Salmonellosis recommendations. Salmonellosis: what it is and how to treat it. If there is a process of dehydration, what to do?

Salmonellosis is an acute infectious disease caused by bacteria of the Salmonella genus, with a fecal-oral transmission mechanism, occurring primarily in the gastrointestinal tract. The nature of the course of the disease differs in each specific case, from asymptomatic lesions to severe forms with toxic and dehydration shock. Pathogenic pathogens enter the body, most often, after eating contaminated food, due to improper cooking of food.

Salmonellosis has its own disease code according to ICD 2010 (International Classification of Diseases 2010) - A02.

Prevalence and adverse outcome

The source of infection is animals and humans (the patient and the bacteria carrier). The main role in the spread of salmonellosis belongs to animals, in which the infection can be asymptomatic (bacterial carriage), or with pronounced manifestations. For humans, the greatest danger is posed by domestic animals, as well as livestock intended for slaughter, cattle, and pigs. With the development of epidemic forms, the level of infection among 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 clear symptoms of salmonellosis are dangerous for people, but also apparently healthy carriers without pronounced clinical symptoms. As soon as the body is exposed to stress or hypothermia, weakens and can no longer restrain the development of salmonella, active inflammation begins in the intestines with the generalization of the process through the bloodstream throughout the body, where salmonella invades various organs and tissues.

Salmonellosis is one of the most common intestinal infections. Over the past 10 years, there has been a trend of increasing incidence in various groups of patients. Often, intestinal infections are considered diseases that are more typical for disadvantaged areas, for poor 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, wherever there are animals or food products of animal origin.

The increase in the prevalence of the disease is facilitated by the intensification of livestock farming, when the raising, slaughter and sale of poultry and cattle increases in volume every year. Active migration processes, urbanization, globalization and the resulting increase in the volume of movement of food products across state borders play an important role in the development of the disease.

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.

Cases of disease associated with oral infection from poultry meat, eggs, as well as products and dishes prepared from them are especially often recorded. If an infection enters a poultry farm, most of the livestock becomes infected within the first day due to the ability of the pathogen to transmit transovarially. Adults are more often exposed to infection through food products; young children are also sensitive to household 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, spread among patients in medical institutions. The spread of infection in hospitals is facilitated by overcrowding of wards, unreasonable movement of patients from ward to ward, lack of necessary support facilities, reuse of disposable instruments, and poor-quality treatment of bedding. In infectious diseases hospitals, household contact 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. Basically, outbreaks of nosocomial salmonellosis are typical for children's hospitals.

A child can become infected with salmonellosis from a sick mother in utero, during childbirth, or through breast milk.

Salmonellosis is a dangerous infectious disease from which you can die. The overall mortality rate from salmonellosis is 1-3%. Children get sick with it somewhat more often and suffer more severely, 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 infected die from an asymptomatic course.

Classification by type of salmonellosis

Depending on the degree and direction of damage in the body, on the external manifestations of the disease, all forms and types of course are displayed in the following classification:

• localized (gastrointestinal): occurs in the gastric, gastroenteric or gastroenterocolitic variant;
• generalized in typhus-like or septic variant;
• carriage (bacterial excretion): can be acute, chronic or transient.

Gastrointestinal (localized) form

It is considered a relatively mild type of disease in which the pathogen practically does not leave the intestines. It occurs in the form of acute gastritis, acute gastroenteritis or gastroenterocolitis. Accompanied by cramping abdominal pain, nausea and profuse loose stools. Some patients initially experience only fever and signs of general intoxication, and changes in the gastrointestinal tract appear somewhat later. They are most pronounced towards the end of the first and on the second and third days from 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 is ingested from food. The severity and duration of manifestations of the disease depend on the severity.

Gastric variant

It is observed less frequently than the other two options. It is characterized by an abrupt onset with repeated vomiting and severe pain in the epigastric region. Intoxication symptoms are mild, no, the course of the disease is short-term - up to 3-4 days. The prognosis is favorable - after starting to take the medication, the pathogen quickly dies, without having time to cause serious harm to the body.

