Salmonellosis is an acute infectious disease caused by bacteria of the genus Salmonella, with a fecal-oral transmission mechanism, occurring with a primary lesion of the gastrointestinal tract. The nature of the course of the disease differs in each specific case, from asymptomatic damage to severe forms with toxic and dehydration shock. Pathogenic pathogens enter the body, most often, after consuming contaminated food, due to improper cooking of food.
Salmonellosis has its own disease code in accordance with the ICD 2010 (International Classification of Diseases 2010) - A02.
Prevalence and adverse outcome
The source of infection is animals and humans (sick and bacteria carrier). The main role in the spread of salmonellosis belongs to animals in which the infection may be asymptomatic (bacteriocarrier), or with pronounced manifestations. For humans, the greatest danger is represented by domestic animals, as well as livestock intended for slaughter, cattle, pigs. With the development of epidemic forms, the level of infection in poultry can reach more than 50%, pigs - 2.8-20%, sheep and goats -1.8-4.4%.
It should be noted that not only sick animals with vivid symptoms of salmonellosis are dangerous for people, but also outwardly healthy carriers without a pronounced clinic of symptoms. As soon as the body is subjected to stress or hypothermia, weakens and can no longer restrain the development of Salmonella, active inflammation in the intestine begins with the generalization of the process of blood flow throughout the body, where Salmonella is introduced into various organs and tissues.
Salmonellosis is a common intestinal infection. Over the past 10 years there has been a tendency to increase the incidence of various groups of patients. Often, intestinal infections are considered diseases that are more typical for disadvantaged areas, for disadvantaged and polluted settlements. This does not apply to salmonellosis, since it is equally common in large, well-appointed cities and in less civilized areas, that is, everywhere where there are animals or food products of animal origin.
The increase in the prevalence of the disease contributes to the intensification of animal husbandry, when the cultivation, slaughter and sale of poultry and cattle increases every year. An important role for the development of the disease is played by active migration processes, urbanization, globalization and the resulting increase in the volume of movement of food across state borders.
Salmonellosis is dangerous because it quickly becomes an epidemic, it is recorded as sporadic cases and epidemic outbreaks, and it is usually quite difficult to decipher their origin.
Especially often recorded cases of disease associated with oral ingestion of infection in the body from poultry meat, eggs, as well as from products and dishes prepared from them. If the infection enters the poultry farm, most of the livestock becomes infected already on the first day due to the ability of the pathogen to transovarial transmission. Adults are more likely to be infected through the food products, young children are sensitive to the domestic route of infection.
The epidemiological danger of outbreaks increases in warm seasons: the end of spring and summer are considered the time most suitable for the active spread of the pathogen.
In addition, salmonellosis can be nosocomial, that is, to spread among patients in medical institutions. Proliferation of wards, unreasonable transfer of patients from ward to ward, lack of necessary support facilities, reuse of disposable tools, poor-quality processing of bedding contribute to the spread of infection in hospitals. In the conditions of infectious diseases hospitals, contact-resistant transmission of antibiotic-resistant strains of S. typhimurium or S. haifa occurs. Due to the fact that these pathogens exist in hospitals, they develop resistance to disinfectants and antibiotics. In general, outbreaks of nosocomial salmonellosis are characteristic of children's hospitals.
A baby can become infected with salmonellosis from a sick mother in utero, during childbirth, and also through breast milk.
Salmonellosis is a dangerous infectious disease from which you can die. The overall mortality rate for salmonellosis is 1-3%. Children suffer from it more often and suffer heavier, so among children under the age of 2-3 years, the percentage of deaths reaches 3-5%. In addition, in the acute form of the disease, death occurs in 1-2% of patients, while up to 20% of those who are asymptomatic die.
Salmonellosis type classification
Depending on the degree and direction of the lesion in the body, on the external manifestations of the disease, all forms and types of the course are displayed in this classification:
- localized (gastrointestinal): held in gastritic, gastroenteritic or gastroenterocolitic variant;
- generalized in typhoid or septic version;
- carrier state (bacteria): acute, chronic, or transient.
Gastrointestinal (localized) form
It is considered a relatively light type of disease in which the pathogen practically does not extend beyond the intestines. It occurs in the form of acute gastritis, acute gastroenteritis or gastroenterocolitis. Accompanied by fever, spastic abdominal pain, nausea and vomiting, abundant loose stools. In some patients, at first only fever and signs of general intoxication are noted, and changes in the gastrointestinal tract are joined somewhat later. They are most pronounced by the end of the first and on the second and third days of the onset of the disease. The incubation period does not exceed 72 hours, and in children and people with weak bodies the disease manifests itself 2-4 hours after salmonella ingestion with food. The severity and duration of the manifestations of the disease depend on the severity.
