Intestinal Infection: Salmonellosis - Symptoms And Treatment

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Intestinal Infection: Salmonellosis - Symptoms And Treatment
Intestinal Infection: Salmonellosis - Symptoms And Treatment
Video: Intestinal Infection: Salmonellosis - Symptoms And Treatment
Video: Salmonellosis - causes, symptoms, diagnosis, treatment, pathology 2023, February

Intestinal infection: Salmonellosis is an infectious disease of the digestive system resulting from infection with bacteria of the genus Salmonella, accompanied by severe intoxication and dehydration, sometimes of the typhoid type, or with septicemia. The most dangerous in terms of salmonellosis are thermally poorly processed eggs, dairy and meat products. The course of salmonellosis can occur according to the gastrointestinal or generalized variant, bacterial excretion without clinical manifestations is possible. The diagnosis of salmonellosis is exposed when salmonella is found in the feces and vomit of the patient.

The content of the article:

  • 1 Salmonellosis - what is it
  • 2 Causes of the disease
  • 3 What Happens During Salmonellosis
  • 4 Ways of transmission of salmonellosis
  • 5 Diagnosis of salmonellosis
  • 6 Laboratory diagnostics of salmonellosis
  • 7 Symptoms of salmonellosis
  • 8 Complications of salmonellosis
  • 9 Treatment of salmonellosis
  • 10 Prevention of salmonellosis

Salmonellosis - what is it

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Intestinal infection: Salmonellosis is primarily a zoonotic disease. This is the name of diseases transmitted to humans from animals or from products obtained from animals. Thus, the source of infection can be both live animals (dogs, cats, cows, pigs, wild and poultry, fish) and livestock products - meat, milk, eggs.

Salmonellosis is an infectious disease that primarily affects the organs of the gastrointestinal tract. Salmonellosis is caused by bacteria of the genus Salmonella. Salmonellosis is characterized by a severe course, and the risk of contracting the disease is quite high, so anyone should know how this disease manifests itself and how to avoid it.

Neither salting nor preservation kills these bacteria. Their only "Achilles' heel" is the effect of disinfectants - most of them quickly kill the bacilli of salmonellosis. Also, salmonellosis bacteria have significant resistance to most antibiotics.

Causes of the disease

Intestinal infection: Salmonellosis. Salmonella is a genus of gram-negative, mobile, facultatively anaerobic, rod-shaped microorganisms. Relatively stable in the environment. They can remain viable in water for up to 5 months, in soil for up to one and a half years, in meat for up to six months, in poultry carcasses for up to a year or more. About 20 days are stored in milk, a month in kefir and four in butter. In cheese, Salmonella can remain alive for up to a year, 3-9 months in egg powder and 17-24 days in eggshells. Salmonella die after 5-10 minutes at a temperature of 70 ° C. They can withstand boiling for some time if they are in the thickness of a large piece of meat. When boiling, eggs die after 4 minutes. In milk and meat products, salmonella not only persist, but also actively multiply, while not affecting the organoleptic properties of the products.Microorganisms are quite resistant to salting and smoking, and when frozen, they increase the lifespan. Currently, resident (otherwise - hospital) strains of Salmonella have been identified, which have a high degree of resistance to antibiotic therapy and disinfectants.

What Happens During Salmonellosis

Intestinal infection: Salmonellosis. Salmonella, having overcome the factors of nonspecific protection of the oral cavity and stomach, enter the lumen of the small intestine, where they attach to the membranes of enterocytes and release thermostable and / or thermolabile exotoxins. With the help of permeability factors (hyaluronidase), pathogens through the brush border penetrate into the enterocytes. The interaction of bacteria with epithelial cells leads to degenerative changes in microvilli. Interventions of pathogens into the submucous layer of the intestinal wall are counteracted by phagocytes, which is accompanied by the development of an inflammatory reaction.

When bacteria are destroyed, a lipolysaccharide complex (endotoxin) is released, which plays a major role in the development of intoxication syndrome. The lipopolysaccharide complex activates the arachidonic cascade by lipoxygenase and cyclooxygenase pathways.

