Salmonella Enterica

Question 1

What diseases does it cause?

Answer 1

1. Typhoid and paratyphoid fever - Enteric fever
2. Gastroenteritis

Question 2

How is Salmonella categorised?

Answer 2

1. Systemic invasive bacteraemic disease: S. Typhi, S.Paratyphi A/B/C
2. Gastroenteritis/Non-typhoidal Salmonella: S.Enteritidis, S.Typhimurium, S.Singapore, S.Choleraesius

Question 3

How is NTS acquired?

Answer 3

Usually from animal sources, primarily poultry meat/eggs

Question 4

How is S.Typhi acquired?

Answer 4

Always comes from humans

Question 5

What does NTS cause?

Answer 5

1. Gastroenteritis (most common)
   *Diarrhoea, vomitting, abdominal pain (self-limiting) *
2. Bacteraemia
3. UTI
4. Invasive infections (leading to osteomyelitis, artheromatous plaque in artery, meningitis)

Question 6

Who gets NTS bacteraemia?

Answer 6

Elderly and malnourished infants
Immune compromised - sickle cell, HIV, malaria
Especially sub-Saharan Africa

Question 7

What does S.Enteritidis cause in sickle cell disease patient?

Answer 7

Osteomyelitis

Question 8

Who gets NTS UTI?

Answer 8

SLE

Question 9

How is typhoid fever transmitted?

Answer 9

Contaminated F&B/dirty water
Human to human

Question 10

What is the clinical presentation of Typhoid fever?

Answer 10

• Rose spots - transient and often missed
• Fever, anorexia, epistaxis, cough, headache, abdominal pain, constipation, bradycardia
• Enlarged liver and spleen

Question 11

How is Typhoid fever diagnosed?

Answer 11

BLOOD CULTURES
-stool not so helpful
-urine cultures become positive later
-serology not very well

Question 12

How to prevent Typhoid fever?

Answer 12

1. Clean food and water - proper sewage disposal
2. Detect and treat carriers - screen kitchen staff
3. Vaccination and health precautions if travel to risk areas
   -Ty 21a (oral live attenuated; NOT FOR IMMUNOSUPPRESSED)
   -Vi (injectable)
   -Conjugated vaccine

Question 13

How to treat Typhoid?

Answer 13

Ceftriaxone/Azithromycin
Ciprofloxacin if susceptible