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Key Features

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Essentials of Diagnosis
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  • Nausea, vomiting, headache, meningismus

  • Fever, diarrhea, abdominal pain

  • Culture of organism from stool, blood, or other specimens

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General Considerations
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  • Salmonella infections in childhood occur in two major forms

    • Gastroenteritis (including food poisoning)

    • Enteric fever (typhoid fever and paratyphoid fever)

  • Transmission occurs by the fecal-oral route via contaminated food, water, fomites, and sometimes person-to-person

  • Incubation period is 12–24 hours

  • Numerous foods, especially milk and egg products, are associated with outbreaks

  • Animal contact also can be a source for Salmonella

  • Because salmonellae are susceptible to gastric acidity, the elderly, infants, and patients taking antacids or H2-blocking drugs are at increased risk for infection.

  • Most cases of Salmonella meningitis (80%) and bacteremia occur in infancy.

  • Newborns may acquire the infection from their mothers during delivery and are at special risk for developing meningitis

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Demographics
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  • Incidence of typhoid fever has decreased in the United States

  • Incidence of Salmonella gastroenteritis has greatly increased in the past 15–20 years

    • Highest attack rates occur in children younger than age 6 years, with a peak in the age group from 6 months to 2 years

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Clinical Findings

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Symptoms and Signs
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  • Fever, vomiting, and diarrhea usually develop in infants

  • Older children also may complain of headache, nausea, and abdominal pain

  • In the usual case, diarrhea is moderate and subsides after 4–5 days, but it may be protracted

  • Stools are often watery or may contain mucus and, in some instances, blood, suggesting shigellosis

  • Drowsiness and disorientation may be associated with meningismus

  • Splenomegaly occasionally occurs

  • Convulsions occur less frequently than with shigellosis

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Diagnosis

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  • Isolation of the organism from stool, blood or, in some cases, from urine, CSF, or pus from a suppurative lesion confirms diagnosis

  • WBC count usually shows a polymorphonuclear leukocytosis but may show leukopenia

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Treatment

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  • Careful attention must be given to maintaining fluid and electrolyte balance, especially in infants

  • In uncomplicated Salmonella gastroenteritis, antibiotic treatment

    • Does not shorten the course of the clinical illness

    • May prolong convalescent carriage of the organism

  • Colitis or secretory diarrhea due to Salmonella may improve with antibiotic therapy

  • Because of the higher risk of sepsis and focal disease, antibiotic treatment is recommended in

    • Infants younger than age 3 months

    • Severely ill children

    • Children with sickle cell disease, liver disease, recent gastrointestinal surgery, cancer, depressed immunity, or chronic kidney or heart disease

  • Infants younger than age 3 months with positive stool cultures or suspected salmonellosis sepsis should be

    • Admitted to the hospital

    • Evaluated for focal infection including cultures of blood and CSF

    • Given treatment intravenously

  • A third-generation cephalosporin is usually recommended due to frequent resistance to ampicillin and TMP-SMX

  • Older patients in whom bacteremia develops during the course of gastroenteritis

    • Should receive parenteral treatment initially and oral medications ...

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