DIC develops with microcirculation disorders. The latter cause changes in metabolism with the accumulation of acidic products in organs and tissues (metabolic acidosis). Prostaglandins stimulate the secretion of electrolytes and fluids into the intestinal lumen, contraction of smooth muscle and increased peristalsis, which ultimately leads to the development of diarrhea and dehydration. In addition, dehydration is facilitated by the action of bacterial enterotoxins, which activate the adenylate cyclase system and the production of cyclic nucleotides.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

The consequence of dehydration and intoxication is a violation of the activity of the cardiovascular system due to extracardiac mechanisms, which is manifested by tachycardia and a tendency to lower blood pressure. With the maximum severity of exicosis, the development of cellular hyperhydration is possible due to the difference in osmotic potentials between cells and the intercellular space.

Intestinal infection: Salmonellosis. Clinically, the condition is manifested by acute swelling and edema of the brain. Microcirculation disorders and dehydration lead to degenerative processes in the kidney tubules. Acute renal failure develops, the first clinical sign of which is oliguria with further accumulation of nitrogenous toxins in the blood.

Usually (95-99% of cases) Salmonella does not spread beyond the submucous layer of the intestine, causing the development of the gastrointestinal form of the disease. Only in some cases is it possible for pathogens to enter the bloodstream, while a generalized form of salmonellosis with a typhoid or septic course is observed. The generalization of infection is facilitated by the insufficiency of cellular and humoral immune responses.

Microscopic examination of the intestinal wall reveals changes in the vessels in the form of hemorrhages in the mucous and submucous layers of the intestinal wall. In the submucosal layer, in addition to microcirculatory disorders, a leukocyte reaction and edema develop.

Ways of transmission of salmonellosis

  • The primary source of infection is considered to be farm animals - cattle, pigs, horses, sheep, as well as waterfowl wild birds, in which salmonellosis is asymptomatic. For years, these animals are able to excrete the pathogen with urine, feces, milk, saliva and be a source of infection for the person caring for them during transportation, processing and storage of carcasses. Recently, unfavorable sanitary conditions for keeping chickens have led to an increase in cases of human infection with salmonellosis through chicken eggs;
  • the source of infection for humans is either a patient with salmonellosis, or a carrier that has no signs of the disease. In case of infection from person to person, the transmission mechanism is mainly fecal-oral, that is, through dirty hands, only in rare cases, contact and household - when caring for patients, in a close team, especially in a hospital, kindergarten;
  • a large percentage of cases of human infection occurs through food - meat of birds, animals, fish, finished thermally unprocessed foods - salads, fruits, confectionery products, beer.
Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Infection is especially dangerous for children under one year old, since this can lead to severe generalized forms of salmonellosis, the treatment of which in babies presents serious difficulties. As the child grows, his susceptibility to salmonella decreases. Any intestinal infections have seasonal fluctuations, so epidemiological outbreaks are most often observed in the hot, warm season.

Diagnostics of the salmonellosis

Intestinal infection: Salmonellosis. Salmonellosis should be distinguished from many diseases accompanied by the development of diarrheal syndrome: shigellosis, escherichiosis, cholera, viral diarrheal infections, mushroom poisoning, heavy metal salts, phosphorus-organic compounds, etc.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

In addition, in some cases, there is a need for urgent differential diagnosis of salmonellosis from myocardial infarction, acute appendicitis, an attack of gallstone disease, thrombosis of mesenteric vessels. The gastroenteric variant of salmonellosis is characterized by the predominance of signs of intoxication in the first hours of the disease, then the development of dyspeptic phenomena - nausea and vomiting, spastic abdominal pain, diarrhea with watery, foamy fetid stools.

The gastroenterocolitic variant is distinguished by a decrease in the volume of bowel movements from the 2-3rd day of illness, the appearance of mucus and, possibly, blood, spasm and soreness of the colon, sometimes tenesmus. Salmonella gastritis, as a rule, develops against the background of general toxic signs of varying severity.

