Cerrada)
17 AUGUST 2017
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The definitive diagnosis of enteric fever requires the isolation of S. - advised to monitor their food and water intake carefully
typhi or S. paratyphi from blood, bone marrow, other sterile sites, consider vaccination
rose spots, stool, or intestinal secretions. z Three vaccine alternatives are available:
o sensitivity of blood culture is only 4080%, may de due to 1. a heat-killed, phenol-extracted, whole-cell vaccine (two
high rates of antibiotic use parenteral doses)- min. age of 6 years old
Bone marrow culture is 5590% sensitive, and, unlike that of blood 2. Ty21a-attenuated S. typhi vaccine (four oral doses)- min.
culture, its yield is not reduced by up to 5 days of prior antibiotic age of 2 years old
therapy. 3. ViCPS consisting of purified Vi polysaccharide from the
Culture of intestinal secretions (best obtained by a noninvasive bacterial capsule (one parenteral dose)- min. age of 6
duodenal string test) can be positive despite a negative bone marrow months
culture. z CDC
If blood, bone marrow, and intestinal secretions are all cultured, the 1. A persons traveling to developing countries who will have
yield is >90%. prolonged exposure to contaminated food and water or close
Stool cultures, although negative in 6070% of cases during the first contact with indigenous populations in rural areas
week, can become positive during the third week of infection in 2. domestic vaccination includes people who have intimate or
untreated patients. household contact with a chronic carrier
Serologic tests including the classic Widal test for "febrile 3. laboratory workers who frequently work with S. typhi
agglutinins" z Given the decreased incidence of side effects and the similar short-
high rates of false-positivity and false-negativity not term efficacy the current bias is toward vaccination of travelers with
clinically useful either Ty21a or ViCPS.
Polymerase chain reaction, DNA probe assays being developed
NON- TYPHOIDAL SALMONELLOSIS
TREATMENT: Unlike S. typhi and S. paratyphi, whose only reservoir is humans,
z Chloramphenicol- standard treatment for enteric fever until the nontyphoidal salmonellosis is acquired from multiple animal
emergence of plasmid-mediated resistance reservoirs
z Ampicillin, trimethoprim-sulfamethoxazole - mainstays of treatment main mode of transmission
food products contaminated with animal products or waste
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Quinolones or 3 gen. For MDR S. typhi. most commonly eggs and poultry
cephalosporins undercooked meat
Ceftriaxone (1- 2 gm IV or IM for 80% effective, 6- weeks duration unpasteurized dairy products, seafood fresh produce
10- 14 days is equivalent to oral z S. enteritidis associated with chicken eggs is emerging as a major
or IV chloramphenicol for cause of food-borne disease.
susceptible strains
CLINICAL MANIFESTATIONS:
amoxicillin, TMP-SMZ,
z Gastroenteritis
ciprofloxacin, or norfloxacin
- indistinguishable from that caused by other enteric pathogens.
Surgical correction In cases of anatomic abnormality
- Nausea, vomiting, and diarrhea occur 648 h after the
ingestion of contaminated food or water.
- Patients often experience abdominal cramping and fever (38
39C; 100.5102.2F).
- Diarrheal stools are usually loose, non- bloody, and of
moderate volume.
- Usually self-limited
Diarrhea resolves within 37 days and fever within 72 h.
- Stool cultures remain positive for 45 weeks after infection
andin rare cases of chronic carriage (<1%)for >1 year.
- Antibiotic treatment usually is not recommended and may
prolong fecal carriage.
z Reactive arthritis (Reiter's syndrome) can follow Salmonella
gastroenteritis
- seen most frequently in persons with the HLA-B27
histocompatibility antigen
z rare soft tissue infections - usually at sites of local trauma in
immunosuppressed patients
DIAGNOSIS:
1. Stool
2. Blood culture
TREATMENT:
z Antibiotic treatment not generally recommended associated with
increased rates of relapse and prolonged gastrointestinal carriage
z Patients with AIDS and Salmonella bacteremia should receive 1 to 2
weeks of intravenous antibiotic therapy followed by 4 weeks of oral
therapy with quinolones
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