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Salmonella Infections

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Salmonella Infections (TREATMENT OF ENTERIC FEVER.. Cont ..) Diagnosis: Usually positive in: Culture of Blood 1st Week Stools 2nd Week Urine 3rd Week Serology ... – PowerPoint PPT presentation

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Title: Salmonella Infections


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Salmonella Infections
2
Salmonella Infections
  • Salmonellas are a major cause of food borne
    diseases (Food Poisoning). Members of this genus
    also.
  • Cause enteric fever (typhoid and parathyroid
    fevers). These are only human pathogens.
  • They are members of the family enterobacteriaceae
    sharing all their characters. They are non
    Lactose fermenters and they are motile.

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Antigenic Structures Two Main Types of Antigens
Are Available.
  • Heat stable polysaccharide which is part of the
    cell wall called Somatic or O antigen.
  • Flagella antigens or H antigen
  • Two phase are available.
  • Phase I and Phase II
  • A third antigen or the envelope or Vi antigen
  • According to these antigens the members of the
    Salmonella are divided into serogroup from A T.

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(Salmonella Infections .. Cont.)
  • Clinically the Salmonellas are divided into two
    main divisions
  • Enteric fever or (typhoid and paratyphoid fever)
    causing Salmonellas.
  • These are
  • Salmonella typhi
  • Salmonella paratyphi A
  • Salmonella paratyphi B
  • Salmonella paratyphi C
  • The clinical features of infection by these
    organisms is fever, and generalized symptoms of
    systemic infection. There is also blood stream
    infection and localization in certain organs in
    the body. Besides these there are also
    gastrointestinal symptoms. Antibiotic treatment
    is always advised for these infections.

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(Two Main Divisions of Salmonella.. Cont..)
  • Food borne diseases or food poisoning
    Salmonellas.
  • They are also called gastroenteritis causing
    Salmonellas. Infection by these Salmonella is
    mostly confined to the gastrointestinal tract
    presenting with abdominal pain, vomiting and
    diarrhoea. They rarely cause systemic
    infections. However, they can cause systemic or
    generalized infection in immunocompromised
    patient, the very young or the very old patients.
    Antibiotic treatment is not advised for these
    infection unless there is systemic infection.
    The treatment is only fluid and electrolytes
    replacement if there is severe diarrhoea and / Or
    vomiting.

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Typhoid And Paratyphoid Fever (Enteric Fever)
  • It is one of the causes of pyrexia of unknown
    origin syndrome (P.U.O. Or F.U.O.)
  • Causative agents
  • 1. Salmonella typhi 2. Salmonella paratyphi
    A
  • 3. Salmonella paratyphi B 4. Salmonella
    paratyphi C
  • Methods of Transmission
  • By faecal - oral route through contaminated food
    items or water by faecal material from patients
    or carriers.

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(TYPHOID AND PARATYPHOID FEVER.. Cont.)
  • PATHOGENESIS (See the diagram).
  • Infective dose is 102 organisms. This dose is
    affected by host factors. E.g. Lower stomach
    acidity
  • When the organisms are ingested they overcome the
    gastric acidity and reach the small intestine and
    start multiplying and attachment to microville
    and enter the cells and further multiply in the
    Peyers mesentric lymphnodes ? thoracic duct ?
    blood ? RES ? blood ? gall bladder,
    intestines ? faeces.

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Pathogenesis Of Typhoid Fever
  • S. TYPHI
    SMALL INTESTINE
  • BILE
  • GALL BLADDER
    M.L. NODES
  • THORACIC DUCT
  • BACTEREMIA
    BLOOD
  • R.E.S.
  • MULTIPLICATION PHASE DURING
  • INCUBATION PERIOD
  • BLOOD (SEPTICAEMIA) ONSET OF SYMPTOMS

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(TYPHOID AND PARATYPHOID FEVER.. Cont.)
  • Clinical Features
  • Incubation period is 10-14 days after which the
    patients starts to have fever which is the main
    presenting symptom accompanied by other symptoms
    of a generalized infection e.g. General
    malaise, fever, headache, sweating and later on
    gastrointestinal.
  • Symptoms like
  • diarrhoea
  • abdominal pain
  • vomiting

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(CLINICAL FEATURESCONT..)
  • If not treated the intestinal infection can be
    severe enough to cause perforations. The patient
    may also have general central nervous system
    involvement appearing as delirium, and maybe
    coma.
  • In fair skin people some skin rash may appear
    called ROSE SPOTS.
  • The organisms live intracellularly in the
    macrophages of the reticuloendothelial system
    i.e. The liver, spleen, liver, and lymph nodes.

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(TYPHOID AND PARATYPHOID FEVER.. Cont.)
  • Being an intracellular organism this leads to
  • Immunity is mainly cell mediated
  • Antibodies protects only against the bacteraemia
    phase so they are not protective, although their
    presence is diagnostic.
  • Antibiotic used for treatment should be those
    which enter and work inside the cell.
  • Relapse is common.

