, the patient has all the signs of acute intestinal damage:
- fever and chills;
- nausea and vomiting;
- abdominal pain.
With severe electrolyte disturbances, dehydration, heart rhythm disturbances, cramps in the limbs are possible.
In the event that the disease acquires a generalized form, after some time the listed signs are supplemented by symptoms characterizing the damage to one or another organ or organ system (cardiovascular, lungs, kidneys, enlargement of the liver and spleen, CNS disorders).
Usually, the acute period of salmonellosis passes in 5-10 days, and recovery after it takes up to a month.
Asymptomatic salmonellosis is a long-term bacteriocarrier in which a person does not have clinical manifestations of salmonellosis, but the infectious agent is consistently present in his feces. At the same time, a person feels healthy, however, at the same time, he poses an epidemiological danger to others.
Gastrointestinal and generalized forms of salmonellosis occur in patients with mild, moderate or severe severity. The severity is differentiated by two main factors. First of all, we are talking about the intensity of symptoms: the severity of nausea, the frequency of vomiting, temperature indicators, the presence or absence of pain, seizures. More significant is the determination of the severity by the magnitude of water and electrolyte losses, by the degree of dehydration. From this point of view, for example, the frequency of diarrhea or vomiting is not as important as it is important to pay attention to the volume of fluid that the patient loses. Similarly, according to this indicator, mild, moderate and severe degrees of the disease are also distinguished.
The most common form of salmonellosis is gastrointestinal. In about 45% of those infected, it proceeds mildly, begins acutely, there is a low-grade fever, general weakness, single vomiting, loose watery stools up to 5 times a day. In total, diarrhea lasts 1 to 3 days. The loss of fluid in this case is no more than 3% of the total body weight.
Generalized salmonellosis is usually not mild.
Most common among all cases. The patient's temperature rises, the values \u200b\u200breach up to 39 degrees. The fever lasts 3-4 days, with recurrent vomiting present. Diarrhea lasts up to a week, up to 10 bowel movements are observed daily. Tachycardia is expressed, arterial pressure decreases. There is a loss of fluid volume of about 6% of body weight. There is a possibility of complications and the transition of the disease to a typhoid-like or septic form.
There is an increase in temperature above 39 degrees, the patient's fever lasts from 5 days. At the same time, symptoms of intoxication are pronounced. Vomiting is repeated and does not go away from 2-3 days or more. Stool more than 10 times a day, profuse, watery and frothy. The stools may contain mucus and blood. In total, diarrhea lasts a week or longer. The liver and spleen are enlarged, icterus of the sclera and skin is noticeable. In addition, there is cyanosis of the skin, a decrease in blood pressure and tachycardia.
Changes in kidney function are noticeable: oliguria, erythrocytes and casts in the urine, albuminuria, increased content of residual nitrogen. Against this background, acute renal failure may develop. Dehydration of 2-3 degrees is expressed in dry skin, aphonia, cyanosis, convulsions in the lower extremities. There is a loss of fluid in the amount of 7-10% of body weight. A blood test shows a thickening of the blood in the form of an increased level of hemoglobin, hematocrit and erythrocytes, a moderate shift to the left of the leukocyte formula.
The main difficulty for the attending physician in the presence of suspected salmonellosis is to make a differential diagnosis with other diseases accompanied by diarrheal syndrome: shigellosis, cholera, escherichiosis, food and chemical poisoning. In some cases, it becomes necessary to differentiate salmonellosis from myocardial infarction, acute cholecystitis, acute appendicitis, thrombosis of mesenteric vessels.
For a correct diagnosis, it is necessary to collect anamnesis of the disease and epidemiological anamnesis and as accurately as possible to establish all symptoms, frequency and intensity of their manifestation. Salmonellosis localized in the intestine from the first hours of the disease is accompanied by intoxication, after some time dyspeptic phenomena are added in the form of nausea, vomiting, and spastic pains in the abdomen. Then there is diarrhea with liquid and frothy, foul-smelling stools of a greenish color. From 2-3 days, tenesmus may appear during defecation, mucus appears in the stool, sometimes blood impurities.
If typhoid-like and septic forms of salmonellosis begin with such manifestations, they are easier to detect, otherwise, differential diagnosis should be carried out to discard the variant of typhoid fever and purulent sepsis.
It is possible to reliably establish the diagnosis of “salmonellosis” only by identifying the pathogen in the feces of the affected person. In generalized forms, salmonella is present in blood cultures. In addition, microorganisms can be found in the washings of the intestines and stomach.