It is observed less often than the other two options. It is characterized by an abrupt onset with repeated vomiting and severe pains in the epigastric region. Intoxication symptoms are mild, there is no diarrhea, the course of the disease is short-term - up to 3-4 days. Forecasts are favorable - after the start of taking the medication, the pathogen dies quickly, without having managed to cause serious harm to the body.
If the process goes into a generalized course, the patient develops a typhoid-like form, similar in clinical picture to typhoid-paratyphoid lesion, or septic form.
It develops acutely, already a couple of hours after infection with the pathogen, signs of the disease appear. The patient has characteristic symptoms of intoxication, dehydration, the temperature rise can reach 40-40.5 degrees. Further, there are spastic pains in the epigastric and umbilical zone of the abdomen, nausea and repeated vomiting. After each vomiting relief does not occur, the person continues to stir. Diarrhea joins after a half to two hours, initially feces look like characteristic fecal masses, and then become watery, frothy and acquire a greenish tint. After 2-3 days, the volume of feces decreases, mucus appears in them, sometimes blood streaks. Large intestine with palpation is painful and spasmodic. In the process of defecation appear tenesmus - sharp cutting pains in the rectum, not dependent on the allocation of feces. Symptoms are similar to the state of acute dysentery.
The most common form, which also begins acutely, 2-3 hours after the pathogen enters. Against the background of water and electrolyte imbalance, the patient's temperature increases, nausea and vomiting, spasms and abdominal pain, intense diarrhea with a liquid foamy stool of a greenish hue appear. The severity of a lesion is determined not by the frequency of acts of defecation and vomiting, but by the loss of fluid. Tenesmus during bowel movements are absent.
The skin of the patient has a pale color, in complex cases, cyanosis is noticeable. The tongue is dry, covered with a whitish or yellow coating. The intestine is swollen, with palpation corresponds to soreness and rumbling. With auscultation of the heart tachycardia is noticeable, a decrease in blood pressure is determined. Urine excretion is markedly reduced. In severe cases, clonic convulsions appear.
This form of flow is characterized by the release of the pathogen from the intestine. There is a generalization of the lesion. With blood flow, salmonella is spread throughout the body and is introduced into various organs and tissues. Infection acquires an extensive nature, because of which such a course is considered difficult. It proceeds in a septic and typhoid form.
The most severe version of the generalized form of salmonellosis. The disease begins acutely, in the early days it has a typhoid current. In the future, the condition of patients worsens. Body temperature becomes abnormal - with a large daily range, repeated chills and profuse sweating. The patient is tormented by chills, and during periods when the fever subsides, he feels sweating, tachycardia, and myalgia. Next, hepatosplenomegaly is formed - a syndrome of a pronounced increase in the liver and spleen at the same time.
The duration of the disease is long, torpid, the general condition is characterized by weakness, malaise, disability.
In some internal organs and tissues, secondary foci of inflammation begin to form, with the result that the clinical manifestations of this variant of salmonellosis are very diverse, and its diagnosis is difficult. Formed purulent focus in the symptoms comes to the fore. Purulent foci often develop in the locomotor system: osteomyelitis, arthritis. Sometimes there are septic endocarditis, aortitis with the subsequent development of aortic aneurysm. Cholecysto-cholangitis, tonsillitis, cervical suppurative lymphadenitis, meningitis (the latter usually in children) occur relatively often. Less common are purulent foci of other sites, for example, liver abscess, infection of ovarian cysts, salmonella strumite, mastoiditis, abscess of the gluteal region.
The disease often begins acutely. In some patients, symptoms of gastroenteritis may be the first symptoms of the disease. Further, nausea, vomiting and diarrhea gradually cease, while the body temperature rises, constantly or in waves. In most patients, the onset and course of the disease is similar to typhoid and paratyphoid A and B. The symptoms of intoxication are increasing - severe headache, insomnia, and a general feeling of weakness. The duration of fever 1-3 weeks.
By the end of the first week of the onset of the disease, the patient has a simultaneous enlargement of the liver and spleen (hepatolienal syndrome). Blood pressure is low, there is noticeable bradycardia. Due to the fact that the pattern of the flow resembles typhoid fever, there is some difficulty in the differential diagnosis. Without testing for a specific pathogen, it is rather difficult to make a correct diagnosis.
After the transferred salmonellosis, especially after manifest forms, the part of convalescents becomes bacterial carriers. In this form, there are no clinical symptoms, and it is detected by bacteriological and serological studies. The Salmonella media carriers are divided into the following categories: acute bacteriocarrier, chronic carrier state, transient carrier state.
Acute carriage is characterized by salmonella exposure lasting from 15 days to 3 months. If salmonella is released 3 or more months after recovery, we are talking about a chronic carrier state. Transit carrier is a carrier in which the seeding of Salmonella from the secretions occurs once or twice, while the clinical manifestations of the disease are not detected, and no significant antibody titres are observed.
