Internal Medicine

Salmonella

Definition of salmonella

Salmonella are a group of more than 2000 bacteria that are gram-negative, rod-shaped and actively motile. They belong to the genus Salmonella and mostly affect the intestines (Entereobactrericeae).

Classification

Salmonella are one of the Zoonosesi.e. transmission from human to animal or vice versa is possible. A transmission of Salmonella through a Smear infection respectively.

You can find diseases caused by Salmonella in "Typhoid salmonellosis" and "Enteric salmonellosis" organize.

Typhoid salmonellosis

are through Salmonella Typhi / Paratyphi caused (typhoid / paratyphoid)
are ingested through food / water and enter the lymphatic system via the gastrointestinal tract
Contamination through human excretors, contaminated water, contaminated food

Result: generalized, septic clinical picture (severe fever and considerable feeling of illness)
Treatment: antibiotics always required

Enteric salmonellosis

e.g. by Salmonella Enteritidis or S. Tymphimurium caused
only colonize the intestines if infected -> vomiting diarrhea with fever
Infection often via farm animals
Contagion also through human excretors, contaminated water, contaminated food

Usually no antibiotic therapy necessary!

history

Found in 1880 Robert Koch the causative agent of Typhus abdominalis.
1884 could Georg Gaffky growing Salmonella in culture for the first time
In 1885 the causative agent of "pig cholera" became Daniel Elmer Salmon discovered. The genus Salmonella was named after him.

Epidemiology

Typhoid Salmonella step in Northern and Central Europe just very sporadic on. They are mostly imported by travelers. An accumulation only occurs in a chain of unfavorable circumstances (e.g. floods + high temperatures + poor hygienic conditions, e.g. after natural disasters such as hurricanes).

Enteric salmonella however, are increasing in frequency worldwide. The most important Source of infection here are Farm animals. From there, the pathogens are transmitted via food (raw eggs, raw poultry meat, milk, mussels). Often a group illness (e.g. family, canteen) is caused by joint consumption of contaminated products.

Symptoms

Typhoid Salmonella have an incubation period of 1-3 weeks. The first symptom is a staircase feverwhich rises first to 39 ° C, then to 40 ° C, and finally to 41 ° C. In addition, there are abdominal pain and headaches, Drowsiness, Swelling of the spleen, decrease in white blood cells (Leukopenia) and Slow heartbeat (Bradycardia). diarrhea (Diarrhea) possibly with Intestinal bleeding can occur from the 3rd week of illness.

Enteric salmonella have a incubation period from 1-2 days. Acute diarrhea and fever appear first. Improvement can occur within a few days without specific therapy, i.e. Enteric salmonella are self-limiting. In the case of massive diarrhea and / or vomiting, especially in infants, small children and seniors, water and electrolyte losses (loss of body salts) can lead to corresponding symptoms

diagnosis

Typhoid salmonella are in Blood, urine and chair verifiable. Antibody detection is also possible.
Enteric samonella can only be detected in stool.
For both types of pathogens it is possible to cultivate them on special media and thus detect them. However, this usually takes at least 2 days.

Therapy of salmonella

Typhoid Salmonella must be included Antibiotics be treated. The active ingredients are particularly suitable here Aminopenicillin (e.g. Amoxi-CT®, Amoxicillin acis®, AmoxiHEXAL®, Ampicillin-ratiopharm®), Flourchinolone (e.g. Ciprobay® , Avalox®, Actimax®), Chloramphenicol (e.g. Paraxin®)

In the case of an infection with enteric salmonella, therapy with Antibiotics Only necessary in exceptional cases (e.g. in the case of severe disease and / or weakened patients).
Support should be for a sufficient amount of water to drink taken care of to balance the water and electrolyte balance. In severe cases, this can also be done through infusions.
Apple pectin (e.g. Kaoprompt®) or loperamide (e.g. Imodium akut®, Loperamid-Ratiopharm®).

At a Salmonella infection Therapy is mainly symptomatic. This means that the treatment is not intended to cure the disease, but rather to lessen the symptoms so that the patient has a milder course and fewer symptoms until the disease goes away on its own.
With salmonellosis, this can usually be done without hesitation, as it is normally harmless and apart from that Antibiotics There are no effective drugs, which, however, have their own side effects, some of which can be more serious than the actual disease and therefore usually cannot be used sensibly.

The main symptoms of the salmonellosis (Salmonella enteritis) are diarrhea and Vomit. This can cause those affected to receive significant amounts liquid and Electrolytes to lose. For this reason, the most important component of therapy for this disease is to balance the water and mineral balance. Patients are encouraged to drink plenty (many doctors recommend up to one glass of water every half hour!), taking on caffeinated beverages like cola or coffee should be avoided, as these tend to dehydrate the body additionally. Still water and tea are best, as these are the least stressful on the stomach. To prevent an electrolyte deficiency, a person affected can take electrolyte solutions that are available at the pharmacy.

In the worst case, both water and nutrients can be administered in the hospital using infusion solutions. Also on the nutrition It is important to pay attention to the fact that patients often have a reduced appetite, but it is particularly important to supply the body with sufficient energy to successfully combat the disease.

It is advisable to have one during sick leave diet to be carried out that is as low in fat as possible in order to Gastrointestinal tract not to be burdened additionally. On the other hand, the following are well tolerated:

zwieback
dry bread
Potatoes
Soups or Bananas (which also because of their high content of potassium are particularly cheap).

Further measures of therapy concern the acute symptoms of salmonellosis. With heavier nausea drops can be administered against it. When patient fever develop, this should also be treated with medication. As long as the temperature does not exceed 39 ° C, it is best to give Paracetamol as this is usually well tolerated by children. Although suppositories are often used in children, it is better to use juices for this disease, as these can work better due to the diarrhea.

Patients at increased risk include the elderly and infants and young children. Due to their physique, they have fewer opportunities to compensate for a loss of fluid on their own and therefore show more severe courses in salmonellosis.
Also Immunocompromised react more strongly to the infection, because the immune system is not so capable of fighting the pathogen by itself.
For this reason, these high-risk groups also come more often Antibiotics used in treatment. Either ampicillin, ciprofloxacin or cotrimoxazole are preferred for this. However, it must be noted that antibiotics increase the time the pathogens are eliminated with the stool, which is why an indication should always be carefully checked.

prophylaxis

An important cornerstone of prophylaxis is to create good hygienic conditions, as drinking water contaminated with faeces is a source of infection in countries with poor hygienic conditions.
As a tourist in such countries, you should avoid eating uncooked food, ice cream and unboiled water.

Read more on the topic: Typhoid vaccination