Types of tests
A patient suspected of having salmonellosis should have three main types of tests:
- test blood (serological examination);
- culture, or bacteriological examination;
A serological test is a test of blood taken from a patient's vein. Antibodies to salmonella in human blood can be detected as early as 5-7 days after infection. The development and course of the disease can be seen by changes in antibody titers. In addition, based on the results of the analysis, the doctor determines the optimal treatment regimens.
The main serological methods used for blood tests for salmonellosis:
- in paired sera (interval - 6-7 days);
- PKA (coagglutination test);
- RLA (latex agglutination reaction);
- ELISA (enzymatic immunoassay).
According to the indicators of hematocrit, blood viscosity, acid-base state and electrolyte composition, a conclusion is made about the degree of dehydration of the body, and the ongoing rehydration therapy is corrected as necessary.
How to prepare for blood donation for salmonella? A blood test is taken in the morning, on an empty stomach. The day before, the patient needs to give up physical activity and emotional upheaval. A serological test is prescribed 7-10 days after the onset of the disease, since in the first days antibodies to the pathogen have not yet formed in the blood. In terms of time, the preparation of results takes 1-2 days.
The rapid method of blood testing involves enzyme immunoassay, which takes less time.
In addition, a complete blood count is ordered to determine the extent of the inflammatory process.
A blood test should be taken in the following cases:
- cultures are negative;
- the person was in contact with an infected person;
- in the second week from the onset of the disease, if the symptoms do not subside.
Bacteriological examination, or culture, provides more accurate data than serological analysis. The materials for the study are all the patient's biological fluids (feces, urine, bile, blood, pus, vomit, washings of the stomach and intestines). The collected materials are sown on a selenite or magnesium nutrient medium, which is favorable for the reproduction of Salmonella. Next, the container is sent to a special box with a temperature of 37 degrees Celsius, that is, to conditions that promote the growth and reproduction of bacteria, if they were originally present in the selected material. The results of the analysis are usually prepared within 3-5 days - this is how long, on average, it takes for microorganisms to reach a specific concentration. It is also possible to use several differential diagnostic media (Ploskireva, Endo, bismuth-sulfite agar).
The standard of bacteriological cultures for salmonellosis is the isolation of a culture of pathogenic bacteria using selective enrichment media, and differential diagnostic media, followed by biochemical identification, the establishment of a serovar isolate in agglutination reactions.
As such, the analysis does not require preparation, it is taken from those admitted to the hospital with the corresponding symptoms immediately after hospitalization.
Coprogram is a general analysis of feces that shows pathogenic changes in the structure of feces, for example, the presence of undigested fiber, blood, leukocytes, an increased amount of starch and fibers.
A few days before the laboratory examination, it is recommended to exclude flour products and sweets from the diet, stop taking iron-containing drugs and laxatives. The material is collected fresh, in the morning after waking up and the first toilet. Preparation of the coprogram takes 2-3 days.
Salmonellosis testing is mandatory for women who plan to become pregnant. During pregnancy, the doctor leading the woman can also prescribe tests, even if she does not have visually obvious signs of the disease. In pregnant women, feces, blood from a vein, and a swab from the anus are taken for analysis.
For children, it is important not only to be tested for salmonellosis if they have relevant symptoms, but also preventive examinations. If salmonellosis is suspected in a child, it is important to conduct a comprehensive diagnosis in a timely manner for a quick diagnosis. Children are given:
- serologic testing (7-10 days after infection onset);
- stool culture;
- anal swab;
- express diagnostics (immunofluorescent method).
Ways to treat the disease
Treatment of the disease at home is possible only if the patient has a mild form of salmonellosis. Children, pregnant women, people with a weakened immune system, in the presence of a moderate or severe form of the disease, must be hospitalized for observation in a hospital.Medical products (preparations, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor's prescription. Recommended reading: " Why can't you take medications without a doctor's prescription?". Bed rest is indicated for the patient, especially with severe manifestations of dehydration and intoxication. If the patient's condition allows, treatment begins with washing the stomach and intestines, siphon enemas, taking enterosorbents, for example, Enterosgel, Atoxil, activated charcoal.
The presence of dehydration of the 1st or 2nd degree in a patient requires the appointment of glucose-salt solutions - Regidron, Citroglucosolan, Oralit, by infusion method of administration. Droppers with solutions must be placed already before the start of the main treatment. Lost water reserves also need to be replenished with frequent fractional drinking in volumes up to 1 liter per hour in the first 2-3 hours, and then, when monitoring the level of fluid and consumption, 1-1.5 liters of fluid every 3-4 hours.
In case of dehydration of 3-4 degrees, isotonic polyionic solutions are administered intravenously by stream until the manifestations of dehydration shock are eliminated. Next, the patient is prescribed droppers.
