Salmonella fever, symptoms

Particular strains of salmonellae (section 4.2) such as Sal. typhi, Sal. paratyphi and Sal. typhimurium are able not only to penetrate into intestinal epithelial cells and produce exotoxins but also to penetrate beyond into subepithelial tissues. These organisms therefore produce, in addition to the usual symptoms of salmonellosis, a characteristic systemic disease (typhoid and enteric fever). Following recovery frxm such infection the organism is commonly found associated with the gall bladder, hi this state, the recovered person will excrete the organism and form a reservoir for the infection of others. 

Patients with complicated typhoid fever (i.e., metastatic foci, ileal perforation, etc.) should receive parenteral therapy with ciprofloxacin 400 mg twice daily or ceftriaxone 2000 mg once daily. Antimicrobial therapy can be completed with an oral agent after initial control of the symptoms of typhoid fever. In persons with AIDS and a first episode of Salmonella bacteremia, a longer duration of antibiotic therapy (1-2 weeks of parenteral therapy followed by 4 weeks of oral fluoroquinolone) is recommended to prevent relapse of bacteremia. 

Typhoid fever is caused by Salmonella typhii bacilli. The condition has an incubation period of about 5-23 days. Classic symptoms of typhoid fever include headache, abdominal pain with constipation or diarrhoea. Rose-coloured spots and macular rashes on the abdomen are characteristic of typhoid fever. 

Typhoid fever caused by Salmonella typhi or S. paratyphi is an important and prevalent cause of continuous fever without localizing symptoms in the tropics. The diagnosis can be confirmed with a bloodculture. Response on therapy is often seen only after 3 days when the fever subsides. Chloramphenicol-resistant Salmonella typhi was first described in Vietnam in 1973. Its prevalence reached 95% in the 1970s and then decreased to 54% in the 1980s after cotrimoxazole became the treatment of choice. In the mid-1993, there was a dramatic increase in the number of strains of S. typhi, isolated in the hospital and from patients in the outbreaks, which are resistant to the three first-line antibiotics chloramphenicol, cotrimoxazol and ampicillin. This indicated that there was an urgent need for effective antibiotics for the treatment of typhoid fever. 

The onset of symptoms of Salmonella gastroenteritis is usually 6-72 h. Acute symptoms may last for 1-2 days or may be prolonged depending on host factors, ingested dose, and strain. Arthritic symptoms may occur 3 weeks after onset of acute symptoms. Symptoms are more severe in the elderly, infants, and immunocompromised individuals. S. typhi and S. paratyphi A, B, and C produce typhoid and typhoid-like symptoms in humans. Enteric fever (typhoid fever) may develop other symptoms include anorexia, abdominal pain, malaise, myalgias, headache, cough, diarrhea or constipation, and... 

The other component of salmonella enteric infection, presenting with the main symptom of diarrhea, is bacterial infiltration of intestinal mucosa and acute inflammation, which contributes to the clinical manifestations of fever and diarrhea. 

Systemic and local immune responses, humoral and cellular, are mounted by the host but these are not associated with host protection. Necrosis of Peyer s patches, which may lead to intestinal perforation, is attributed to interaction of bacterial factors and host immune response. It is also interest that in typhoid fever there is no strong association with HIV infection, whereas in HIV infection there is an increased incidence of non-typhi Salmonella infection. Headache, pharyngitis and arthralgia may be present. Gastrointestinal symptoms are usually constipation, abdominal pain and tenderness. Other symptoms which may occur are diarrhea, the pea soup type containing inflammatory mononuclear cells. The biliary tree and liver is involved presenting cholecystitis and hepatitis. Splenomegaly may develop. 

Salmonella typhi is a generalized systemic infection, which produces the following symptoms fever, headache, malaise, anorexia, enlarged spleen, rose spots on the trunk of the body, and constipation. These symptoms are followed by more serious ones, including ulceration of Peyer s patches in the ileum, which can produce hemorrhage or perforation. Mild and atypical infections can also occur, with a death... 

Salmonella paratyphi is a bacterial enteric (intestinal) infection with an abrupt outbreak, which produces the following symptoms continued fever, headache, malaise, enlarged spleen, rose spots on the trunk of the body, and diarrhea. These symptoms are similar to those of typhoid fever, but the death rate is much lower. Mild and asymptomatic infections may also occur upon exposure. Outbreaks and locations are similar to those of the other salmonella bacteria. The infectious dose is 1000 organisms by ingestion. Transmission occurs by direct or indirect contact with feces or, in rare cases, urine of patients or carriers. It is spread by food, especially miUc and dairy products, shellfish, and in some isolated cases, water supplies. Incubation depends on the strength of the dose, but usually 1-3 weeks for enteric fever and 1-10 days for gastroenteritis. Antibiotic treatment with chloramphenicol, ampicillin, or TMP-SMX is usually effective. 

Indeed, symptoms of pathogen-specific enteritis are not sufficiently unusual to distinguish a disorder form those due to Salmonella, Shigella, Campylobacter or Yersinia or other pathogens. The combination of fever and faecal leukocytes or erythrocytes is indicative of inflammatory diarrhoea,but the definite diagnosis is based on culture or demonstration of specific organisms on stained faecal smears. 

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