The diagnosis of “Salmonella carriage” is relevant only if all symptoms of the disease disappear completely. The carrier period is counted from the date of the disappearance of clinical manifestations, or from the date of the first detection of Salmonella during the examination.
Transient carriage is the most unstable state, since the pathogen can be released periodically with acute and chronic bacterial carriers, as well as with asymptomatic form of salmonellosis, which the specialist needs to differentiate from each other.
Etiology of the disease
The disease is caused by various serotypes of bacteria of the genus Salmonella. Sources of infection are mainly domestic animals and birds, however, the person (the patient, the carrier) as an additional source also plays a certain role. The transmission mechanism is fecal-oral. Ways of transmission: through food products obtained from infected livestock and poultry, as well as contact-household, less often water (salmonella may be present in water, for example, in open water bodies and running water), air-dust is possible.
Infection of people occurs during the care of animals, in the process of slaughter at meat processing plants, as well as the use of meat infected with intravital or posthumous. Also, the source of infection is milk, dairy products.
Approximately 10% of cats and dogs have salmonellosis carriers. In synanthropic rodents, this figure is higher - up to 40%. Among wild street birds (starlings, pigeons, sparrows, gulls) the disease is widespread. By contaminating the environment with their droppings, the birds thus contribute to the spread of the pathogen.
Over the past 30 years, scientists have observed an increase in the number of salmonellosis outbreaks in farm birds, primarily in chickens.
A person is the source of some types of pathogen - S. typhimurium and S. haifa, especially in a hospital setting. Contagious infection is most dangerous for children under the age of one year, who are especially susceptible to Salmonella. The duration of the infectious period in a patient directly determines the nature of the course and duration of the disease. In animals, it can last for months, and in humans from 2-3 days to 3 weeks. The reconvalescence, that is, the hidden carrier state, sometimes lasts for years.
The most dangerous in terms of salmonellosis are chicken eggs. The disease is observed with improper culinary treatment, when infected products, mainly meat (minced meat, products from it, jelly, meat salads, boiled sausages), were in conditions favorable for the reproduction of Salmonella.
The waterway of infection is characteristic of the defeat of the pathogen of animals in special livestock farms and farms, poultry farms. In hospitals, especially in children's medical institutions and maternity hospitals, the household contact method of the spread of the disease prevails.
In urban conditions, there is an air-dust path of propagation, in which the main role is played by wild birds, polluting habitats and feeding their droppings.
Regardless of the state of the body, age and gender, a person’s natural susceptibility to salmonella is very high, that is, the lesion will develop in almost 98% of cases of body contact with the pathogen. As for the duration and severity of the course, it can be different in people with strong immunity, adults and healthy, or in young children, premature babies, the elderly. Immunity - type-specific, short-lived (5-6 months).
Symptoms of the disease
Visible external manifestations of salmonellosis determine its type of course, and differentiate the disease from other infectious lesions. The most common variant is gastroenteric, which is accompanied by dehydration, general intoxication, fever. Signs of intoxication develop incrementally, reaching headaches and aching muscles, weakness and disability.
In addition, salmonellosis manifests itself by pain in the umbilical region and upper abdomen, along the large intestine. Spastic pains, undulating, from mild to very intense attacks. Nausea and repetitive vomiting that does not bring relief.
Diarrhea is a characteristic sign of salmonellosis, and the appearance of feces (watery, offensive, frothy, with a greenish color), as well as their number, draws attention to itself. Against the background of vomiting and diarrhea, a dehydration syndrome develops.
On examination, the pallor of the skin, bloating, dry mouth attracts attention. The tongue is coated with thick bloom. Auscultation of the heart is determined by tachycardia, the pulse is softly filled. Severe dehydration is accompanied by cramps in the lower limbs.
Further, the symptoms begin to differ depending on which variant of the course is observed in the diseased person.
Gastroenterocolitic type of salmonellosis is accompanied by a decrease in the amount of feces by 2-3 days from the onset of the disease. In the feces appears mucus, blood impurities. The intestine is spasmed, responds to palpation with pain, there are tenesmus. The gastritic form passes without tenesmus and diarrhea. Temperatures range from subfebrile to high.
Symptoms of generalized form have characteristic differences. For example, the typhoid-like course is extremely similar to the clinic of typhoid fever, when, along with nausea, vomiting and diarrhea, fever of a wavy or stable nature appears. When this occurs, a noticeable increase in the spleen and liver, a hemorrhagic rash appears on the skin. Blood pressure lowered, bradycardia present.
In septic flow, in addition to the typical gastrointestinal clinic, the patient has a long remitting fever, chills, tachycardia, sweating, and an enlarged spleen and liver. There may be noticeable inflammation of the iris, which determines electrolyte disturbances in the body.
Course of the disease
The onset of the disease is clinically measured from the moment the first symptoms appear, but in reality the disease begins with an incubation period when it does not manifest itself. Further, after the appearance of the first clinical symptoms, the stage of active development of the infectious process begins. After the concentration of the pathogen in the body begins to decline, and the acute symptoms gradually subside, we can speak about the beginning of the patient's recovery, but this statement is not true for all forms of salmonellosis.
