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home - Colon - Colonic Infection - Salmonella Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Salmonella

Invasive disease —-5 % develop bacteremia with secondary endocarditis, mycotic aneurysm, and osteomyelitis-10% of bacteraemics >50yrs will have infective arteritis. 8-72 hours post ingestion The higher the dose, the worse the illness D and V. Fever. Abdo pain -Fever resolves within 48 to 72 hours, ImmunocompetentOnly treat if......-Severe diarrhoea (more than 9 or 10 stools per day) -High fever -A need for hospitalizationImmunocompetent Risky GroupsInfants <3 months/ Adults >50Endovascular or osseous prosthesisImmunocomprmoised- treat for 14 daysChronic CarriageExtended antibiotics course(cipro for 6wks)Confirm eradication with cultures 6 mnths post-tx Treatment Groups Treatments include 3-7d of:Fluoroqui-nolone (increasing resistance (2.5% in 2003).AmoxicillinTrimethoprim- sulfamethoxa-zole.iv 3rd genera-tion ceph. Duration of diarrhoea: 4-10 daysDuration of excretion: 5 weeks, longer in children.-Intermittent shedding is common, so a single negative culture is not that reassuring. MacConkey Agar Minimum of 48 hours-72 hours culture Salmonella and Shigella are lactose negative therefore form translucent areas on MacConkey’s agar Salmonella-Shigella Agar Hektoen enteric agar If non-typhoidal -Most nontyphoidal Salmonellae produce hydrogen sulfide, which causes colonies to appear light greenish with black centers on Hektoen enteric agar or white with black centers on Salmonella-Shigella agar. -Enrichment broths (tetrathionate or selenite). Used if low numbers of organisms-Inhibit E. coli over Salmonella or shigella -Further biochemical and antisera analysis specific for Salmonella O and Vi antigens. Diagnosis Can be done by faecal cultures.Can also use rectal swabs 0.5% get chronic carriage (>1 year).- Mortality rates of 0.5 to 1 % (probable overesti-mate) Non- typhoidal Salmonella Enteric Fever Clinical Presentation Written by Dr Sebastian Zeki Adherence Penetration Lumen Multiplication Secretion of water and electrolytes Diarrhoea Systemic dissemination Deep tissue invasion Lysosomal digestion Phagocytosis by neutrophils and macrophages Columnar epithelial cells of the small intestine Salmonella Entry Lamina propria

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