Typhoid and septic variants of the generalized form of salmonellosis are easier to suspect if they begin with manifestations of gastroenteritis; in other cases, their differential diagnosis with typhoid fever and sepsis is extremely difficult.

Laboratory diagnostics of salmonellosis

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Intestinal infection: Salmonellosis. The basis is the isolation of the pathogen by crops of vomit and feces, and in the generalized form and blood. The material for bacteriological research can also be gastric and intestinal washings, urine, and bile. With a septicopyemic variant of the disease, seeding of pus or exudate from inflammatory foci is possible.

For epidemiological control of outbreaks of salmonellosis, bacteriological analysis of food residues suspected of contamination, as well as washings from dishes, is carried out. It is imperative to use enrichment media (magnesium medium, selenite medium), several differential diagnostic media (Endo, Ploskireva, bismuth-sulfite agar), a fairly wide range of biochemical tests and a set of monovalent adsorbed O- and H-sera.

More promising is the rapid detection of Salmonella antigens in RCA, RLA, ELISA and RIA.

To establish the degree of dehydration and assess the severity of the patient's condition, as well as to correct the ongoing rehydration therapy, hematocrit, blood viscosity, indicators of acid-base state and electrolyte composition are determined.

Salmonellosis symptoms

Intestinal infection: Salmonellosis. There are several clinical forms of salmonellosis, each of which has its own characteristics of the course:

the gastrointestinal form is the most common and accounts for 96–98% of all cases. It is accompanied by gastritis, gastroenteritis or gastroenterocolitis. The onset of the disease is characterized by an increase in body temperature (up to 39 ° C), general weakness, headache, chills, nausea and vomiting, abdominal pain, upset stools (loose stools from 5 to 10 times a day or more). Symptoms appear depending on the severity of the disease. In severe salmonellosis, diarrhea lasts 7 days or more, there is repeated vomiting, loss of fluid by the body. Intoxication and dehydration lead to skin cyanosis, tachycardia, a decrease in blood pressure, acute renal failure may develop

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis
  • the generalized form (typhoid-like variant) usually has an acute onset. Among her first symptoms are stool disorders, and general intoxication. After a couple of days of the disease, intestinal dysfunction disappears, but the fever remains the same, and the symptoms of intoxication are increasing. Patients have apathy, lethargy, pallor of the skin, a rash may appear on the abdomen, the liver and spleen are enlarged, the stomach is swollen;
  • the generalized septic form is the most severe variant of salmonellosis. The body temperature of patients fluctuates greatly, chills, and strong sweating are observed. Septic foci can occur on other organs, therefore the clinical symptoms of this form of the disease are very diverse, difficult to diagnose and difficult to treat. With the development of purulent foci in the musculoskeletal system, osteomyelitis and arthritis develop; lymphadenitis, meningitis, tonsillitis, aortitis, endocarditis often occur. The septic form of salmonellosis can last for quite a long time and end fatally, especially for infants and the elderly;
Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis
  • bacteriocarrier is a form characterized by the absence of clinical symptoms. It can be diagnosed only with bacteriological and serological examinations. There are several categories of bacterial carriers: acute, chronic and transient. Acute carriage lasts from 15 days to three months and occurs after the transferred manifest forms of salmonellosis. If Salmonella bacilli are shed for more than three months, the carrier becomes chronic. Transient carriage is diagnosed if Salmonella has been found once or twice after a previous negative test result;
  • the subclinical form of salmonellosis is characterized by the presence of salmonella in the analysis of feces simultaneously with the release of anti-salmonella antibodies. This form proceeds without clinical manifestations.

Intestinal infection: Salmonellosis. The most dangerous complication in salmonellosis is infectious-toxic shock, accompanied by acute edema and swelling of the brain, acute cardiovascular failure, often against the background of acute adrenal insufficiency and acute renal failure.

Edema and swelling of the brain, arising against the background of exicosis, are manifested by bradycardia, short-term hypertension, redness and cyanosis of the skin of the face and neck ("strangulated syndrome"), rapidly developing paresis of the muscles innervated by the cranial nerves.