At the discretion of the doctor, additional correction of the content of potassium ions is carried out, intravenous solutions of potassium chloride or potassium citrate are administered 1 g per day 3-4 times.
After correcting the water and electrolyte balance in the body, macromolecular colloid preparations such as Hemodez or Reopoliglyukin can be prescribed to relieve the manifestations of intoxication. With severe metabolic acidosis, an additional 4% sodium bicarbonate solution is administered intravenously.
In the gastrointestinal form of the course, indomethacin is prescribed to relieve the symptoms of intoxication, mainly in the early stages of the lesion, 50 mg three times within 12 hours.
Prescribing antibiotics and etiotropic drugs is relevant for a generalized type of course. Fluoroquinolones (0.5 g twice a day), Levomycetin (0.5 g 4-5 times a day), Doxycycline (0.1 g daily) are used.
To normalize the processes of digestion, enzyme preparations are used - Creon, Festal, Pancreatin.The text is for informational purposes only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: " Why you can't go on a diet on your own". It is important to adhere to the rules of Pevsner's diet #4 for the duration of treatment, and to follow diet #13 after diarrhea is eliminated, until complete recovery patient.
Prevention of infection
Prevention of salmonellosis, first of all, is carried out at the national level, since this disease is highly contagious and can quickly develop into an epidemic. Veterinary and sanitary-epidemiological control, which is carried out jointly by the relevant services, is of leading importance. Supervisory authorities in the veterinary field constantly monitor and record the incidence among animals, livestock, poultry, and also supervise the quality and purity of feed and meat products. Sanitary and epidemiological authorities take into account and control cases of disease in people, monitor trends in the development and duration of the disease at a specific time in a specific area. In addition, the sanitary and epidemiological services are in charge of studying the serotype structure of the pathogen isolated from the affected, as well as found in food products.
Responsible government departments are developing methods for diagnosing and standardizing procedures for recording and reporting cases, as well as quality control of food products sold, especially imported ones.
Salmonellosis is a contagious and rapidly spreading disease that can infect an entire livestock or poultry population in a few days. The disease is also rapidly transmitted from person to person. That is why anti-epidemic preventive measures against the causative agent of salmonellosis are of such a detailed nature - in order to avoid the formation of an epidemic.
With regard to preventive measures among the population, there are no specific ways to protect yourself from the disease. Vaccines against salmonellosis have not been developed due to the instability of the immunity produced and the antigenic diversity of the pathogen.
Prevention is based on sanitary and veterinary measures that ensure proper conditions for the slaughter of farm animals, storage, transportation and sale of products of animal origin, as well as cooking from them. For this purpose, deratization and disinfection measures are periodically carried out at livestock enterprises, farms and poultry farms, animals are vaccinated, feed and feed ingredients are taken for selective control.
Prevention of salmonellosis in the medical hospital setting is also important to protect patients from being infected by carriers. In this regard, disinfection measures are constantly carried out in infectious diseases hospitals, the fulfillment of all requirements for the disinfection of medical devices, utensils, and common areas is strictly monitored.
Bacteriological studies are periodically carried out in preschool, medical and preventive institutions, as well as food industry enterprises and public catering establishments. In addition, all persons who first come to work in the listed institutions are required to undergo a bacteriological examination, including for salmonellosis, in order to prevent the possible spread of infection.
Is it possible to protect yourself from salmonella? The main rules that every person must remember in order not to become infected with the pathogen and not get sick with salmonellosis are similar to the requirements for the prevention of other infectious diseases - wash your hands more often, do not eat in unfamiliar and unreliable places, strengthen the immune system and temper the body.
In addition, when buying eggs, meat and poultry, dairy products, special attention should be paid to where they are bought, whether sellers have documents with the results of checking products by a bacteriological laboratory. All animal products must be carefully handled to protect against possible contamination. It is unacceptable, for example, to eat raw meat or eggs, especially in the summer, when Salmonella activity is highest.
Why salmonellosis is dangerous
The most dangerous consequence of salmonellosis is the occurrence of infectious-toxic shock, with the manifestation of brain symptoms, cardiovascular insufficiency, adrenal and renal insufficiency. In this case, death can occur very quickly.
When the brain swells, bradycardia, short-term hypertension, cyanosis and redness of the skin on the neck and face, and rapid muscle paresis appear. Further, increasing shortness of breath joins, cerebral coma sets in.
If the patient has severe anuria and oliguria, it may be an onset of acute renal failure against the background of severely low blood pressure. Further, the signs characteristic of uremia increase.
