Mar 06, 2018
Salmonellosis is a classical oral, acute infectious disease of animals and humans, characterized by the development of gastrointestinal, less often typhoid-like and septic forms.
Etiology of .According to the current generally accepted view, the term salmonellosis combines a group of diseases characterized by a variety of clinical manifestations caused by multiple serovars( about 2000) of bacteria and the Salmonella family. Enterobacteriaceae.
The whole group of bacteria is divided into subgenera, serovars, biovars and phagovars.
Salmonella - Gram-negative small sticks( 2-4 x 0.5 μm), mobile due to the presence of flagella, with the exception of S. gallina-rum and S. pullorum species, as well as sedentary mutants.
Salmonellosis pathogens represent a large group of bacteria, of which the most common are Breslau( mouse typhoid), Gertner( the causative agent of rat typhoid), suipe-tifer( a microbe that can be detected in swine fever).The entire group of salmonella belongs to the same family as the bacteria of typhoid, paratyphoid A and B.
Salmonella are quite stable in the external environment. In dry feces they can remain viable up to 4 years, in manure - up to 3 months. When cooking infected meat for 2.5 hours, salmonella is killed only in small pieces( no more than 200 g).In milk, they are not only preserved, but also multiply, and it does not change its appearance and taste.
Resistant to physical and chemical factors( moisture, low and high temperatures, UV rays, disinfectants, etc.), among which S. typhimurium and S. enteritidis are most viable. The optimum growth is 35-37 ° C, aerogenic.
II.The severity of the process:
III.Course of the disease:
Examples of diagnosis:
Complication: subcompensated intestinal dysbacteriosis.
The variety of clinical forms of salmonellosis can be explained by the peculiarities of the pathogenesis of this disease. In particular, the pathogenicity of the pathogen to all parts of the gastrointestinal tract, with the development of invasive diarrhea, as well as the presence of bacteremia with the defeat of immunocompetent systems and internal organs.
The incubation period lasts from 6 to 14 hours, rarely 1-2 days. The disease begins acutely.
With mild illness, nausea, sometimes vomiting, loose stools several times a day, abdominal pain. The general condition of the patients is little disturbed, the temperature is normal or subfebrile. Recovery occurs 1-2 days even without treatment.
In severe cases, the symptoms of acute gastroenteritis with marked intoxication due to toxin poisoning prevail: severe abdominal pain, profuse vomiting, diarrhea, dehydration, general weakness, anuria, convulsions of limbs;blood pressure drops, pulse frequent, weak filling and tension. Stools, initially watery and fetid, with a severe course of the disease may lose their stool and look like a rice broth. The temperature is 38-39 °.Sometimes, in severe conditions, vomiting and profuse diarrhea appear in patients;blood pressure and body temperature decrease, cyanosis, convulsions, anuria appear, the voice becomes hoarse, which reminds the cholera with the flow.
In some cases, salmonellosis occurs in the form of generalized( typhoid-like) and septic forms. The generalized form can begin with phenomena of gastroenteritis or with fever without signs of this disease and in the clinical course remind the condition with typhoid fever or paratyphoid.
Of complications are possible gastritis, pancreatitis, cholecystitis, cholangitis, chronic colitis.
In addition, the age of children, the presence of background immune deficiency, as well as unfavorable premorbid factors( perinatal CNS damage, exudative diathesis, enzymopathy, intrauterine infections, etc.) influence the possibility of forming generalized forms of salmonellosis.
In addition, the likelihood of developing severe forms of the disease affects the virulence of salmonella.
The greatest proportion is children with a gastrointestinal form of the disease - 90%.Typhoid-like variant is registered in 1.8% of patients, septic variant - in 0.6% of children. The share of documented atypical forms accounts for about 10% of patients with salmonellosis.
The main clinical manifestations of the gastrointestinal form of salmonellosis can be grouped into the following syndromes:
The severity criteria for salmonellosis are:
I. General manifestations:
Gastrointestinal form of salmonellosis is recorded in 90% of children.
Gastroenteritis is more common in older patients, enterocolitis in infants. Depending on the severity of intoxication, toxicosis and exsycosis, the frequency of the stool is allocated to mild, moderate and severe forms of the disease.
The mild form of salmonellosis usually develops in older children and is caused mainly by salmonella of rare groups and S. enteritidis.
