Salmonellosis: symptoms and treatment, signs, prevention
What it is? Salmonellosis is a disease from a group of intestinal infections transmitted from animals, a sick person and a carrier of infection to a healthy person by a fecal-oral route.
When entering the human intestine, the bacteria of the genus Salmonella cause intoxication and loss of fluid and electrolytes with diarrhea and vomiting;it is also possible to develop generalized forms of pathology.
In the absence of treatment, the disease almost always leads to severe complications and can result in death of a person.
The causative agent of the disease in children and adults is the gram-negative rod Salmonella, which can live both in the affected cell and outside it. Along the perimeter of most of these bacteria are flagella, which provide their owners some mobility.
Bacteria resistant in the environment:
At the moment, around 2300 types of these bacteria are isolated in the world, which are divided according to their antigenic structure into different variants( serovars) and groups.
The main toxic factor for humans is endotoxin, which is a unit of the bacterial cell wall. It is released into the intestines of the infected person during the breakdown of salmonella, absorbed into the blood. It is he that causes symptoms of intoxication, raises the body temperature of a person, triggers allergic reactions in the body.
There is also a second toxin, which is synthesized in the intestine by live salmonella. The degree of its toxicity depends on what type and type of bacteria got into the body. This toxin, affecting the cells of the human intestine, causes diarrhea, impaired absorption of water and electrolytes through the intestine.
Salmonellosis can proceed in different ways, and it will depend not so much on the initial state of the organism as on the pathogenicity of the Salmonella that comes to it, which depends on such factors:
Sources of infection - people, birds, warm-blooded animals. Especially dangerous in terms of infection are cattle and pigs, in which the bacterium does not always cause the disease, but can form a carrier. Such animals actively extract salmonella with feces, it gets into their milk and meat. Used in the absence of proper heat treatment such products cause a person salmonellosis.
An important role in the spread of salmonella is also played by birds, in which not only eggs but also meat are infected. A person becomes infected by drinking raw or eating an unprocessed egg of such a bird( especially in this regard, the yolk is dangerous), using not enough thermally processed meat.
It can also get infected if it does not wash your hands after touching the items on which the bird droppings were kept. If salmonella enters the poultry farm, then it not only spreads quickly among adults, but is also transmitted from the infected bird to its next generation in the egg.
Rodents, pets and "urban" birds( pigeons, sparrows) can also be sources of infection.
Among people, carriers of Salmonella are dangerous as a source of infection. They do not have clinical signs of the disease, however, they produce a fairly large number of bacteria with feces, which can continue even within a year. Such bacteria may already be resistant to a large number of antibiotics if the carrier person underwent treatment for salmonellosis.
Periodically registered and hospital outbreaks of this disease. They are especially dangerous in maternity hospitals or children's hospitals: children, especially up to one year of age, have a special susceptibility to these bacteria.
Bacteria are transmitted:
1) By fecal-oral route:
The incidence increases in the warm and hot season( this is due to the storage feature), but nosocomial outbreaks, especially in children's hospitals, occur during the cold season.
Also read the symptoms and treatment of intestinal infection.
In adults, salmonellosis occurs in several basic forms. The course of it can be as erased, and very heavy, when in the first hours of the emergence of pathology complications develop.
The severity of the symptoms of salmonella depends not only on the characteristics and dose of bacteria that enter the body.
Disease is more severe in such persons:
Gastrointestinal form - the most frequent scenario of the disease. In this case, the disease develops suddenly. First signs:
If you help at this stage( drink "Activated charcoal", wash the stomach well), then diarrhea can be avoided( then it will be called a gastritic variant).If there was a long( more than a day) incubation period, nausea and vomiting may not be.
Somewhat later, vomiting develops diarrhea, which is accompanied by pain in the upper half of the abdomen. The stool is liquid, fetid, initially can have a fecal character, then resembles water with green marsh mud. Diarrhea can be observed 10 or more times a day.
Reminds the first variant, but by the second or third day the volume of fluid lost with feces decreases, blood and mucus can be detected in the stool. The large intestine becomes painful during palpation, and the act of defecation can be accompanied by painful spasms of the intestine - tenesmus.