Acute cardiovascular insufficiency is accompanied by the formation of collapse, a decrease in body temperature, the appearance of pale skin, cyanosis, and cooling of the extremities. Further, the pulse may disappear due to a sharp drop in blood pressure.
Other possible complications of the previous disease:
- hypovolemic shock;
- numerous septic complications in the form of purulent inflammation of the joints, abscesses of the kidneys, liver, spleen;
- urinary tract infections;
- brain abscess;
- peritonitis, pneumonia, appendicitis.
In general, the prognosis is favorable if treatment is started on time.
The disease does not cause the formation of specific immunity, so it is absolutely possible to get sick again.
Pregnant women may develop similar complications - dehydration, dryness, tachycardia, seizures, toxic infectious shock, liver, kidney and adrenal insufficiency, as well as pathologies of the cardiovascular system. The liver, spleen may increase, pains appear in the joints and in the region of the heart.
The greatest danger of infection is for the unborn child, especially in the first and third trimester. At the beginning of pregnancy, in the first months, salmonellosis, like other infectious diseases, can cause irreversible developmental disorders, fetal death, and miscarriage. A pronounced state of intoxication and high fever can lead to spontaneous abortion, since it is known that a body temperature of 37.7 and above in a future mother significantly increases the risk of miscarriage for up to 12 weeks.
In the second and third trimester, Salmonella provokes the development of placental insufficiency and exfoliation of the placenta against the background of severe general intoxication of the mother's body. The child does not receive enough nutrients and oxygen, which is why he develops developmental delays. Malnutrition of the fetus can also lead to premature birth.
Maternal dehydration, which accompanies acute salmonellosis, negatively affects the unborn child, he does not receive the microelementsand minerals necessary for growth . Constant vomiting and diarrhea lead to the depletion of available reserves of nutrients and vitamins. Because of this, for up to 22 weeks, an abortion is possible, or the birth of a premature baby with a small weight.
Frequently asked questions
What is the death temperature of Salmonella
Salmonella is a group of microorganisms that is quite resistant to external influences. It is especially important to know the temperature at which microorganisms begin to die in order to understand how to properly prepare and process food.
Salmonella is not afraid of low temperatures, for example, in a freezer or refrigerator, bacteria are able to remain viable for a long time, with no opportunity for reproduction. As soon as the temperature becomes positive, microorganisms begin pathogenic activity. The optimum temperature for reproduction of salmonella is from 10 to 40 degrees, the growth of a colony is possible in the range from 7 to 48 degrees. Under conditions lower than 10 degrees, the breeding rate is significantly reduced.
The temperature directly affects the time during which Salmonella dies. So, at 55 degrees, the pathogen is killed in an hour and a half. At 60 degrees salmonella dies after 12 minutes. If the temperature reaches values above 70 degrees, death occurs in 60 seconds. According to this principle, milk is pasteurized - the product is brought to a temperature of 63 degrees, and kept at this level for half an hour. During such a period of time, all pathogenic flora dies, except for the causative agents of botulism, while milk retains its beneficial properties.
Eggs boiled in boiling water for 3-4 minutes can only be considered safe if the infection has not entered the shell.
With meat, the situation is more complicated, minced meat and frozen meat are especially dangerous in this regard. In a frozen piece of meat or poultry, the pathogen can persist for up to a year. In the depth of a piece of meat, salmonella can withstand heat treatment by boiling, as well as baking in an oven at temperatures above 120 degrees for several hours. For example, when boiling a piece of meat weighing 500 grams, the death of the pathogen occurs after 2.5-3 hours.
Salmonellosis is a highly contagious, contagious infectious disease that first attacks the human gastrointestinal tract, and if left untreated, is transferred to other systems, tissues, organs, causing their damage. Typical symptoms of salmonellosis (nausea, vomiting, fever, weakness, tachycardia) can be similar to heart failure, appendicitis, food poisoning, dysentery or typhoid fever, so if you feel a strong deterioration in well-being and the symptoms described, it is better to immediately consult a doctor. If the disease takes a mild course, it is likely that it will be possible to do without hospitalization. However, if the patient has a moderate or severe course with high fever, severe symptoms and increasing intoxication, hospitalization is mandatory.
- Brest Central Polyclinic. - Salmonellosis: symptoms, treatment, prevention.
- Medicine JSC. - Salmonellosis.
- World Health Organization. - Salmonella (non-typhoid).
- Invitro group of companies. - Salmonellosis.
- Medicom Clinic. - Salmonellosis: symptoms, treatment.
- Clinic "SM-Doctor". - Salmonellosis.
- Official branch of the Israeli hospital Hadassah Medical Moscow. - Salmonellosis.