The disease begins acutely, accompanied by mild ailment, a decrease in appetite, an increase in body temperature to 37.2-38 ° C.Patients may be disturbed by minor pain in the abdomen. With this form of the disease, vomiting is single or absent. The chair is quickened to 3-5 times a day, it is mushy or liquid, without pathological impurities or with a small amount of mucus and greens. Changes from internal organs are absent.
The patient's condition quickly( after 3-5 days) is normalized.
The medium-heavy form is the most common variant of the course of salmonellosis.
The disease begins acutely - after 6 hours - 3 days after ingestion of the infected product or 3-7 days after the contact route of infection.
The first symptoms of the disease include weakness, lethargy, adynamia, decreased appetite, abdominal pain, which are localized in the epigastric and peripump regions, are moderately expressed.
Early signs of the disease include nausea, vomiting. Repeated vomiting is characteristic of the food pathway of infection. In this case, it is often the first sign of the disease, but it does not last long - 1-2 days. With the development of the gastroenterocolitis variant, vomiting may appear in the 1-2 days, it is infrequent 1-2 times a day, but lasts 2-3 days or more, that is, it has a persistent character.
The moderate form of salmonellosis is accompanied by a fever. In this case, it is not possible to identify any patterns. It is possible to raise the body temperature to 38-39 ° С from the first day. However, it is possible that the temperature rises to the maximum values by the 2nd-3rd day. Elevated temperature persists for 4-5 days.
Increasing stool usually begins with the first day, but the most pronounced diarrhea syndrome is on the 2nd-3rd day after the onset of the disease. The nature of the stool depends on the version of the gastrointestinal form of salmonellosis. So, with the enteric version, the chair is plentiful, watery, foamy, offensive, with greens( often of the "swamp type" type).With the development of enterocolitis in the abundant stool, there are impurities of mucus, blood.
With a moderate form of the disease, the stool frequency reaches 7-10 times, and the duration of diarrhea is 7-10 days.
With palpation of the abdomen, patients are characterized by diffuse soreness, rumbling along the colon, bloating.
Patients in the first year of life may have a slight increase in the liver.
Due to the development of dehydration in children, often a decrease in the tone of the tissues, skin elasticity, dry mucous membranes, decreased diuresis, weight loss of 3-7%.
The medium-severe form of the disease usually occurs without serious complications and after 7-12 days results in recovery.
Severe form of salmonellosis often develops in young children, with unfavorable factors of premorbid state, with nosocomial infection, and is mainly caused by S. typhimurium.
The disease begins violently, accompanied by a sharp increase in body temperature to 39-40 ° C, often a chill.
The condition of patients deteriorates significantly, they become very sluggish, drowsy, the reaction to the environment decreases. Children refuse to eat and drink. Patients are disturbed by excruciating nausea, repeated, sometimes indomitable vomiting.
The stool frequency usually exceeds 10 times a day. It is plentiful, fetid, green. Most patients have mucus and blood in their bowel movements.
Skin covers in children are very pale, possibly cold extremities, the appearance of cyanosis. Turgor tissues and the elasticity of the skin are sharply reduced, the mucous membranes are dry, the tongue is dry, covered with a thick white coating.
Cardiovascular disorders develop in all patients. The frequency, voltage and pulse content change, arterial and central venous pressure decreases. Heart sounds are significantly muted. Possible the development of infectious-toxic shock I-II degree.
The nervous system is often affected, which is manifested by headache, dizziness( in older children), drowsiness or sleep disturbance, convulsions( in young children).
In children, bloating is defined, the possibility of intestinal paresis is not ruled out. In most patients, there is an increase in the liver and spleen( less often).
Dehydration of II-III degree in hypotonic or isotonic type develops in young children.
In severe form of salmonellosis, complications develop in most patients, and recovery occurs in 2-3 weeks.
A typhoid-like form of salmonellosis is observed in older children and is 1.8% of the total number of patients with salmonellosis.
This form may have a beginning similar to the gastrointestinal form, i.e., start with deterioration of the general condition, increase in body temperature, the appearance of abdominal pain, vomiting, and loose stool. However, the disease does not end in recovery after 3-7 days, but acquires features characteristic of typhoid fever.