This form is rare in pure salmonellosis - it is observed either when a mixed pathogenic microflora enters the intestine, or when the colon's disease is accompanied by constipation.
occurs much less frequently. It is life-threatening, it can take one of these options:
1) Typhoid-like variant. It is characterized by a sharp beginning. The first appears chill, the temperature rises, there is weakness, lethargy. In the first day or two, there are diarrhea, nausea, vomiting. Then the intestinal manifestations disappear, and the temperature remains high, weakness, headache, dizziness increase.
The fever acquires a wavy character. On the 5th-7th day, a specific pale pink rash of a polygonal shape may appear on the skin of the abdomen, which then acquires a more rounded appearance. The diameter of such elements is 1-3 mm, they are called "roseola".In addition, there may be a decrease in blood pressure and a decrease in heart rate( less than 65 beats per minute in an adult and a child over 14).
2) The septicopyemic variant develops when two kinds of Salmonella - S. typhimurium and S. cholerae suis enter the body with weakened immunity. This begins with a fever, a fever accompanied by severe sweating and increased heart rate( above 90 per minute in adults and children older than 14 years).
The condition of patients progressively worsens. At the forefront of the lesions of internal organs( especially the liver, kidneys, lungs);liquid stools are single or observed several times. In these patients, a disturbance of consciousness develops rapidly;can be symptomatic of meningitis, endocarditis, liver abscess, osteomyelitis and other pathologies. These diseases will not complicate salmonellosis, but the peculiarities of its course. This form ends most often lethal.
Bacteriovenosis can be observed from several weeks to several years. Even cases of lifelong allocation of salmonella with feces are described. This form can be detected by chance, when a person is examined, and not only after the transferred salmonella. Bacteriosis is dangerous for others, and not for the carrier itself, so it must be treated.
It is possible to suspect this disease in adults according to its clinical pattern, by the characteristic kind of stool, by the fact that in the general blood test there are high numbers of leukocytes with a stab-shift.
The same diagnosis is confirmed by the excretion of the pathogen( salmonella) from:
With the 4th-5th day of the disease, the diagnosis can also be confirmed by detecting antibodies to Salmonella in the blood in high titers. For this, the reactions of RPHA, RNGA are used. From the second week, RA and DAC become positive. These analyzes are taken in dynamics, they are more suitable for the diagnosis of retrospective.
Salmonella therapy should be performed in an infectious inpatient setting. Treatment consists of the following stages:
It is possible to list such main types of complications:
There is no special vaccine against salmonellosis. The main prevention is:
When entering the human intestine, the bacteria of the genus Salmonella cause intoxication and loss of fluid and electrolytes with diarrhea and vomiting;it is also possible to develop generalized forms of pathology.
In the absence of treatment, the disease almost always leads to severe complications and can result in death of a person.
Characteristics of the causative agent of salmonellosis
The causative agent of the disease in children and adults is the gram-negative rod Salmonella, which can live both in the affected cell and outside it. Along the perimeter of most of these bacteria are flagella, which provide their owners some mobility.
Bacteria resistant in the environment:
- in raw water live about 4 months;
- in household dust - up to a year and a half;
- in meat stored in the freezer - about a year;
- in milk - almost a month;
- for up to 2 months in beer, sausage and unfrozen meat.
At the moment, around 2300 types of these bacteria are isolated in the world, which are divided according to their antigenic structure into different variants( serovars) and groups.
The main toxic factor for humans is endotoxin, which is a unit of the bacterial cell wall. It is released into the intestines of the infected person during the breakdown of salmonella, absorbed into the blood. It is he that causes symptoms of intoxication, raises the body temperature of a person, triggers allergic reactions in the body.
There is also a second toxin, which is synthesized in the intestine by live salmonella. The degree of its toxicity depends on what type and type of bacteria got into the body. This toxin, affecting the cells of the human intestine, causes diarrhea, impaired absorption of water and electrolytes through the intestine.