In children, the course and duration of the incubation period depend on the endurance of the organism. Usually this stage lasts from several hours during food infection, up to 3-4 days, if the pathogen enters the body through contact-household means. The greater the concentration of infection and microbiological toxins in the body, the shorter the period of incubation of the pathogen, and the heavier the course of the disease is expected.
In adults, the incubation period also lasts from several hours to several days. In general, this category of patients is less susceptible to contact-domestic infection.
Period of development
The age of the child and the state of the immune system determine the severity of the development of salmonellosis. In addition, the course of infection, the number and type of Salmonella in the children's body have an impact on the course of the disease. The main impact of microorganisms falls on the gastrointestinal tract, where microbes get, breaking the barrier in the stomach (hydrochloric acid).
In infants, the development is gradual: first, the baby becomes sluggish and capricious, his appetite disappears, the temperature rises. Further joins vomiting and loose stools. First, the discharge has a normal color, defecation occurs 5-6 times a day. Then the condition worsens, the increase in body temperature reaches more than 38 degrees. The child has frequent diarrhea (more than 10 times per day), while the stools have a greenish color and foamy consistency. By the 7th day of the course, mucus and blood streaks appear in them. If during diarrhea there is no replenishment of the lost reserves of fluid, the baby begins to have dehydration, which is noticeable due to dryness of the mucous membranes of the mouth, dryness of the tongue, dropping out of the spring, the appearance of severe thirst, reduced urine output.
In newborns, the common symptoms of salmonellosis most often prevail over the gastrointestinal pattern. The temperature may remain normal, but the child refuses to eat, ceases to gain weight. He has anxiety, he suffers from frequent regurgitation, his skin looks pale. The stomach is swollen.
In children with a weakened body, for example, on artificial feeding, premature babies, babies with congenital abnormalities, the disease quickly takes a generalized course of sepsis, leading to the defeat of various internal organs:
- the liver;
- the kidneys;
The flow is very heavy, with high fever and an enlarged liver and spleen.
Older children suddenly overtake the disease - the process begins with fever (more than 38 degrees), followed by headache with dizziness, severe and repeated vomiting, loss of appetite and weakness. The next are abdominal pains and diarrhea, with a greenish, offensive, fetid stool. If you do not begin treatment during this period, the process is generalized, with the involvement of the large intestine, with the appearance of mucus and blood in the stool. At the same time, pain in the abdomen becomes cramping. The process is accompanied by severe dehydration; toxic shock shock and renal failure may occur.
Older children usually return to normal after 1-3 weeks, young children, especially newborns, are ill for longer - up to several months. Accordingly, the recovery process in them lasts longer, and several months after recovery, salmonellae continue to be excreted in the urine and feces.
Disorders of the digestive process in children persist up to 3 months due to the inadequacy of the pancreas. In babies with an adverse allergic background, food allergy manifestations may increase. Manifestations can be expressed weakly, or accompanied by instability of the chair, bloating and pain in the abdomen, especially associated with the use of dairy foods.
The development of the disease in adults can take place in several variants, the intensity of which depends on the general condition of the body, and the concentration of the pathogen in it. Initially, salmonellosis is manifested by intoxication, headache, fever, aching and chills. The next stage of microbial reproduction is accompanied by the appearance of nausea and repeated vomiting, abdominal pain. Frequent diarrhea leads to dehydration, discharge quickly take the form of a greenish watery foam with an unpleasant odor. Such a course is characteristic of the gastrointestinal form of the disease. The described symptoms last up to a week, after which comes a feeling of well-being.
If salmonellosis takes on a generalized appearance, the patient has a weakness, perhaps a wave-like fever, insomnia, headache, pallor of the skin, muffled heart tones. Remitting-type fever, chills, tachycardia, and excessive sweating signaling the disease to become typhoid. The duration of this stage is usually at least several weeks. The disease is difficult, complications may occur.
Forms of flow
The chronic course of the disease is possible if a person has a certain concentration of the pathogen in the body, but there are no obvious external expressions of the lesion. The chronic form is also called bacteriocarrier. On average, the period of isolation of bacteria from a person who has had salmonellosis lasts about 3 months, sometimes longer. A patient's transient chronic carriage is observed if a pathogen is sown from a feces once or twice, after which further test results are negative. At the same time, the examined person lacks serological, clinical and colonoscopic signs of damage.
Chronic transient carriage occurs as a result of the ingestion of a very small number of weakly virulent pathogens. In this case, only with in-depth specific examination, most transient carriers show signs of infectious, subclinical proceeding salmonellosis.
At the same time, an infectious disease is the result of the interaction of the host organism with the pathogen in specific environmental conditions. If the response of the carrier is absent in this case, physicians have no reason to talk about the infection process or the disease.