Fever of undulating or irregular type up to 38-39 ° C, lasts 10-14 days or more. Increased lethargy, adynamia, there is a sleep disorder, a headache. Stomach noted abdominal bloating, enlarged liver, spleen. Sometimes on the skin of the abdomen there is an unhealthy rosaceous rash. Bradycardia develops, systolic murmur is detected, blood pressure decreases.
In other cases, the disease may begin with symptoms of intoxication, and gastroenterocolitis syndrome is weak or nonexistent. Relapses are rare.
The duration of this form of salmonella infection is 3-4 weeks.
The septic form is a sepsis of salmonella etiology, the development of which is caused by a sharp decrease in immunity, so it occurs in infants, infants, patients with IDS and other "risk groups", usually caused by highly virulent, multiresistant strains of S. typhimurium.
The disease begins with the phenomena of gastroenteritis, after which a typical picture of septicopyemia develops. At the same time, the condition of patients is significantly deteriorating. The body temperature is irregular, with large daily swings, repeated chills, profuse sweating. Often observed exanthema in the form of petechiae and / or major hemorrhages, pyoderma. From the first days of the disease, signs of damage to the nervous and cardiovascular systems are determined.
Secondary septic foci can form in different organs, and there is no regularity.
Purulent foci often develop in the lungs, in the musculoskeletal system( osteomyelitis, arthritis): Cholecysto-cholangitis, meningitis, tonsillitis, lymphadenitis, urinary tract infection are relatively common. Sometimes there is septic endocarditis, aortitis.
Specific character of multiple lesions is confirmed by the detection of salmonella in cerebrospinal fluid( purulent meningitis), sputum( pneumonia), urine( urinary tract infection).In parallel with this, salmonella are sown from blood and feces.
Septic variant of salmonellosis is characterized by a long, severe course and can end fatal.
Meningoencephalitic form refers to generalized forms of salmonellosis. It differs from the septic form in that meningoencephalitis is the only secondary septic focus. It occurs in children of early age, newborns, patients with background IDS and lesion of the nervous system.
The disease usually begins with gastroenteritis, after which the condition worsens due to increased intoxication and neurological symptoms. There is a headache or its equivalents( anxiety, monotonous cry), vomiting increases, swelling, tension, pulsation of the large fontanel are revealed. Cramps may occur. In later terms, meningeal symptoms, focal signs, loss of consciousness are found.
This form of salmonellosis proceeds very hard, can result in death or the formation of intracranial complications.
The grated form of salmonellosis is a very mild gastrointestinal form of the disease that usually develops in older children and is caused by S. enteritidis and salmonella of rare groups.
With an erased form, the general condition does not suffer, the body temperature remains normal. Against the background of a satisfactory general condition, a 1-2-fold diluted stool without pathological impurities appears. Sometimes there are short-term pains in the abdomen.
The disease ends with recovery( often self-recovery) after 1-2 days.
Subclinical form is not clinically apparent. This is essentially salmonella-carrying. However, there is an increase in the titer of specific antibodies and morphological changes in the intestine( catarrh of the small intestine mucosa).
Carrier. After the transferred salmonellosis, acute( from 15 days to 3 months) or chronic( more than 3 months) bacteriocarrier can form. It is observed in children less often than in adults.
The development of carriage is promoted by adverse premorbid conditions. Slow liberation of the body from salmonella occurs when acute salmonella infection occurs against the background of exudative enteropathy, dysfermentosis, intestinal dysbiosis.
In addition, there is a transient, or "healthy", carrier. This kind of carrier is said in the event that the detection of the pathogen in the feces was not preceded by the acute form of salmonellosis. In addition, the results of a serological study( RNGA) with salmonella diagnosticum in dynamics should be negative.
Features of the course of salmonellosis in newborns and children of the first year of life.
Newborns and infants have the highest sensitivity to salmonella. It is for this age group that nosocomial infection and the contact route of infection are characteristic.
Clinical manifestations of salmonellosis in infants are very diverse.
With the development of the gastrointestinal form, an enterocolitis variant is often recorded. In this situation, it is characterized by a gradual increase in all symptoms, pronounced toxicosis, dehydration, frequent development of hemolite, hepatomegaly. The disease often takes place heavily.
It is for these age groups that the septic form of salmonellosis is characteristic.