If the process becomes generalized, the patient develops a typhus-like form, similar in clinical picture to typhoid-paratyphoid lesions, or a septic form.

Gastroenterocolitic variant

It develops acutely; within a couple of hours after infection with the pathogen, signs of the disease appear. The patient experiences characteristic symptoms of intoxication and dehydration, which can reach 40-40.5 degrees. Then spasmodic pain appears in the epigastric and umbilical zone of the abdomen, nausea and repeated vomiting. After each vomiting there is no relief, the person continues to feel sick. Diarrhea begins after one and a half to two hours; initially, the stool looks like characteristic feces, and then becomes watery, foamy and acquires a greenish tint. After 2-3 days, the volume of stool decreases, mucus and sometimes streaks of blood appear in them. The large intestine is painful and spasmodic on palpation. During defecation, tenesmus appears - sharp cutting pain in the rectum, independent of the release of feces. The symptoms are similar to those of acute dysentery.

Gastroenteric variant

The most common form, which also begins acutely, 2-3 hours after exposure to the pathogen. Against the background of water-electrolyte imbalance, the patient's temperature increases, nausea and vomiting, cramps and pain in the abdomen, intense diarrhea with liquid, foamy stool of a greenish tint appear. The severity of the lesion is determined not by the frequency of bowel movements and vomiting, but by the loss of fluid during this process. There is no tenesmus during defecation.

The patient's skin is pale in color; in difficult cases, cyanosis is noticeable. The tongue is dry, covered with a whitish or yellow coating. The intestine is swollen and responds to palpation with pain and rumbling. Upon auscultation of the heart, tachycardia is noticeable, and a decrease in blood pressure is determined. Urine output is noticeably reduced. In severe cases, clonic convulsions appear.

Generalized form

This form of flow is characterized by the release of the pathogen from the intestine. Generalization of the lesion occurs. With the bloodstream, salmonella spread throughout the body and invade various organs and tissues. The infection becomes widespread, which is why this course is considered severe. It occurs in a septic and typhus-like form.

Septic form

The most severe variant of the generalized form of salmonellosis. The disease begins acutely; in the first days it has a typhoid-like course. Subsequently, the condition of the patients worsens. Body temperature becomes abnormal - with large daily variations, repeated chills and profuse sweating. The patient suffers from chills, and during periods when the fever subsides, he feels increased sweating, tachycardia, and myalgia. Next, hepatosplenomegaly is formed - a syndrome of pronounced enlargement of the liver and spleen at the same time.

The course of the disease is long, torpid, the general condition is characterized by malaise, loss of ability to work.

In some internal organs and tissues, secondary foci of inflammation begin to form, as a result of which the clinical manifestations of this variant of salmonellosis are very diverse, and its diagnosis is difficult. The formed purulent focus in the symptoms comes to the fore. Purulent foci often develop in the musculoskeletal system: osteomyelitis, arthritis. Sometimes septic endocarditis and aortitis are observed, followed by the development of an aortic aneurysm. Cholecysto-cholangitis, tonsillitis, cervical purulent lymphadenitis, and meningitis occur relatively often (the latter usually in children). Less common are purulent foci of other localizations, for example, liver abscess, infection of an ovarian cyst, Salmonella strumitis, mastoiditis, abscess of the gluteal region.

Typhoid-like

The disease often begins acutely. In some patients, the first symptoms of the disease may be signs of gastroenteritis. Further, nausea, vomiting and diarrhea gradually stop, while the body temperature rises, constantly or in waves. In most patients, the onset and course of the disease is similar to typhoid fever and paratyphoid fevers A and B. Symptoms of intoxication increase - severe, insomnia, and a general feeling of weakness. Duration of fever is 1–3 weeks.

