Information for Health Professionals
Nontyphoidal Salmonella are among the most commonly reported enteric bacterial pathogens in the United States; the U.S. Centers for Disease Control and Prevention (CDC) estimates Salmonella cause about 1.35 million infections, 26,500 hospitalizations, and 420 deaths each year in the United States. In California, about 5,000 salmonellosis cases are reported each year. However, it is estimated that only 1 of every 29 people who are infected with Salmonella bacteria seek medical care and are diagnosed with salmonellosis (Scallan et al., 2011).
The most common illness associated with nontyphoidal Salmonella infection is acute gastroenteritis with diarrhea, abdominal pain, fever, and vomiting. Illness usually lasts 3 to 5 days, and most people recover without treatment. More severe illness, including bacteremia, can occur, which may develop into sepsis or extraintestinal infection (such as meningitis or osteomyelitis). Reactive arthritis may occur as a rare complication. Conversely, asymptomatic infections may also occur.
Ensuring adequate hydration is important in the management of salmonellosis; antibiotics are usually not necessary. Patients should be educated regarding prevention of further spread by effective hand washing, particularly after using the toilet, changing diapers, and before preparing or eating food. The importance of proper hygiene must be stressed, as excretion of the organism may persist for several weeks. Patients should be asked to think about everything they ate and did during the seven days prior to illness onset. This information may help public health investigators solve outbreaks.
Diagnosing Salmonella infection requires testing a specimen, such as stool or blood. The test can be a culture that isolates the bacteria or a culture-independent diagnostic test that detects genetic material of the bacteria.
Healthcare providers are required to report cases of salmonellosis to the local health department (LHD) within one working day of identification. In addition, LHDs may need to restrict the activities of persons with salmonellosis from certain work or activities (such as food handling, health care,
or day care) until they have been examined and cleared
by their LHD.
Key Points
Antibiotics are not recommended for treating immunocompetent patients with uncomplicated Salmonella infection, as antimicrobial treatment may be associated with prolonged Salmonella shedding and with antibiotic resistant organisms.
Confirmation of Salmonella through culture is ideal because it enables public health scientists to determine the serotype, identify antibiotic resistance characteristics, and perform whole genome sequencing for outbreak detection.