In young children, the disease is often accompanied by the formation of complications: fermentopathy, intestinal dysbacteriosis, malabsorption syndrome, pneumonia, otitis, anemia, urinary tract infection, etc.
In 35% of patients, salmonellosis occurs as a mixed infection( with rotavirus gastroenteritis, UPI,shigellosis, acute respiratory infections).
Severe forms are more common in children with a burdened premorbid condition. Particularly adverse effects are associated with herpesviral and chlamydial infections. In this case, a lethal outcome is possible.
Features of the course of salmonellosis, depending on the serovar pathogen. The microbial landscape of salmonella, isolated from people( sick and carriers), varied. Annually, 15 to 39 serovars are allocated, but S. typhimurium prevails - 65% of the number of all the selected crops, followed by S. enteritidis - 23%.
Diseases caused by various salmonella serovars have their own peculiarities.
So, in case of salmonellosis caused by S. enteritidis, the gastroenteric is the predominant variant of the gastrointestinal form of the disease. Infection occurs by alimentary tract and is recorded in patients of different age groups. The disease proceeds in mild and moderate forms, quickly ending with recovery.
For salmonellosis caused by S. typhimurium, the predominant route of infection is the contact one. The disease can occur in different age groups, but more often infants are sick. For this salmonellosis is characterized by nosocomial infection. Clinically, the disease is characterized by the development of enterocolitis( in 80-90% of patients), a greater incidence of hemocolitis( in 50-70% of patients), prolonged bowel dysfunction( within 10-15 days), development of toxicosis, exsicosis, complications. The possibility of generalization of the infection is not ruled out.
The more severe course of salmonellosis caused by S. typhimurium is related both to the characteristics of the causative agent( primarily to multidrug resistance to antibiotics) and to the high incidence of nosocomial infection.
Salmonella has a complex identification system that includes the following features:
Salmonella bacteria also possess a wide range of enzymatic properties that F. Kaufman was used to base the division into 4 subgenus:
Salmonellae have 3 main antigens:
Specifica set of antigenic factors makes up the structure characteristic for each serovar. According to the Kaufmann-White classification, all salmonella are divided into 5 serological groups - A, B, C, D, E and rare groups( F-Z), each containing serovars, differing in H-antigen. Each antigen can have variations( Vi-antigen is a variation of O-antigen).
The identification of the O-bacteriophage, which lyses more than 97.55% of the Salmonella strains, is of great importance. Typical phages are known for S. typhimurium, S. enteritidis, S. dublin, etc.
S. typhimurium includes 90 phagotypes, which account for up to 90% of human diseases.
In humans, as a rule, about 100 serovars are caused, among which most often are S. typhimurium, S. enteritidis, S. helderberg, S. london, S. neuport, S. derbi, S. moskau, S. anatum andother
Host-adapted can cause disease, mainly in humans or only in certain species of animals and birds.
So, S. gallinarum, as a rule, cause disease in chickens, S. abortus-ovis - sheep, S. abortus-equi - in horses, S. cholerae-suis - in pigs.
However, it is known that these same serovars cause diseases not only in other animal species, but also humans.
S. typhi, S. paratyphi A and S. paratyphi C cause disease only in humans. Serovar S. paratyphi, being mainly a causative agent of infection in humans, is able to cause disease in cattle, causing epizootics in young animals and chickens.
The pathogenesis of salmonellosis is caused by a number of pathogenicity factors, among which the most important are adhesion, invasion and toxigenicity.
Adhesion is an element of colonization, i.e., the ability of the microorganism to multiply on the surface of the epithelium of a macroorganism. Special factors of adhesion in Salmonella are not found.
Adhesin functions are performed by fibrils, pectins and a lipopolysaccharide complex.
Invasiveness of is the ability of salmonellae to overcome the glycocleax and without significantly damaging the brush border to penetrate into the epithelial cells without destroying the cell membrane that surrounds the salmonella forms vacuoles. The latter are transferred first to the basal part of the epithelial cell, then to the underlying tissues. Salmonella, absorbed by macrophages, not only do not undergo phagocytosis, but persist and even reproduce;on the lymphatic ways get into the blood, which eventually leads to the generalization of the infectious process.
Salmonella toxins are divided into 2 types: exo- and endotoxins.