By the end of the first week from the onset of the disease, the patient experiences a simultaneous enlargement of the liver and spleen (hepatolienal syndrome). Blood pressure is low and there is noticeable bradycardia. Due to the fact that the clinical picture resembles typhoid fever, there is some difficulty in differential diagnosis. Without testing for a specific pathogen, it is quite difficult to make a correct diagnosis.

Bacterial carriage

After suffering from salmonellosis, especially after manifest forms, some convalescents become bacteria carriers. This form has no clinical symptoms and is detected by bacteriological and serological tests. Salmonella bacteria carriers are divided into the following categories: acute bacterial carriage, chronic carriage, transient carriage.

Acute carriage is characterized by the release of Salmonella lasting from 15 days to 3 months. If salmonella is isolated 3 or more months after recovery, we are talking about chronic carriage. Transient carriage is a state in which Salmonella is inoculated from secretions once or twice, but clinical manifestations of the disease are not detected and the formation of significant antibody titers is not observed.

The diagnosis of “carriage of Salmonella” is relevant only if any symptoms of the disease completely disappear. The period of carriage is counted from the day of disappearance of clinical manifestations, or from the day of the first detection of salmonella during examination.

Transient carriage is the most unstable condition, since the pathogen can be released periodically during acute and chronic bacterial carriage, as well as in the asymptomatic form of salmonellosis, which must be differentiated by a specialist from each other.

Etiology of the disease

The disease is caused by various serotypes of bacteria of the genus Salmonella. The sources of infection are mainly domestic animals and birds, but humans (patient, carrier) also play a certain role as an additional source. The transmission mechanism is fecal-oral. Routes of transmission: through food products obtained from infected livestock and poultry, as well as through household contact, less often water (salmonella can be present in, for example, open water bodies and water pipes), airborne dust is possible.

Humans become infected when caring for animals, during the slaughter process in meat processing plants, and also when consuming meat infected intravitally or posthumously. Dairy products are also a source of infection.

Approximately 10% of cats and dogs carry salmonellosis. In synanthropic rodents this figure is higher – up to 40%. Among wild street birds (starlings, pigeons, sparrows, gulls), the disease is widespread. By contaminating environmental objects with their droppings, birds thus contribute to the spread of the pathogen.

Over the past 30 years, scientists have observed an increase in the number of outbreaks of salmonellosis in poultry, primarily in poultry.

Humans are a source of some pathogen species, S. typhimurium and S. haifa, especially in hospital settings. Contagious infection is most dangerous for children under one year of age, who are especially susceptible to salmonella. The duration of the patient’s infectious period directly determines the nature of the course and duration of the disease. In animals it can last for months, and in humans it can last from 2-3 days to 3 weeks. Convalescent, that is, latent carriage, sometimes lasts for years.

The most dangerous in terms of salmonellosis are considered. The disease is observed during improper culinary processing, when infected products, mainly meat (minced meat, minced meat products, jelly, meat salads, boiled sausages), were in conditions favorable for the proliferation of salmonella.

The water route of infection is typical for the pathogen infecting animals on special livestock complexes and farms, and poultry farms. In hospitals, especially in children's medical institutions and maternity hospitals, the contact and household method of spreading the disease predominates.

In urban environments, there is an airborne dust distribution path in which wild birds play a major role, polluting habitats and feeding with their droppings.

Regardless of the condition of the body, age and gender, the natural level of human susceptibility to salmonella is very high, that is, damage will develop in almost 98% of cases of contact of the body with the pathogen. As for the duration and severity of the course, it may differ in people with strong immunity, adults and healthy people, or in small children, premature babies, and the elderly. Immunity is type-specific, short-lived (5 – 6 months).

Symptoms of the disease

Noticeable 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, and increased body temperature. Signs of intoxication develop progressively, reaching headaches and muscle aches, weakness and loss of ability to work.