Then the increasing shortness of breath joins, and, finally, there comes a cerebral coma with loss of consciousness. Severe oliguria and anuria is an alarm signal of the possible onset of acute renal failure.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

This suspicion is heightened if urine is still not excreted after blood pressure is restored. In such cases, it is urgent to determine the concentration of nitrogenous toxins in the blood. In the future, patients develop symptoms characteristic of uremia.

Acute cardiovascular failure is characterized by the development of collapse, a decrease in body temperature to a normal or subnormal level, the appearance of pallor and cyanosis of the skin, cooling of the extremities, and later - the disappearance of the pulse due to a sharp drop in blood pressure. If the adrenal glands are involved in the process (hemorrhages in them due to disseminated intravascular coagulation), the collapse is very resistant to therapeutic influences.

Complications of salmonellosis

Intestinal infection: Salmonellosis. The most dangerous option, considered as a complication of the disease (in any form), is the development of an infectious-toxic shock, which occurs in combination with acute cerebral edema and swelling, as well as with an acute form of heart failure, which develops, in turn, from - for acute adrenal and renal failure. Swelling and edema of the brain, manifested due to exicosis, are characterized by the addition of bradycardia, reddening of the skin and its cyanosis in the neck and face (defined as "strangulated syndrome"), short-term hypertension (increased pressure).

In addition, there is also a rapid development of muscle paresis (weakening of their voluntary movements), the innervation of which is provided in particular by the cranial nerves. Further, dyspnea joins the considered state, gradually increasing, after which a cerebral coma develops, followed by a loss of consciousness by the patient.

The appearance of pronounced oliguria (a decrease in the volume of urine excreted), as well as anuria (that is, the complete absence of its excretion) - all this is evidence of the possible development of acute renal failure. Strengthening of these suspicions is noted in the event that urine is still not excreted after an adequate level of blood pressure has been restored. In such a situation, it is important to urgently examine the blood in terms of determining the concentration of nitrogenous toxins in it.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Subsequently, the course of the condition under consideration is accompanied by an increase in symptoms that are relevant for uremia (self-poisoning of the body against the background of impaired renal functions). As for the complication in the form of acute cardiovascular failure, it is characterized, in particular, by the gradual development of collapse with a simultaneous decrease in temperature to normal values ​​or subnormal values ​​(within 35-36 degrees).

The skin becomes pale, its cyanosis is possible, the limbs become cold, the pulse disappears somewhat later, which is accompanied by a sharp decrease in pressure. In the case of involvement of the adrenal glands in the process, the state of collapse is accompanied by an extreme degree of resistance to taking therapeutic measures to it (that is, there is no susceptibility to therapy).

Based on the above complication:

  • purulent arthritis affecting the joints;
  • collapse, accompanied by a sharp decrease in blood pressure and the negative impact of toxic waste products of pathogens on the cardiovascular system;
  • acute heart and kidney failure;
  • osteomyelitis; endocarditis;
  • cerebral abscess; pneumonia;
  • appendicitis; meningitis; peritonitis;
  • the development of dehydration is most often observed in children.

The prognosis for patients who have a typhoid or gastroenteric course of salmonellosis is favorable.

Salmonellosis treatment

Intestinal infection: Salmonellosis. Salmonellosis treatment should be carried out in an infectious diseases hospital. Patients need bed rest and a diet that excludes foods that irritate the stomach, enhance peristalsis and fermentation processes.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Complex treatment of the disease: antibacterial therapy aimed at destroying the causative agent of the disease; correction of violations of water-salt metabolism with solutions of rehydron, trisol; reducing the manifestations of intoxication syndrome by the introduction of solutions of glucose and rheopolyglucin; removal of toxins directly from the intestinal lumen using sorbents (Smecta, Enterosgel); diarrhea treatment (Imodium); restoration of digestive function with the help of enzyme preparations (Mezim, Creon); to restore the intestinal microflora, eubiotics are prescribed (Bifidumbacterin, Linex).