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Diagnosis Of Enteric Fever
  • Clinical history of travel outside and eating
    in public places. Common in people retrieving
    from Pakistan, Sudan, and Egypt.
  • Clinical Examination
  • Temperature as stepladder appearance.
  • Rose spots
  • Hepatosplenomegaly
  • Rarely enlarged Lymph nodes

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(TREATMENT OF ENTERIC FEVER.. Cont..)
  • Clinical Features
  • Culture of
  • Fever
  • Malaise
  • Headache
  • G.I.T
  • C.N.S Features
  • Skin rash (Rose spots)
  • Acquired By
  • Food, water, orally
  • Large spleen, liver

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(DIAGNOSIS OF ENTERIC FEVER...Cont..)
  • Laboratory Diagnosis
  • Culture
  • Specimen blood / bone marrow 1st week
  • faeces 2nd week
  • urine 3rd week
  • Faeces should be culture on
  • Bile salt containing media e.g. DCA or
    Selenite F broth medium Look for non-lactose
    fermenters then do biochemical tests and
    serological tests.
  • Serological test on patient serum
  • People who get infected by Salmonella typhi and
    paratyphi A, B, and C develop antibodies against
    these organisms. These ntibodies can be
    detected by agglutination test in the Widal Test
    looking for rising titre of these antibodies.
  • General more low WBC, low Hb, high ESR

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Complications of Enteric Fever
  • Relapse if treatment is not given for required
    period of 2 weeks.
  • Perforation of the last part of the small
    intestine, not commonly seen these days why?
    Because of early diagnosis and treatment.
  • Carrier state this is not an uncommon
    complication. It is mainly in the gall bladder
    although Salmonella paratyphi b can be in the
    tubules of the kidney.
  • It is more common in females.
  • It is dangerous in these patients who are food
    handlers as they can transmit it to other people.
  • It is also difficult to treat as it may need
    prolonged treatment.

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Treatment Of Enteric Fever
  • Replace fluid if there is dehydration.
  • Antibiotic are very important in the treatment
    of enteric fever.
  • Chloramphenicol, the best drug but can not always
    be used as it has rare severe bone marrow
    complications.
  • Ampicillin
  • Cotrimoxazole
  • Nowadays and mainly from Indian Subcontinent
    some patients are infected with Salmonella strain
    resistant to these three first line enteric fever
    drugs.
  • These are usually treated by
  • Ciprofloxacin
  • Ceftriaxone

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(TREATMENT OF ENTERIC FEVER.. Cont..)
  • Treatment of Carriers
  • Ampicillin or Cotrimoxazole
  • May need to surgically remove the gall bladder.
  • Prevention
  • Good water supply
  • Good hygiene
  • Vaccination for people going to endemic areas.

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(TREATMENT OF ENTERIC FEVER.. Cont..)
  • Diagnosis Usually positive in
  • Culture of
  • Blood 1st Week
  • Stools 2nd Week
  • Urine 3rd Week
  • Serology
  • Widal 2nd -3rd Week
  • C.I.E.
  • Patient serum diluted
  • titre Anti O
  • Anti H Good water supply
  • Culture on DCA.
  • Salenite broth
  • N.L.F
  • Biochemical Serological tests

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Food poisoning
  • Zonosis


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(TREATMENT OF ENTERIC FEVER.. Cont..)
  • Food Posioning, gastroenteritis Or Food borne
    disease causing Salmonellas
  • They cause
  • Gaseroenteritis
  • Food borne diseases (85 of cases)
  • Food posioning
  • There are more than 2000 species
  • The infective dose is high 106 - 108
  • E.g.
  • S. typhimurium
  • S. dublin
  • S.london
  • S.khartoum
  • Now given only number for names.

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(TREATMENT OF ENTERIC FEVER.. Cont..)
  • They could be zoonotic from all types of animals
    mainly chickens.
  • They could be obtained from human food handlers
  • They can causes systemic disease in
  • Immunocompromised patient e.g. Leukemics, AIDS
  • Very young less than 4 years
  • Very old more than 70 years
  • Treatment
  • Replacement of water (fluid) and electrolytes in
    case of severe diarrhoea
  • Antibiotic not indicated if there is no systemic
    infection.

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Shigella
  • Bacillary dysentery
  • Shigellosis

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Characteristics
  • Enterobacteriacae
  • Gram-negative bacilli
  • Non-motile
  • Non-lactose fermenter ( NLF )
  • H2S negative
  • Capsule (K-antigen)
  • O somatic antigen

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Species
  • Sh. dysenteriae . 10 serotypes (most
    serious)
  • Sh . flexineri 6 serotypes (developing
    nations)
  • Sh. bodyii 15 - serotypes
  • Sh. sonei 1 - serotype (United states)

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Bacillary dysentery
  • Acute bacterial infection of the intestine
    (colon)
  • Caused by all species.
  • Varies in severity .
  • Major cause of diarrhial disease and mortality.
  • Developed countries.
  • (POOR HYGIENE , NUTRITION)
  • (CONTAMINATED FOOD , WATER)

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Epidemiology
  • Human
  • Fecal-oral route.
  • ( water , food , feces , flies )
  • Person-person contact.
  • Childhood.
  • ID 10 - 100 organisms.
  • High infectivity.
  • IP - 1 4 days.
  • Source cases and carriers.
  • Daycare centers, mental institutions, travel and
    homosexuals.

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Clinical picture
  • Fever
  • Bloody diarrhea
  • Abdominal cramps
  • Tenesmus
  • Mucus and pus
  • Convulsions
  • Mild infection watery diarrhea
  • Bacteremia rare
  • REITER,S syndrome .
  • Hemolytic uremic syndrome .

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Clinical picture
  • Mild illness rehydration.
  • short ( 48 72 h)
  • SH . Sonei
  • Bacillary dysentery
  • ANTIMICROBIAL THERAPY ( SHORTEN THE DURATION ,
    PREVENT SPREAD)
  • AMPICILLIN (PLASMID RESISTANCE)
  • COTRIMOXAZOLE (RES.)
  • CIPROFLOXACIN
  • CEFTRIAXONE

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Prevention
  • Supply of pure water
  • Personal hygiene ( hands )
  • Sewage disposal
  • Food hygiene
  • Insect control ( flies )
  • Vaccine ( oral )
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