Salmonellosis can proceed in different ways, and it will depend not so much on the initial state of the organism as on the pathogenicity of the Salmonella that comes to it, which depends on such factors:
- the ability to parasitize inside the cell;
- the presence of structures that allow salmonella to stick to the host cell;
- the ability to multiply not only in the intestines, but also other organs and tissues;
- endotoxin formulation;
- ability to form L-forms and form resistance to antibiotics;
- is a composition of enzymes that allow bacteria to enter the cell;
- the ability to enter the blood and spread to different organs and tissues.
Reasons: how can you catch salmonellosis
Sources of infection - people, birds, warm-blooded animals. Especially dangerous in terms of infection are cattle and pigs, in which the bacterium does not always cause the disease, but can form a carrier. Such animals actively extract salmonella with feces, it gets into their milk and meat. Used in the absence of proper heat treatment such products cause a person salmonellosis.
An important role in the spread of salmonella is also played by birds, in which not only eggs but also meat are infected. A person becomes infected by drinking raw or eating an unprocessed egg of such a bird( especially in this regard, the yolk is dangerous), using not enough thermally processed meat.
It can also get infected if it does not wash your hands after touching the items on which the bird droppings were kept. If salmonella enters the poultry farm, then it not only spreads quickly among adults, but is also transmitted from the infected bird to its next generation in the egg.
Rodents, pets and "urban" birds( pigeons, sparrows) can also be sources of infection.
Among people, carriers of Salmonella are dangerous as a source of infection. They do not have clinical signs of the disease, however, they produce a fairly large number of bacteria with feces, which can continue even within a year. Such bacteria may already be resistant to a large number of antibiotics if the carrier person underwent treatment for salmonellosis.
Periodically registered and hospital outbreaks of this disease. They are especially dangerous in maternity hospitals or children's hospitals: children, especially up to one year of age, have a special susceptibility to these bacteria.
Bacteria are transmitted:
1) By fecal-oral route:
- basically, through food - meat and dairy dishes, less often - through vegetable and fish products;
- , the waterway of spread of infection prevails when animals and birds are infected, meat, milk and eggs are later consumed by people;
- is important and the air-dust path, when a person becomes infected when he gets into the mouth of dust in which bacteria were stored from dried bird droppings.
- through the dishes;
- personal care items;
- through a medical tool;
- door handles;
- the hands of the mother or medical personnel;
- swaddling tables;
- arenas.
The incidence increases in the warm and hot season( this is due to the storage feature), but nosocomial outbreaks, especially in children's hospitals, occur during the cold season.
Also read the symptoms and treatment of intestinal infection.
Symptoms of salmonellosis
In adults, salmonellosis occurs in several basic forms. The course of it can be as erased, and very heavy, when in the first hours of the emergence of pathology complications develop.
The severity of the symptoms of salmonella depends not only on the characteristics and dose of bacteria that enter the body.
Disease is more severe in such persons:
- 1) Children under 2 years;
- 2) People who suffer from anemia of various kinds( they have septic forms of pathology);
- 3) Persons with a distended stomach or suffering from gastritis with a low secretion of gastric juice;
- 4) Having an initial intestinal dysbiosis;
- 5) Against the background of already existing inflammatory or traumatic pathologies.
Gastrointestinal form - the most frequent scenario of the disease. In this case, the disease develops suddenly. First signs:
- weakness;
- loss of consciousness;
- headache;
- dizziness;
- severe abdominal pain.
If you help at this stage( drink "Activated charcoal", wash the stomach well), then diarrhea can be avoided( then it will be called a gastritic variant).If there was a long( more than a day) incubation period, nausea and vomiting may not be.
Somewhat later, vomiting develops diarrhea, which is accompanied by pain in the upper half of the abdomen. The stool is liquid, fetid, initially can have a fecal character, then resembles water with green marsh mud. Diarrhea can be observed 10 or more times a day.
Enterocolitis form of salmonellosis
Reminds the first variant, but by the second or third day the volume of fluid lost with feces decreases, blood and mucus can be detected in the stool. The large intestine becomes painful during palpation, and the act of defecation can be accompanied by painful spasms of the intestine - tenesmus.
This form is rare in pure salmonellosis - it is observed either when a mixed pathogenic microflora enters the intestine, or when the colon's disease is accompanied by constipation.