Most often, salmonellosis occurs in the form of an acute illness, with corresponding obvious and abrupt manifestations. The duration of the pathological process, taking into account the correctly chosen treatment, does not normally exceed 1.5 months. However, recently, especially in industrialized regions, physicians have noted an increase in the number of cases of salmonellosis with a protracted course of up to 3 months. The question of whether such a long course of the disease can be considered chronic cannot be decided unequivocally, since in each case the degree of manifestation of the symptoms of a lesion is different.
The increase in the duration of the disease is associated with a sharp decrease in the resistance of the human body, changes in its immunological processes, as well as a decrease in adaptive abilities under the influence of harmful external factors, in particular, environmental pollution.
Thus, acute is the carrier state, in which the release of the pathogen lasts from 2 weeks to 3 months. Chronic form of salmonellosis lasts for 3 months and longer.
The classic form of salmonellosis is an acute course with characteristic signs and symptoms that constantly, clearly and intensely bother the patient.
Depending on whether the infection goes beyond the intestines or not, acute salmonellosis runs as a localized or generalized process. In a localized form of salmonellosis, the patient has all the signs of acute bowel damage:
- fever and chills;
- nausea and vomiting;
- stomach ache.
With pronounced electrolyte disturbances, with dehydration, possible heart rhythm disturbances, cramps in the limbs.
If the disease acquires a generalized form, to the listed symptoms, some time later, symptoms are added that characterize the damage of one or another organ or organ system (cardiovascular, lung, kidney, enlarged liver and spleen, disorders of the central nervous system).
Usually the acute period of salmonellosis is 5-10 days, and recovery after it takes up to a month.
Asymptomatic salmonellosis is a long-term bacterial carrier, in which a person has no clinical manifestations of salmonellosis, but the infectious agent is consistently present in his stools. At the same time, a person feels healthy, however, at the same time, he is an epidemiological danger to others.
Degrees of severity
Gastrointestinal and generalized forms of salmonellosis are treated in patients in the form of light, moderate or severe severity. The severity is differentiated by two main factors. First of all, we are talking about the intensity of the symptoms: the severity of nausea, frequency of vomiting, temperature indicators, the presence or absence of pain, seizures. More significant is the determination of the severity of the magnitude of water and electrolyte losses, according to the degree of dehydration. From this point of view, for example, the frequency of diarrhea or vomiting is not as important as it is important to pay attention to the volume of fluid that the patient loses. Similarly, according to this indicator, mild, moderate and severe disease is also distinguished.
The most common form of salmonellosis is considered gastrointestinal. In about 45% of those infected, it proceeds to a mild degree, it begins acutely, there is subfebrile fever, general weakness, single vomiting, and watery liquid stools up to 5 times a day. In total, diarrhea lasts from 1 to 3 days. The loss of fluid in this case does not exceed 3% of the total body mass.
Generalized salmonellosis, as a rule, does not occur in mild form.
Most common among all patients. At the patient the temperature rises, the values reach 39 degrees. Fever lasts for 3-4 days, with repeated vomiting. Diarrhea lasts up to a week, no more than 10 feces are observed daily. The tachycardia is expressed, arterial pressure goes down. There is a loss of fluid volume of about 6% of body weight. There is a possibility of complications and the transition of the disease to the typhoid or septic form.
The temperature rises above 39 degrees, the patient fever lasts from 5 days. At the same time pronounced symptoms of intoxication. Vomiting is repeated and does not pass from 2-3 days or more. Stools more often 10 times a day, copious, watery, and frothy. There may be mucus and blood in the stool. In total, diarrhea lasts a week or longer. The liver and spleen are enlarged, ikterichnost sclera and skin. In addition, there is cyanosis of the skin, lower blood pressure and tachycardia.
Significant changes in the kidneys: oliguria, red blood cells and cylinders in the urine, albuminuria, elevated levels of residual nitrogen. Against this background, acute renal failure may develop. Dehydration of 2-3 degrees is expressed in dry skin, aphonia, cyanosis, cramps in the lower extremities. There is a loss of fluid in the amount of 7-10% of body weight. The blood test shows a thickening of the blood in the form of elevated levels of hemoglobin, hematocrit and red blood cells, a moderate left-shift leukocyte formula.
The main difficulty for the attending physician in the presence of suspected salmonellosis is to make a differential diagnosis with other diseases accompanied by diarrheal syndrome: shigellosis, cholera, colibacillosis, food and chemical poisoning.In some cases, there is a need for differentiation of salmonellosis from myocardial infarction, acute cholecystitis, acute appendicitis, thrombosis of mesenteric vessels.
