Treatment for Salmonella Infection

Salmonella infections usually resolve in five to seven days, and many times require no treatment unless the patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhea may require re-hydration, often with intravenous fluids. Treatment with antibiotics is not usually necessary; however, if the infection spreads from the intestines, or otherwise persists, the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, ceftriaxone, amoxicillin, or ciprofloxacin. The length of treatment varies depending on the extent of a patients illness, and can range from 14 days for enteric fever to six weeks for bactremia (Mayo Clinic, 2007, April 12). Some Salmonella bacteria have become antibiotic-resistant. Consult your healthcare provider if you believe you have become ill with salmonellosis.

Antimicrobial Resistance in Salmonella Bacteria

Antimicrobial resistance in bacteria is an emerging and increasing threat to human health. Physicians should be aware that antimicrobial resistance is increasing in foodborne pathogens and that patients who are prescribed antibiotics are at increased risk for acquiring antimicrobial-resistant foodborne infections. In addition, increased frequency of treatment failures for acute illness and increased severity of infection may be manifested by prolonged duration of illness, increased frequency of bloodstream infections, increased hospitalization or increased mortality, (Angulo, Nargund, & Chiller, 2004). The use of antimicrobial agents in the feed of food animals is estimated by the FDA to be over 100 million pounds per year. Estimates range from 36 to 70 percent of all antibiotics produced in the United States are used in a food animal feed or in prophylactic treatment to prevent animal disease. In 2002, the Minnesota Medical Association published an article by David Wallinga, M.D., M.P.H. who wrote: According to the [Union of Concerned Scientists], 70 percent of all the antimicrobials used in the United States for all purposesor about 24.6 million pounds annuallyare fed to poultry, swine, and beef cattle for nontherapeutic purposes, in the absence of disease. Over half are medically important antimicrobials, identical or so closely related to human medicines that resistance to the animal drug can confer resistance to the similar human drug. Penicillins, tetracyclines, macrolides, streptogramins, and sulfonamides are prominent examples. (Wallinga, 2002). The National Antimicrobial Resistance Monitoring System (NARMS) reported that Campylobacter has been recovered from 47 percent of chicken breasts tested in recent studies. In the same NARMS studies, five multi-drug resistant strains of Salmonella Newport were recovered from ground beef, ground turkey, and pork chops. According to the report, antimicrobial resistance among these foodborne bacteria is not uncommon and often associated with the use of antimicrobial agents in food animals, (Stevenson, et al., 2002). Ceftriaxone-resistant Salmonella has also been reported (Fey et al.,

2000). The emergence of multidrug-resistant Salmonella typhimurium in the United States is another example of a drug-resistant bacteria spreading from animals to humans (Glynn et al., 1998). CDC reports: A large proportion of serotype Typhimurium isolates were resistant to multiple antimicrobial drugs; in a 2003 national survey, 45% were resistant to one or more drugs and 26% had a five-drug resistance pattern characteristic of a single phage type, DT104 (2). Similarly, serotype Newport has emerged as a major multidrug-resistant pathogen (CDC, 2007). The use of antibiotics in feed for food animals, on animals prophylactically to prevent disease, and the use of antibiotics in humans unnecessarily must be reduced. European countries have reduced the use of antibiotics in animal feed and have seen a corresponding reduction in antibiotic-resistant illnesses in humans (Angulo, Baker, et al., 2004).

Symptoms of Salmonella Infection

An infectious dose of Salmonella is small, probably from 15 to 20 cells. Typically, nontyphoidal Salmonella produces a self-limiting febrile gastrointestinal illness that is indistinguishable from that caused by other bacterial enteric pathogens. Dehydration is the principal clinical concern. The incubation period the time between ingestion of Salmonella bacteria and the onset of illness varies from six to 72 hours (Mayo Clinic, 2007, April 12; MMWR Recomm Rep, 2001). Salmonella can cause three different kinds of illness: gastroenteritis, typhoid fever, and bacteremia. Symptoms of Salmonella gastroenteritis include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. In mild cases diarrhea may be non-bloody, occur several times per day, and not be very voluminous; in severe cases it may be frequent, bloody and/or mucoid, and of high volume. Fever generally occurs in the 100F to 102F (38C to 39C) range. Vomiting is less common than diarrhea. Headaches, myalgias (muscle pain), and arthralgias (joint pain) are often reported as well. Whereas the diarrhea typically lasts 24 to 72 hours, patients often report fatigue and other nonspecific symptoms lasting 7 days or longer.

Complications of Salmonella Infection

Typhoid fever, also known as enteric fever, is caused by Salmonella serotype typhi. The onset of symptoms usually occurs between 5 and 21 days after ingestion of Salmonela typhi bacteria. Symptoms may include constipation, cough, sore throat, headache, and a rash on the infected individuals chest, as well as the slowing of the heartbeat and enlargement of the liver and spleen (Mayo Clinic, 2007, April 12). Bacteremia is characterized by infection of tissues surrounding the brain and spinal cord (meningitis) and infection within the bloodstream (sepsis). This condition occurs when Salmonella enter and circulate within an infected individuals bloodstream, and is accompanied by few symptoms (Mayo Clinic, 2007, April 12). Reiters syndrome, which includes and is sometimes referred to as reactive arthritis is an uncommon, but debilitating, result of a Salmonella infection. Reiters syndrome is a disorder that causes at least two of three seemingly unrelated symptoms: reactive arthritis, eye irritation, and urinary tract infection (Hill Gaston & Lillicrap, 2003). The reactive arthritis associated with Reiters develops when a person eats food that has been tainted with bacteria. Reactive arthritis is characterized by the inflammation of one or more joints following an infection localized in another portion of the body, commonly the gastrointestinal tract. The symptoms of Reiters Syndrome usually occur between one and three weeks after the infection. The three most common symptoms of Reiters syndrome are arthritis, eye irritation, and urinary tract symptoms. The arthritis associated with Reiters syndrome typically affects the knees, ankles, and feet, causing pain and swelling. Wrists, fingers and other joints can be

affected, though with less frequency. Patients with Reiters syndrome commonly develop inflammation where the tendon attaches to the bone, a condition called enthesopathy. Some patients with Reiters syndrome also develop heel spurs, bony growths in the heel that cause chronic or long-lasting foot pain. Arthritis from Reiters syndrome can also affect the joints of the back and cause spondylitis, inflammation of the vertebrae in the spinal column. The duration of reactive arthritis symptoms can vary greatly. Most of the literature suggests that the majority of patients recover within a year. The condition, can, however, be permanent. One study found nearly 50 percent of patients with post dysenteric reactive arthritis continued to have symptoms roughly one year after onset (Inman, et al., 1998). The involvement of the eye in Reiters syndrome is most commonly manifested as conjunctivitis, inflammation of the mucous membrane that covers the eyeball, or uveitis, an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. The third site for Reiters syndrome symptoms is the urogenital tract. This includes the prostate, urethra, and penis in men and the fallopian tubes, uterus, and vagina in women. Men may notice an increased need to urinate, a burning sensation when urinating, and a discharge from the penis. Some men also develop prostatitis. Symptoms of prostatitis include fever, chills, increased need to urinate, and a burning sensation when urinating.