In addition, salmonellosis manifests itself as pain in the umbilical region and upper abdomen, along the large intestine. The pain is spastic, wave-like, from mild to very intense attacks. I am concerned about nausea and repeated vomiting, which does not bring relief.

Diarrhea is a characteristic sign of salmonellosis, and the appearance of the stool (watery, foul-smelling, foamy, greenish in color), as well as its quantity, attracts attention. Against the background of vomiting and diarrhea, dehydration syndrome develops.

Upon examination, attention is drawn to the pallor of the skin. The tongue is covered with a thick coating. Auscultation of the heart reveals tachycardia, the pulse is softly filled. Severe dehydration is accompanied by cramps in the lower extremities.

The gastroenterocolitic type of salmonellosis is accompanied by a decrease in the volume of feces by 2-3 days from the onset of the disease. Mucus and blood appear in the stool. The intestine is spasmodic, responds to palpation with pain, and tenesmus is present. The gastric form passes without tenesmus and diarrhea. The temperature ranges from low-grade to high.

Symptoms of the generalized form have characteristic differences. For example, a typhoid-like course is extremely similar to the clinical picture of typhoid fever, when, along with nausea, vomiting and diarrhea, a fever of an undulating or stable nature appears. In this case, a noticeable enlargement of the spleen and liver occurs, and a hemorrhagic rash appears on the skin. Blood pressure is low and bradycardia is present.

In septic conditions, in addition to the typical gastrointestinal symptoms, the patient has a long-term remitting fever, chills, tachycardia, severe sweating, and an enlarged spleen and liver. Inflammation of the iris may be noticeable, which determines electrolyte disturbances in the body.

Course of the disease

Stages

The onset of the disease is clinically counted from the moment the first symptoms appear, but in reality the disease begins with the incubation period, when it does not yet 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 decrease and the acute symptoms gradually subside, we can talk about the beginning of the patient’s recovery, but this statement is not true for all forms of salmonellosis.

Incubation period

In children, the course and duration of the incubation period depend on the endurance of the body. Typically, this stage lasts from several hours in case of food infection, to 3-4 days if the pathogen enters the body through contact and household contact. The greater the concentration of infection and microbiological toxins that enter the body, the shorter the incubation period of the pathogen, and the more severe 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 and household infection.

Development period

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 the disease is influenced by the route of infection, the number and type of salmonella that enter the child’s body. The main impact of microorganisms falls on the gastrointestinal tract, where microbes enter after breaking through the barrier in the stomach (hydrochloric acid).

In infants, the development is gradual: at first the baby becomes lethargic and capricious, he loses his appetite, and his temperature rises. This is followed by vomiting and loose stools. At first, the discharge has a normal color, defecation occurs 5-6 times a day. Further, the condition worsens, the increase in body temperature reaches more than 38 degrees. The child develops frequent diarrhea (more than 10 times a day), and the stools have a greenish color and a foamy consistency. By the 7th day of the flow, mucus and streaks of blood appear in them. If during diarrhea the lost fluid reserves are not replenished, the baby begins to become dehydrated, which is noticeable by dry mucous membranes of the mouth, dry tongue, sunken fontanel, the appearance of severe thirst, and decreased urine output.

In newborns, the general symptoms of salmonellosis most often prevail over the gastrointestinal picture. The temperature may remain normal, but the child refuses to eat and stops gaining weight. He exhibits anxiety, suffers from frequent regurgitation, and his skin looks pale. The abdomen is swollen.

In children with a weakened body, for example, on artificial feeding, premature babies, babies with congenital pathologies, the disease quickly takes on a generalized course similar to sepsis, leading to damage to various internal organs:

• meninges;
• liver;
• kidney;
• lungs.

The course is very severe, with high fever and enlarged liver and spleen.