For correct diagnosis, it is necessary to collect a history of the disease and an epidemiological history and as accurately as possible to establish all the symptoms, frequency and intensity of their manifestation. Salmonellosis localized in the intestine from the first hours of the disease is accompanied by intoxication, after a while dyspeptic phenomena in the form of nausea, vomiting, and spastic abdominal pain are added. Further, diarrhea appears with a liquid and frothy fetid stool of greenish color. From 2-3 days it is possible the appearance of tenesmus during defecation, mucus appears in the stool, sometimes blood impurities.
If the typhoid-like and septic form of salmonellosis begins with such manifestations, they are easier to detect, otherwise a differential diagnosis must be made to discard the variant of typhoid and purulent sepsis.
Reliably establish the diagnosis of “salmonellosis” is possible only by identifying the pathogen in the feces of the affected. In generalized forms, salmonella is present in the blood baccosev. In addition, microorganisms can be found in the washings of the intestine and stomach.
Types of analyzes
A patient who is suspected of having salmonellosis needs to take three main types of tests:
- blood test (serological examination);
- bakposev, or bacteriological examination;
A serological test is a blood test taken from a patient’s vein. Antibodies to salmonella in human blood can be detected already 5-7 days after infection. The development and course of the disease can be seen by changes in antibody titers. In addition, based on the results of the analysis, the doctor determines the optimal regimen of therapy.
The main serological methods for which blood tests are performed for salmonellosis:
- RNAA (analysis with complex and group salmonella erythrocyte diagnosticums, when formulating the reaction in paired sera. Interval - 6-7 days);
- RCA (coagglutination reaction);
- RLA (latex agglutination reaction);
- ELISA (enzyme immunoassay).
According to hematocrit, blood viscosity, acid-base status and electrolyte composition, a conclusion is drawn on the degree of dehydration of the organism, corrects the rehydration therapy as appropriate.
How to prepare for blood donation for salmonella? A blood test taken in the morning, on an empty stomach. The day before the patient needs to abandon physical activity and emotional turmoil. Serological testing is prescribed 7-10 days after the onset of the disease, since in the first days antibodies to the pathogen had not yet formed in the blood. By the time the preparation of the results takes 1-2 days.
The rapid method of studying the blood involves an immunoassay, which takes less time.
In addition, a general blood test is assigned to identify the extent of the inflammatory process.
A blood test should be taken in such cases:
- bakposev gave negative results;
- the person contacted the infected;
- in the second week from the onset of the disease, if the symptoms do not subside.
Bacteriological examination, or bakposev, gives more accurate data than serological analysis. Materials for research are all biological fluids of the patient (feces, urine, bile, blood, pus, vomit, washing water of the stomach and intestines). The collected elements are placed in a selenitic or magnesium nutrient medium, which is favorable for the reproduction of salmonella. Next, the tank is sent to a special box with a temperature of 37 degrees Celsius, that is, in conditions that promote the growth and reproduction of bacteria, if it was originally in the collected material. The results of the analysis are usually prepared within 3-5 days - so much time, on average, microorganisms need for their concentration to reach a specific amount. It is also possible to use several differential diagnostic media (Ploskirev, Endo, bismuth-sulfite agar).
The standard for bacmoni on salmonellosis is to isolate a culture of pathogenic bacteria using selective enrichment media and differential diagnostic media, followed by biochemical identification, and the establishment of the isolate serovar in agglutination reactions.
As such, the analysis does not require preparation, it is taken from those admitted to hospital with the corresponding symptoms immediately after hospitalization.
Coprogram is a general analysis of feces, which shows pathogenic changes in the structure of fecal masses, for example, the presence of undigested fiber, blood, leukocytes, an increased amount of starch and fibers.
A few days before delivery, it is recommended to exclude flour products and sweets from the diet, stop taking iron-containing and laxative preparations. The material is collected fresh in the morning after waking up and the first toilet. Coprogram preparation takes 2-3 days.
Salmonellosis testing is required for women who are planning to become a mother. During pregnancy, the leading woman doctor may also prescribe tests, even if she has no visually obvious signs of illness. Pregnant women take on the analysis of feces, blood from a vein, and a smear from the anus.
For children, not only testing for salmonellosis with relevant symptoms is important, but also preventive examinations. If the child is suspected of salmonellosis, it is important to conduct a comprehensive diagnosis in a timely manner for a quick diagnosis. Children are prescribed:
- serological examination (7-10 days after the start of infection);
- bakposev feces;
- smear from the anus;
- express diagnostics (immunofluorescent method).
Ways to treat the disease
Treatment of the disease at home is possible only if the patient has a mild form of salmonellosis. Children, pregnant women, people with a weakened immune system, in the presence of a moderate or severe form of the disease should be hospitalized for observation in the hospital.
The patient is shown bed rest, especially with pronounced manifestations of dehydration and intoxication. If the patient's condition allows, treatment begins with washing the stomach and intestines, siphon enemas, taking enterosorbents, for example, Enterosgel, Atoxyl, activated carbon.