Inpatient treatment of salmonellosis is indicated for moderate and severe forms of the disease, young children, and the elderly.

  • Non-steroidal anti-inflammatory drugs (indomethacin 0.05x3 times in 9-12 hours) under the cover of drugs that protect the gastric mucosa (smecta, polysorb MP);
  • binding and excretion of toxin from the intestine (polyphepan, lignosorb, activated carbon, vaulen, etc. 5-20 g 3 times a day; enterodesis 5 g in 100 ml of water 3 times a day);
  • detoxification of toxin by enzymes: pancreatin, mezim-forte, etc. in combination with calcium preparations and alkaline and solutions (Bourget mixture);
  • neutralization of the pathogen. A mild course of salmonellosis: furazolidone, furadonin, furagin 0.1x4 times, a course of 5 days or intetrix 2 capsules x 3 times, a course of 5 days or entero-sedimentation 1 tablet 3 times a day. Moderate course: ciprofloxacin (tsiprobay, tsifran 0.5x2 times, ofloxacin (tarivid 0.4x2 times), etc. The course is 7 days. Severe course of salmonellosis: ofloxacin (tarivid) or ciprofloxacin (ciplox) 200 mg 2 times i / v drip A combination of fluoroquinolones with aminoglycosides and cephalosporins is possible. The course is 3-5 days. In the future, fluoroquinolones. The course is 10-14 days.
Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis
  • restoration of salt balance with glucose-salt solutions (rehydron, citroglucosolan, etc.);
  • elimination of toxins through the skin. Skin care. Thermal comfort;
  • preparations of rutin, vitamin C;
  • effect on the intestinal neuromuscular apparatus (buscopan, metacin, belladonna, platifillin and mebeverin, papaverine, no-shpa, halidor);
  • auxiliary agents: herbal medicine (astringent, enveloping, carminative agents), meteospasmil, zeolate;
  • restoration of intestinal biocenosis. The course of biological products from 3 weeks to 1.5 months.

Intestinal infection: Salmonellosis. It should be remembered that salmonellosis is a deadly disease, therefore, at the first signs of the disease, you should consult a doctor. Self-medication in this case is unacceptable and may lead to a decrease in the effectiveness of further treatment prescribed by the doctor.

Prevention of salmonellosis

Prevention of the disease is, in principle, similar to the prevention of other infections of diseases of the gastrointestinal tract, but it also has some peculiarities. They are due to the fact that the main source of infection is animals and poorly processed products obtained from animals.

Intestinal infection: Salmonellosis. Thus, in order to protect yourself from salmonellosis, you must follow simple rules - do not eat raw, poorly cooked or cooked meat, fish or eggs. It should be remembered that Salmonella does not die even after prolonged cooking, for several hours, if the thickness of the meat is more than 15 cm.Thus, before cooking meat, poultry and fish, they should be cut into as small slices as possible.

True, there is an exception - quail eggs are extremely rarely affected by salmonella, so they can even be eaten raw. However, they must also be washed before use.

You should also pay attention to the procedure for cutting raw meat. Some housewives may use the same knife and cutting board to cut raw meat, poultry, and fish and cut raw food. This should not be done - for these purposes, you should use various devices. Meat boards and knives are best washed after use. Also, you should not eat raw milk - only boiled or pasteurized milk.

Intestinal infection: Salmonellosis
Intestinal infection: Salmonellosis

Intestinal infection: Salmonellosis. However, Salmonella can also live in products that seem to be unrelated to animals, for example, in confectionery. This is explained by the fact that contaminated eggs could be used to make flour in such products. Therefore, in general, you should make it a rule not to buy dubious food products from your hands, from street vendors.

The rest of the tips for the prevention of salmonellosis coincides with the standard hygiene rules - wash your hands regularly, especially after visiting the street, contact with animals, do not drink unboiled water, etc. And, of course, to strengthen the immune system, to treat chronic diseases that can lead to the body's vulnerability to infection.

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