In older children, the disease strikes suddenly - the process begins with a high temperature (more than 38 degrees), followed by headache with dizziness, severe and repeated vomiting, loss of appetite and weakness. Abdominal pain and diarrhea with liquid, foul-smelling greenish stool appear next. If treatment is not started during this period, the process generalizes, involving the large intestine, with the appearance of mucus and blood in the stool. Abdominal pain becomes cramping in nature. The process is accompanied by severe dehydration, infectious-toxic shock and renal failure may occur.

Older children usually return to normal after 1-3 weeks; small children, especially newborns, get sick longer - up to several months. Accordingly, their recovery process lasts longer, and several months after recovery, salmonella continues to be excreted in urine and feces.

Digestive disorders in children persist for up to 3 months due to insufficiency of the pancreas. In children with an unfavorable allergic background, the manifestations of food allergies may increase. Manifestations may be mild or accompanied by stool instability, bloating and abdominal pain, especially associated with the consumption of dairy foods.

The development of the disease in adults can occur in several ways, the intensity of which depends on the general condition of the body and the concentration of the pathogen in it. Initially, salmonellosis manifests itself as intoxication, headache, fever, aches and chills. The next stage of microbial proliferation is accompanied by the appearance of nausea and repeated vomiting, and abdominal pain. Frequent diarrhea leads to dehydration, and the discharge quickly takes on the appearance of a greenish, watery foam with an unpleasant odor. This course is typical for the gastrointestinal form of the disease. The described symptoms last up to a week, after which an improvement in well-being occurs.

If salmonellosis becomes generalized, the patient develops weakness, possibly a wave-like increase in temperature, insomnia, headache, pale skin, and muffled heart tones. Remitting fever, chills, tachycardia and increased sweating signal the transition of the disease to a typhoid-like form. The duration of this stage is usually at least several weeks. The disease is severe and complications may occur.

Flow forms

Chronic

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 manifestations of the lesion. The chronic form is also called bacterial carriage. On average, the period of bacteria isolation in a person who has had salmonellosis lasts about 3 months, sometimes longer. Transient chronic carriage in a patient is observed if the pathogen is cultured from the stool once or twice, after which further test results are negative. In this case, the subject does not have serological, clinical and colonoscopic signs of damage.

Chronic transient carriage occurs as a result of the ingestion of a very small amount of weakly virulent pathogens into the body. In this case, only with an in-depth specific examination, the majority of transient carriers show signs of infectious, subclinical salmonellosis.

At the same time, an infectious disease is the result of interaction between the host organism and the pathogen under specific environmental conditions. If there is no response from the host’s body, doctors have no reason to talk about an infectious process or disease.

Most often, salmonellosis occurs in the form of an acute disease, with corresponding obvious and severe manifestations. The duration of the pathological process, taking into account correctly selected treatment, normally does not exceed 1.5 months. However, recently, especially in industrialized regions, doctors have noted an increase in the number of cases of salmonellosis with a prolonged course of up to 3 months. The question of whether such a long course of the disease can be considered chronic cannot be resolved unambiguously, since in each specific case the degree of manifestation of the symptoms of the lesion differs.

An 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, carriage is considered acute when the release of the pathogen lasts from 2 weeks to 3 months. The chronic form of salmonellosis lasts from 3 months or longer.

Acute

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 extends beyond the intestines or not, acute salmonellosis occurs as a localized or generalized process. With a localized form of salmonellosis, the patient has all the signs of acute intestinal damage:

• intoxication;
• fever and chills;
• weakness;
• headache;
• nausea and vomiting;
• diarrhea;
• stomach ache.

With severe electrolyte disturbances, with dehydration, heart rhythm disturbances and cramps in the limbs are possible.

If the disease acquires a generalized form, after some time the listed signs are supplemented by symptoms characterizing damage to a particular organ or organ system (cardiovascular, lungs, kidneys, enlarged liver and spleen, disorders of the central nervous system).

Typically, the acute period of salmonellosis passes in 5-10 days, and recovery after it takes up to a month.