The generalized form of salmonellosis
occurs much less frequently. It is life-threatening, it can take one of these options:
1) Typhoid-like variant. It is characterized by a sharp beginning. The first appears chill, the temperature rises, there is weakness, lethargy. In the first day or two, there are diarrhea, nausea, vomiting. Then the intestinal manifestations disappear, and the temperature remains high, weakness, headache, dizziness increase.
The fever acquires a wavy character. On the 5th-7th day, a specific pale pink rash of a polygonal shape may appear on the skin of the abdomen, which then acquires a more rounded appearance. The diameter of such elements is 1-3 mm, they are called "roseola".In addition, there may be a decrease in blood pressure and a decrease in heart rate( less than 65 beats per minute in an adult and a child over 14).
2) The septicopyemic variant develops when two kinds of Salmonella - S. typhimurium and S. cholerae suis enter the body with weakened immunity. This begins with a fever, a fever accompanied by severe sweating and increased heart rate( above 90 per minute in adults and children older than 14 years).
The condition of patients progressively worsens. At the forefront of the lesions of internal organs( especially the liver, kidneys, lungs);liquid stools are single or observed several times. In these patients, a disturbance of consciousness develops rapidly;can be symptomatic of meningitis, endocarditis, liver abscess, osteomyelitis and other pathologies. These diseases will not complicate salmonellosis, but the peculiarities of its course. This form ends most often lethal.
Bacteriovenosis can be observed from several weeks to several years. Even cases of lifelong allocation of salmonella with feces are described. This form can be detected by chance, when a person is examined, and not only after the transferred salmonella. Bacteriosis is dangerous for others, and not for the carrier itself, so it must be treated.
Diagnosis of salmonellosis
It is possible to suspect this disease in adults according to its clinical pattern, by the characteristic kind of stool, by the fact that in the general blood test there are high numbers of leukocytes with a stab-shift.
The same diagnosis is confirmed by the excretion of the pathogen( salmonella) from:
- feces;
- vomit;
- washing water;
- urine;
- blood;
- contents of ulcers.
With the 4th-5th day of the disease, the diagnosis can also be confirmed by detecting antibodies to Salmonella in the blood in high titers. For this, the reactions of RPHA, RNGA are used. From the second week, RA and DAC become positive. These analyzes are taken in dynamics, they are more suitable for the diagnosis of retrospective.
Treatment of salmonellosis
Salmonella therapy should be performed in an infectious inpatient setting. Treatment consists of the following stages:
- 1) Rehydration, that is, replenishment of the lost volume of fluid by intravenous administration of saline polyionic solutions and 5% glucose. Droppers with solutions of sodium chloride, Ringer, Phillips, Acesol, Trisol and others are placed depending on the electrolyte composition of the patient's blood. In addition to the intravenous route, the patient is also treated with a solution of "Regidron", "Human Electrolyte" and others in small volumes.
- 2) Inside take the maximum possible dose of sorbents - Smekty, Polysorba and others. This helps the toxins of bacteria to bind and go with feces, and not to exert their pathogenic effect on the whole organism.
- 3) Antibacterial therapy for salmonellosis usually consists of taking 1-2 antibiotics, which in the first 3-5 days are administered either intramuscularly or intravenously. Only with a decrease in the symptoms of intoxication, the level of inflammation and the improvement of the general condition is it possible to switch to the use of tableted antibiotics.
Complications of salmonellosis
It is possible to list such main types of complications:
- 1) Collapse.
- 2) Shocks: infectious-toxic( with the disintegration of a large number of microbes in the body) and hypovolemic( with loss of a large amount of fluid with diarrhea and vomiting).
- 3) Toxic reversible brain damage - encephalopathy.
- 4) Violation of the blood coagulation system.
- 5) Pancreatitis.
- 6) Reactive arthritis.
- 7) Pneumonia.
- 8) Urinary tract infection.
Prevention measures
There is no special vaccine against salmonellosis. The main prevention is:
- compliance with personal hygiene measures;
- boiling milk;
- good heat treatment of meat, fish, poultry;
- refusal to drink raw eggs, eating fried eggs;
- abolition of antibiotics only after a negative stool culture;
- vaccination of farm animals.