To exotoxins are the products of vital activity, actively secreted( produced) during the life of bacteria( most often with the function of lesion);endotoxins include those biologically active substances that are released only when the bacterial cell lysis.
In the pathogenesis of salmonellosis, the decisive role is recognized: endo- and exotoxin.
The endotoxin is a complex molecular complex consisting of protein, polysaccharide and lipid A.
The toxicity of the molecular complex is twofold:
A high level of cAMP activates enzyme systems that affect the permeability of membranes, causing an increase in the secretion of electrolytes and fluid.
Exotoxins - they include enterotoxins:
Salmonella antigens include the endotoxin complex, Vi-antigen, thermolabile and thermostable enterotoxins, cytotoxin.
A correlation was established between the severity of the course of the disease, the frequency and level of antigens in the blood, urine, coprofiltrates, the detection of which has diagnostic and prognostic value.
Epidemiology. The characteristics of epidemiology of salmonellosis include widespread distribution in the form of sporadic cases and epidemic outbreaks. The incidence of salmonella remains high among both adults and children. In 2005, 42 174 patients with salmonellosis were registered in the Russian Federation( incidence of 29.17 per 100 thousand of the population).Among those affected, 17,449 children under the age of 14 years( 41.4%).Especially high susceptibility to salmonellosis is observed in children under 2 years old( they account for 43.5 to 58.3%) and individuals with different types of immunodeficiency.
The main sources of infection are domestic farm animals( cattle, pigs), domestic birds( chickens, geese, ducks), cats, dogs, pigeons, wild birds, fish, etc.
The disease develops more often when eating meatand meat products, fish, abundantly seeded with salmonella. Infection of meat can occur during the slaughter of sick animals, improper cutting of carcasses, when meat is contaminated with the contents of the intestine, or if the rules for transportation and storage of meat and meat products are violated if they are contaminated with rodent secretions.
The person is very sensitive to toxins of pathogens of salmonellosis, which can cause massive diseases among people who used the infected product, massed with these microbes and their toxins.
Infectious agents can multiply and accumulate in infected milk and dairy products, confectionery, etc. if stored incorrectly.
Salmonellosis diseases are most often observed in the warm and especially hot season, which depends on the availability of favorable conditions for the propagation of pathogens in food and the greater prevalence of these diseases among livestock.
The greatest epidemiological danger is represented by agricultural animals and birds, in which salmonellosis can take the nature of epizootics.
An important role in the spread of infection belongs to man. The source of infection can be both a patient and a carrier. Infection of children occurs from adults in the process of caring for the child.
The main way of infection is alimentary, in which the leading factors of transmission are food products of animal origin( meat, meat products, eggs, milk and dairy products), fish, vegetables, fruits, berries. Salmonella-infested products do not change their appearance, taste qualities.
Water is often used as a direct or indirect factor in the transmission of infection. An aerogenic path of infection and contact-everyday infection is possible, which is mainly realized among young children. Transmission of the pathogen in this case occurs through the hands of caregivers, bedding, care products, equipment, etc.
Salmonellosis is recorded throughout the year, but more often in the summer months, which can be explained by the deterioration of food storage conditions.
A special epidemic form of the disease is the "hospital" salmonella. Most often, "hospital" salmonella emerges in resuscitation and children's infectious departments. Possible infection of children during their stay in maternity homes, somatic and surgical hospitals."Intrahospital" salmonellosis often occurs in young children, especially from "risk groups", but can develop in older patients with severe somatic pathology.
The peculiarity of "intrahospital" salmonellosis is monoetiology: the main causative agent is S. typhimurium, serovar R ", characterized by multiple resistance to antibacterial agents. The source of infection in these cases is only a person, most often sick children, less often - staff, mothers. The main way of transmission of infection in these situations is contact. Foci of "hospital" salmonellosis is characterized by gradual development, long-term existence, occurrence mainly in the cold season.
One of the characteristics of salmonellosis is the variability of the etiological structure. Prior to 1986, the serovar S. typhimurium dominated, with the incidence of most cases due to hospital strains.
Since 1986, S. enteritidis has become a significant part of the population, with which a number of outbreaks and group diseases are associated.
S. enteritidis and the diseases caused by them have become widespread on a background of intensive industrial poultry farming. In most cases, the source of infection is the chickens, and the leading factor in the transmission of infection is chicken, eggs.