Asymptomatic

Asymptomatic salmonellosis is a prolonged carriage of bacteria in which a person has no clinical manifestations of salmonellosis, but the infectious agent is consistently present in his feces. At the same time, the person feels healthy, however, at the same time, he poses an epidemiological danger to others.

Severity

Gastrointestinal and generalized forms of salmonellosis occur in patients in the form of mild, moderate or severe severity. The degree of severity is differentiated by two main factors. First of all, we are talking about the intensity of symptoms: the severity of nausea, frequency of vomiting, temperature readings, the presence or absence of pain, cramps. More significant is the determination of the severity by the magnitude of water and electrolyte losses and 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 degrees of the disease are also distinguished.

Light

The most common form of salmonellosis is gastrointestinal. In approximately 45% of infected people, it is mild, begins acutely, there is a low-grade fever, general weakness, single vomiting, loose watery stools up to 5 times a day. In total, diarrhea lasts from 1 to 3 days. Fluid loss in this case is no more than 3% of the total body weight.

Generalized salmonellosis, as a rule, does not occur in a mild form.

Average

It is most common among all patients. The patient's temperature rises, reaching 39 degrees. The fever lasts 3-4 days, with repeated vomiting. Diarrhea lasts up to a week, no more than 10 bowel movements are observed daily. Tachycardia is pronounced, blood pressure decreases. There is a loss of fluid volume of about 6% of body weight. There is a possibility of complications developing and the disease turning into a typhus-like or septic form.

Heavy

There is an increase in temperature above 39 degrees, the patient’s fever lasts for 5 days. In this case, the symptoms of intoxication are clearly expressed. Vomiting is repeated and does not go away for 2-3 days or more. Stool more often than 10 times a day, profuse, watery and foamy. There may be mucus and blood in the stool. In total, diarrhea lasts a week or longer. The liver and spleen are enlarged, icterus of the sclera and skin is noticeable. In addition, cyanosis of the skin, decreased blood pressure and tachycardia are observed.

Changes in kidney function are noticeable: oliguria, red blood cells and casts in the urine, albuminuria, increased 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 fluid loss of 7-10% of body weight. A blood test shows thickening of the blood in the form of increased levels of hemoglobin, hematocrit and red blood cells, and a moderate shift to the left in the leukocyte formula.

Diagnosis

The main difficulty for the attending physician if there is a suspicion of salmonellosis is to carry out a differential diagnosis with other diseases accompanied by diarrheal syndrome: shigellosis, cholera, escherichiosis, food and chemical poisoning. In some cases, it becomes necessary to differentiate salmonellosis from myocardial infarction, acute cholecystitis, acute appendicitis, and thrombosis of mesenteric vessels.

To make a correct diagnosis, it is necessary to collect an anamnesis of the disease and an epidemiological history and to establish as accurately as possible all the symptoms, the frequency and intensity of their manifestation. Localized in the intestines, salmonellosis is accompanied by intoxication from the first hours of the disease; after some time, dyspeptic symptoms are added in the form of nausea, vomiting, and cramping abdominal pain. Next, diarrhea appears with liquid and foamy, foul-smelling stools of a greenish color. From 2-3 days, tenesmus may appear during defecation, mucus and sometimes blood may appear in the stool.

If typhoid-like and septic forms of salmonellosis begin with such manifestations, they are easier to detect, otherwise differential diagnosis must be carried out in order to discard the option of typhoid fever and purulent sepsis.

It is possible to reliably establish the diagnosis of “salmonellosis” only by identifying the pathogen in the feces of the affected person. In generalized forms, Salmonella is present in blood culture. In addition, microorganisms can be found in the washing waters of the intestines and stomach.

Types of analyzes

A patient suspected of having salmonellosis needs to undergo three main types of tests:

• blood test (serological test);
• bacterial culture, or bacteriological examination;
• coprogram.

A serological test is a test of blood taken from a patient's vein. Antibodies to salmonella can be detected in human blood 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 treatment regimen.