The presence of 1 or 2 degree dehydration in a patient requires the administration of glucose-saline solutions — Regidron, Citroglucosolan, Oralit, by the infusion method of administration. Droppers with solutions must be placed before the start of the main treatment. Lost water reserves also need to be replenished by frequent fractional drinking in volumes up to 1 liter per hour in the first 2-3 hours, and then monitoring the level of the liquid and consumption of 1-1.5 liters of liquid every 3-4 hours.
With dehydration grade 3-4, isotonic polyion solutions are injected intravenously in a stream until the elimination of manifestations of dehydration shock. Next, the patient is assigned a dropper.
At the discretion of the doctor, the content of potassium ions is additionally corrected; solutions of potassium chloride or potassium citrate are administered intravenously, 1 g daily, 3–4 times.
After correction of the water-electrolyte balance in the body, macromolecular colloidal preparations such as Hemodez or Reopolyglucine can be prescribed to eliminate the manifestations of intoxication. In case of pronounced metabolic acidosis, an additional 4% sodium bicarbonate solution is administered intravenously.
In the gastrointestinal form of the course, indomethacin is prescribed for the relief of symptoms of intoxication, mainly in the early stages of the lesion, 50 mg three times every 12 hours.
The prescription of antibiotics and etiotropic drugs is important in case of a generalized type of course. Fluoroquinolines (0.5 g twice a day), chloramphenicol (05, g 4-5 times a day), Doxycycline (0.1 g daily) are used.
To normalize the processes of digestion using enzyme preparations - Kreon, Festal, Pancreatin.
It is important to adhere to the rules of Pevzner's diet No. 4 for the entire duration of treatment, and to follow diet No. 13 after it is possible to get rid of diarrhea, up to the full recovery of the patient.
Prevention of salmonellosis, in the first place, is carried out at the national level, since this disease is highly contagious and can quickly turn into an epidemic. The leading importance is veterinary and sanitary-epidemiological control, which is carried out jointly by the relevant services. The control bodies in the veterinary field constantly monitor and record the incidence of diseases among animals, livestock, and poultry, and also monitor the quality and purity of feed and meat products. Sanitary-epidemiological bodies take into account and control cases of the disease in people, monitor the development trends and duration of the disease at a specific time in a specific territory. In addition, the sanitary-epidemiological services are responsible for studying the serotype structure of the pathogen, isolated from the affected, as well as found in food.
Responsible government agencies are developing methods for diagnosing and standardizing the procedures for registering and registering cases of the disease, as well as for monitoring the quality of food products sold, especially imported ones.
Salmonellosis is a contagious and rapidly spreading disease that can affect an entire population of livestock or poultry in a few days. The disease is also quickly transmitted from person to person. That is why anti-epidemic preventive measures against the causative agent of salmonellosis are so extensive in nature - to avoid the formation of an epidemic.
With regard to preventive measures among the population, there are no specific ways to avoid the disease. Vaccines against salmonellosis are not developed because of the instability of the produced immunity and the antigenic diversity of the pathogen.
The basis of prevention is sanitary and veterinary measures, which provide adequate conditions for the slaughter of farm animals, storage, transportation and sale of animal products, as well as the preparation of food from them. To this end, deratization and disinfection measures, animal vaccination, animal feed, and feed ingredients are taken periodically at livestock enterprises, farms, and poultry farms.
Also important is the prevention of salmonellosis in a hospital setting in order to protect the majority of patients from being infected by carriers. In this regard, disinfectant measures are constantly carried out in infectious diseases hospitals, the fulfillment of all requirements for the disinfection of medical devices, dishes, and common areas is strictly monitored.
Bacteriological examinations are periodically carried out in preschool, medical and preventive treatment facilities, as well as enterprises of the food industry and catering establishments. In addition, all persons who first come to work in these institutions are required to undergo bacteriological examination, including salmonellosis, in order to prevent the possible spread of infection.
Is it possible to protect against salmonella? The main rules that every person should remember in order not to get infected with a pathogen and not get sick with salmonellosis are similar to the requirements for the prevention of other infectious diseases - wash hands more often, not eat in unfamiliar and unreliable places, strengthen the immune system and temper the body.
In addition, when buying eggs, meat and poultry, dairy products, special attention should be paid to the place where they are bought, whether the sellers have documents with the results of the inspection of the products by the bacteriological laboratory. All products of animal origin must be carefully processed to protect against possible contamination. It is unacceptable, for example, to eat raw meat or eggs, especially in summer, when the activity of Salmonella is greatest.
What is dangerous salmonellosis
The most dangerous consequence of salmonellosis is the occurrence of infectious-toxic shock, with the manifestation of cerebral symptoms, cardiovascular failure, adrenal and renal failure. In this case, death can occur very quickly.
With brain swelling, bradycardia, short-term hypertension, cyanosis and reddening of the skin on the neck and face, rapid muscle paresis appear. Further the increasing short wind joins, there comes a brain coma.
