Comments
INITIAL SYMPTOMS:
Acute gastroenteritis for 3-7 days with fever, diarrhea, vomiting, diarrhea (no blood), and abdominal cramping; [Harrison, p. 545] Diarrhea is usually watery, and rarely is blood present. [Merck Manual]
Fever, if present, usually resolves in 2-3 days, and diarrhea usually resolves in 3-7 days. The stool is usually positive for leukocytes and sometimes positive for blood. Complications include pseudoappendicitis (infrequent) and toxic megacolon (rare). [PPID, p. 2565] Septicemia may lead to skin infection, septic arthritis, cholecystitis, endocarditis, meningitis, osteomyelitis, pericarditis, pyelonephritis, or pneumonia. Salmonellosis is commonly transmitted by food of animal origin (milk, eggs, meat, and poultry) and also by contaminated processed foods. Fruits and vegetables may be contaminated by slicing on a cutting board used for meat or poultry. Contaminated pet foods may be an under-recognized source of transmission. Person-to-person, fecal-oral transmission occurs; also transmitted by contaminated water and pets (e.g., turtles, iguanas, dogs, cats, guinea pigs, and chicks). Risk factors include HIV infection or other immunosuppressed state, achlorhydria, and sickle-cell disease. [CCDM, p. 532-9] Patients with nontyphoidal salmonellosis: up to 8% have bacteremia; 5-10% of these have localized infections. [PPID, p. 2565] Other reservoirs are fish/shellfish, horses, rabbits, and primates. [PPID 7th Ed., p. 4002] Pus and occult blood in stool are common findings. [ID, p. 624] Complications include bacteremia (8%), and 5-10% patients develop localized infections (hepatosplenic abscesses, meningitis, pneumonia, osteomyelitis, and reactive arthritis). [Harrison, p. 545] E. coli O157:H7, salmonella, and shigella are possible agents of bioterrorism. [www.bt.cdc.gov] Transmission may occur by sexual contact (fecal-oral). [Cecil, p. 1885] Fever and splenomegaly are associated with bacteremia. [Guerrant, p. 131] May cause myocarditis; [ABX Guide: Myocarditis]
For updated text and symptoms of infectious diseases, see iddx.com.