The main serological methods used to perform blood tests for salmonellosis:

• RNGA (analysis with complex and group Salmonella erythrocyte diagnostics, when staging a reaction in paired sera. Interval - 6-7 days);
• RCA (coagglutination reaction);
• RLA (latex agglutination reaction);
• ELISA (enzyme-linked immunosorbent assay).

Based on hematocrit, blood viscosity, acid-base status and electrolyte composition, a conclusion is made about the degree of dehydration of the body, and rehydration therapy is adjusted as necessary.

How to prepare for donating blood for salmonella? A blood test is taken in the morning on an empty stomach. The day before, the patient needs to give up physical activity and emotional turmoil. A serological test is prescribed 7-10 days after the onset of the disease, since in the first days antibodies to the pathogen have not yet formed in the blood. The preparation of results takes 1-2 days.

The express method of studying blood involves an enzyme-linked immunosorbent assay, which takes less time.

In addition, a general blood test is prescribed to determine the degree of the inflammatory process.

A blood test must be taken in the following cases:

• bacterial culture gave negative results;
• the person has been in contact with an infected person;
• in the second week from the onset of the disease, if the symptoms do not subside.

Bacteriological research, or bacterial culture, provides more accurate data than serological analysis. Materials for research are all biological fluids of the patient (feces, urine, bile, blood, pus, vomit, gastric and intestinal lavage). The collected elements are placed in a selenite or magnesium nutrient medium, which is favorable for the proliferation of salmonella. Next, the container is sent to a special box with a temperature of 37 degrees Celsius, that is, to conditions that promote the growth and reproduction of bacteria if it was originally in the collected material. Analysis results are usually prepared within 3-5 days - this is the average time it takes for microorganisms to reach a specific concentration. It is also possible to use several differential diagnostic media (Ploskireva, Endo, bismuth sulfite agar).

The standard for bacterial culture for salmonellosis is the isolation of a culture of pathogenic bacteria using selective enrichment media and differential diagnostic media, followed by biochemical identification and determination of the serovar of the isolate in agglutination reactions.

The analysis does not require any preparation; it is taken from those admitted to the hospital with the corresponding symptoms immediately after hospitalization.

A coprogram is a general stool analysis that shows pathogenic changes in the structure of stool, for example, the presence of undigested blood, leukocytes, an increased number of fibers.

A few days before the test, it is recommended to exclude flour products and sweets from the diet, and stop taking iron-containing and laxative medications. The material is collected fresh, in the morning after waking up and using the first toilet. Preparing a coprogram takes 2-3 days.

Testing for salmonellosis is mandatory for women who plan to become a mother. During pregnancy, a woman’s doctor can also prescribe tests, even if she has no visually obvious signs of illness. Pregnant women are tested for stool, blood from a vein, and a smear from the anus.

For children, it is important not only to be tested for salmonellosis if they have the appropriate symptoms, but also to undergo preventive examinations. If a child is suspected of having salmonellosis, it is important to carry out comprehensive diagnostics in a timely manner for a quick diagnosis. Children are prescribed:

• serological examination (7-10 days after the onset of infection);
• stool culture;
• anal swab;
• express diagnostics (immunofluorescence method).

Methods of treating 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 weakened immune systems, and those with a moderate or severe form of the disease must be hospitalized for observation in a hospital.

The patient is prescribed bed rest, especially with severe manifestations of dehydration and intoxication. If the patient’s condition allows, treatment begins with gastric and intestinal lavage, siphon enemas, and taking enterosorbents, for example, Enterosgel, Atoxil, and activated carbon.

The presence of grade 1 or 2 dehydration in a patient requires the administration of glucose-saline solutions - Regidron, Citroglucosolan, Oralit, by infusion. 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 of up to 1 liter per hour in the first 2-3 hours, and then monitoring the fluid level and consuming 1-1.5 liters of fluid every 3-4 hours.