If the patient has a clear anuria and oliguria, we can talk about the onset of acute renal failure against the background of greatly reduced blood pressure. Further, signs characteristic of uraemia increase.
Acute cardiovascular failure is accompanied by the formation of a collapse, a decrease in body temperature, the appearance of pallor of the skin, cyanosis, and cooling of the extremities. Further, the pulse may disappear due to a sharp drop in blood pressure.
Other possible complications of the disease:
- hypovolemic shock;
- numerous septic complications in the form of purulent inflammations of the joints, abscesses of the kidneys, liver, spleen;
- urinary tract infections;
- brain abscess;
- peritonitis, pneumonia, appendicitis.
In general, prognoses, provided timely treatment starts are favorable.
The disease does not cause the formation of specific immunity, so it is absolutely realistic to get sick again.
Pregnant women may develop similar complications - dehydration, dryness, tachycardia, seizures, toxic infectious shock, liver, renal and adrenal insufficiency, as well as pathologies of the cardiovascular system. Liver and spleen may increase, pains in the joints and in the region of the heart appear.
The greatest danger of infection is for the unborn child, especially in the first and third trimester. At the beginning of pregnancy, in the first months, salmonellosis, like other infectious diseases, can cause irreversible developmental disorders, fetal death, miscarriage. The pronounced state of intoxication and high temperature can lead to spontaneous abortion, since it is known that the body temperature of 37.7 and higher in the expectant mother significantly increases the risk of miscarriage in terms of up to 12 weeks.
In the second and third trimester, salmonella provokes the development of placental insufficiency and exfoliation of the placenta against the background of a strong general intoxication of the mother's body. The child does not receive enough nutrients and oxygen, which is why he develops developmental delays. Malnutrition of the fetus can also lead to premature birth.
Dehydration of the mother, which is accompanied by acute salmonellosis, adversely affects the unborn child, he does not receive the trace elements and minerals necessary for growth. Constant vomiting and diarrhea lead to the depletion of existing stocks of nutrients, vitamins. Because of this, it is possible to terminate a pregnancy for up to 22 weeks, or the birth of a premature baby with low weight.
What is the temperature of death of salmonella
Salmonella is a fairly resistant to the external group of microorganisms.It is especially important to know the temperature at which microorganisms begin to die in order to understand how to properly prepare and process food products.
Salmonella is not afraid of low temperatures, for example, in a freezer or a refrigerator, bacteria are able to maintain their viability for a long time, with no possibility of reproduction. As soon as the temperature becomes positive, the microorganisms begin pathogenic activity. The optimal temperature for breeding salmonella is from 10 to 40 degrees, the growth of the colony is possible in the range from 7 to 48 degrees. Under conditions lower than 10 degrees, the reproduction rate is significantly reduced.
The time during which salmonella dies directly depends on the temperature. So, at 55 degrees, the pathogen is killed in an hour and a half. At 60 degrees, salmonella dies after 12 minutes. If the temperature reaches values above 70 degrees, death occurs in 60 seconds. According to this principle, the milk is pasteurized - the product is brought to a temperature of 63 degrees, and held at this level for half an hour. During such a period of time, all pathogenic flora perish, except for pathogens of botulism, while milk retains its beneficial properties.
Eggs that boil in boiling water for 3-4 minutes can be considered safe only if the infection has not penetrated the shell.
With meat, the situation is more complicated, especially in this regard, minced meat and frozen meat. In a frozen piece of meat or poultry pathogen can persist up to a year. In the depth of a piece of meat, salmonella can withstand heat treatment by boiling, as well as roasting in an oven at temperatures above 120 degrees for several hours. For example, when boiling a piece of meat weighing 500 grams, the death of the pathogen occurs in 2.5-3 hours.
Salmonellosis is a highly contagious, contagious infectious disease that first attacks the human gastrointestinal tract and, if left untreated, is transferred to other systems, tissues, organs, causing their defeat. Typical symptoms of salmonellosis (nausea, vomiting, fever, weakness, tachycardia) may be similar to heart failure, appendicitis, food poisoning, dysentery or typhoid fever, therefore, when a severe deterioration in health and the described symptoms occur, it is better to go to a doctor. If the disease takes a mild form of the course, you will probably be able to do without hospitalization. However, if a patient has a moderate or severe course with a high temperature, severe symptoms and increasing intoxication, hospitalization in the hospital is mandatory.
Specialty: therapist, nephrologist.
Total experience: 18 years.
Place of work: Novorossiysk, medical center "Nefros".
Education: 1994-2000 Stavropol State Medical Academy.
- 2014 - "Therapy" full-time advanced training courses on the basis of the State Budgetary Medical Educational Institution of Higher Professional Training "Kuban State Medical University".
- 2014 - "Nephrology" full-time refresher courses on the basis of the Stavropol State Medical University.