Pathogenesis of .The pathogenesis of salmonellosis is based on a set of successive stages that constitute a complex system of interactions between the host parasite.
The disease develops only when living bacteria and their toxins enter the gastrointestinal tract at the same time.
Salmonellosis pathogens are localized in the mucosa and the submucosal intestine, causing hypersecretion and increased intestinal peristalsis. Part of the pathogens through the lymphatic apparatus of the intestine falls into the flow of blood and causes bacteremia. Endotoxin, released during the death of salmonella, affects various organs and systems of the body. First of all, the vascular-nervous apparatus is affected, which is manifested in an increase in the permeability and a decrease in the vascular tone, in the violation of thermoregulation.
The development of salmonellosis is associated with two main factors of the pathogen: infectious and toxic. The dominant factor determines the clinical picture of the disease.
With a massive dose of infection in the upper sections of the gastrointestinal tract, a massive death of salmonella occurs, accompanied by autolysis of bacterial cells with the release of endotoxin and other toxic products. Toxic factor is the leading triggering mechanism of the disease, causing a rapidly developing picture of the toxicoinfection.
With a small dose of infection, the phenomenon of intoxication appears only in the acute period of the disease. The trigger mechanism is the colonization and reproduction of salmonella first in the small intestine, then in other organs, so the infectious process is cyclical, as a result of which generalized or septic forms can develop. The variety of clinical forms of salmonellosis depends on the following factors:
The general scheme for the development of the pathological process includes the following stages:
In the following it is possible to eliminate the pathogen with the reverse development of pathological processes, but also possible long-term bacterial transport.
Immunity. The immune response to salmonella aggression depends on the severity of the disease, the age of the children, the serovar pathogen, the development of mixed infection. The most pronounced and prolonged immune disorders occur in severe forms, in infants, in diseases caused by S. typhimurium and occurring with a stratification of respiratory infection.
With the depletion of adaptive mechanisms, a "weak" type of immune response develops, which is characterized by a sharp decrease in the number of T-lymphocytes and their subpopulations, inhibition of phagocytosis, a lack of switching of antibody synthesis with IgM on IgG, activation of complementary serum activity, and significant accumulation of CIC in the blood.
"Strong" type of response is expressed by a moderate decrease in the T-lymphocytes and their subpopulations, activation of the B-link of the immune system, intensification of phagocytosis processes, safety of neutrophil adaptive reserves, increase in complementary blood activity and CEC level, absence of switching of IgM synthesis to IgG( A.Azizurakhman, 1995).
These immune shifts are the basis of the formation of inflammatory reactions. In moderately severe forms, these changes are protective and adaptive, aimed at restoring homeostasis. In severe forms, they reflect the "sex" in the body.
Pathomorphology. In salmonellosis, the main changes develop in the intestine: in the small intestine there is catarrhal inflammation, in the thick intestine there is catarrhal-hemorrhagic, follicular-hemorrhagic, fibrinous, ulcerative and ulcerative diphtheria. The nature of inflammation depends on the severity of the infectious process and largely determines the local clinical manifestations of salmonellosis.
Simultaneously with the intestine, changes develop in the stomach, mesenteric lymph nodes, internal organs. In particular, in the mucous membrane of the stomach, dystrophy and slushing of the epithelium, edema, hyperemia occur, cell infiltration of the native layer is enhanced.
Degenerative changes are observed in the liver, heart muscle, spleen.
In septic form of salmonellosis in various organs( brain and its membranes, lungs, kidneys, liver, etc.), metastatic foci are detected.
In cases of lethal outcomes in salmonellosis, deep dystrophic changes in the parenchymal organs and hemorrhages are detected. Swelling of the lungs and the brain often serves as the direct cause of death.
Features of nosocomial salmonellosis. The following factors contribute to the appearance and circulation of salmonella in somatic compartments, followed by the formation of "hospital-acquired salmonellosis":
Formation of resistance to most drugs in S. typhimurium serovar R ".
Criteria for "hospital" salmonellosis:
Diagnosis is based on clinical data, carefully collected epidemiological history and laboratory studies.
Vomit( 50-100 ml), stomach washings( 100-200 ml), bowel movements( 10-20 ml) in sterile or boiled jars, and blood( 5-10 ml) per culture are sent to the laboratory.
After a week, you can put the agglutination reaction, for which 1-2 ml of blood is sent to the laboratory from the finger or from the vein.
Diagnosis of salmonella infection in children is carried out on the basis of the following criteria:
Epidemiological data allow to establish contact with a similar infectious patient;the use of poor quality food;stay in the hospital in the next 7 days.
Clinical diagnosis is performed on the basis of the main syndrome:
In addition, after a general blood test, it is possible to detect leukocytosis from moderate to severe, neutrophilia with a shift to the left, increasing POPs. With prolonged course of the disease, anemia may develop.
The final diagnosis of salmonellosis is established on the basis of laboratory data, the basic bacteriological and immunological methods.
Bacteriological methods are aimed at isolating the pathogen from feces, blood, urine and affected organs.
Treatment of .Light forms of salmonellosis do not require treatment and patients often do not resort to medical care. With more severe forms of the disease, it is necessary to wash the stomach with warm water or 0.5-1% solution of baking soda. Rinsing is carried out with the help of a gastric tube or give the patient several times to drink 4-5 glasses of warm water or a solution of baking soda, and then cause vomiting. After washing, a laxative is prescribed( 25 g magnesium sulfate).With severe intoxication, subcutaneous or intravenous injections of 1000-1500 ml of physiological solution in half with 5% glucose solution. In those cases when the patient does not stop vomiting, intravenously pour a hypertonic solution of sodium chloride( 10-20 ml of 10% solution).According to the indications, cardiovascular agents are prescribed: caffeine, cordyamine, ephedrine. In the state of collapse intravenously injected anti-shock fluid Polosquin( 2.5 grams of sodium chloride, 0.5 g of sodium thiosulfate, 1.5 g of calcium chloride, 500 ml of distilled water) 300-500 ml for 15-20 minutes. In case of severe collapse under the control of arterial pressure, 500-1000 ml of polyglucin are injected intravenously( children - at the rate of 10-15 ml per 1 kg of weight).
For severe forms of salmonellosis, it is recommended to inject intravenously, drip( 50-60 drops per Minute), for a single dose of 300-400 ml for an adult and 5-15 ml for 1 kg of a child's weight.more When seizures and shudder are shown warmers to the feet, warm baths
After stopping of vomiting with typhoid and septic forms, antibiotic treatment is prescribed, depending on the indications, give levomycetin inside 0.5 g 4-5 times a day
Prophylaxis .Preventive measuressalmonellosis include sanitary and veterinary supervision of slaughter, careful sanitary supervision in slaughterhouses, proper storage and transportation of meat to prevent its contamination, destruction of rodents, storage of food at low temperatures, their reliable heat treatment, prevention of joint processing of raw and boiled products;timely detection and isolation of patients and carriers of salmonella, compliance with personal hygiene rules.
It is very important to prevent the slaughter of diseased animals in conjunction with a healthy one, as well as to inspect and hold healthy cattle before slaughtering after transportation, hauling, etc. Meat from compulsorily slaughtered cattle should be used centrally, where it is subjected to prolonged heat treatment. Specific prophylaxis is absent.
Events in the hearth. Patients are to be hospitalized. Before the hospitalization of the patient or until recovery, if it is isolated at home, current disinfection is carried out in the hearth, and after finalization or recovery the patient is disinfected.
For persons in contact with the patient, medical supervision is established within the next 6-7 days for the purpose of early detection of possible diseases and carry out a single examination for carriage( excreta and urine).
The discharge of patients from the hospital is performed after complete clinical recovery and a twofold bacteriological study of feces and urine with a negative result.
Admission of children who have been ill with salmonellosis to children's institutions, as well as workers of food enterprises and persons equal to them, is allowed to work after additional clinical observation for 15 days and triplicate testing for carriage of salmonella.
After discharge from the hospital, the patients recovered are examined three times( with an interval of 3-5 days) for carriage during a monthly clinical observation.
Activities held in the team .In case of group illnesses, patients are provided with medical assistance and conduct an epidemiological examination to identify the food product that caused the poisoning and the circumstances that contributed to its infection.
Revealed food products are withdrawn from circulation and take measures to prevent new cases of the disease. Activities to prevent salmonellosis are carried out jointly by epidemiologists and sanitary doctors.