In case of dehydration of 3-4 degrees, isotonic polyionic solutions are administered intravenously in a stream until the manifestations of dehydration shock are eliminated. Next, the patient is prescribed IVs.

At the doctor's discretion, the content of potassium ions is additionally corrected, solutions of potassium chloride or potassium citrate are administered intravenously, 1 g per day 3-4 times.

After correcting the water-electrolyte balance in the body, macromolecular colloidal preparations such as Hemodez or Reopoliglucin can be prescribed to relieve symptoms of intoxication. In case of severe metabolic acidosis, a 4% sodium bicarbonate solution is additionally administered intravenously.

In the gastrointestinal form of the disease, indomethacin is prescribed to relieve symptoms of intoxication, mainly in the early stages of the lesion, 50 mg three times over 12 hours.

The prescription of antibiotics and etiotropic drugs is relevant for the generalized type of course. Fluoroquinolines (0.5 g twice a day), Levomycetin (05.0 g 4-5 times a day), Doxycycline (0.1 g daily) are used.

To normalize digestive processes, enzyme preparations are used - Creon, Festal, Pancreatin.

It is important to adhere to the rules according to Pevzner for the entire duration of treatment, and to follow them after you manage to get rid of diarrhea, until the patient’s complete recovery.

Prevention of infection

Prevention of salmonellosis, first of all, is carried out at the national level, since this disease is highly contagious and can quickly develop into an epidemic. Veterinary and sanitary-epidemiological control, which is carried out jointly by the relevant services, is of key importance. Controlling authorities in the veterinary field conduct constant monitoring and recording of morbidity among animals, livestock, poultry, and also monitor the quality and purity of feed and meat products. Sanitary and epidemiological authorities take into account and monitor cases of the disease in people, monitor trends in the development and duration of the disease at a specific time in a specific area. In addition, the sanitary and epidemiological services are in charge of studying the serotype structure of the pathogen isolated from affected people, as well as those found in food products.

Responsible government departments are developing methods for diagnosing and standardizing procedures for recording and recording cases of the disease, and are also involved in quality control of food products on sale, especially imported ones.

Salmonellosis is a contagious and rapidly spreading disease that can infect an entire population of livestock or poultry in a few days. The disease also spreads quickly from person to person. That is why anti-epidemic prevention measures against the causative agent of salmonellosis are so extensive - in order to avoid the formation of an epidemic.

As for preventive measures among the population, there are no specific ways to protect yourself from the disease. Vaccines against salmonellosis have not been developed due to the instability of the developed immunity and the antigenic diversity of the pathogen.

The basis of prevention is sanitary and veterinary measures that provide proper conditions for the slaughter of farm animals, storage, transportation and sale of products of animal origin, as well as the preparation of food from them. For this purpose, deratization and disinfection measures, vaccination of animals are periodically carried out at livestock enterprises, farms and poultry farms, and feed and feed ingredients are taken for random control.

It is also important to prevent salmonellosis in medical hospitals in order to protect the majority of patients from infection by carriers. In this regard, disinfection measures are constantly carried out in infectious diseases hospitals, and compliance with all requirements for the disinfection of medical devices, utensils, and common areas is strictly monitored.

Bacteriological studies are periodically carried out in preschools, medical institutions, as well as food industry enterprises and public catering establishments. In addition, all persons entering work at the listed establishments for the first time are required to undergo a bacteriological examination, including for salmonellosis, in order to prevent the possible spread of infection.

Is it possible to protect yourself from salmonella? The main rules that every person must remember in order not to become infected with a pathogen and not to get sick with salmonellosis are similar to the requirements for the prevention of other infectious diseases - wash your hands more often, do not eat in unfamiliar and unreliable places, strengthen the immune system and harden the body.

In addition, when purchasing eggs, meat and poultry, and dairy products, you need to pay special attention to where they are purchased and whether the sellers have documents with the results of testing the products by a bacteriological laboratory. All animal products must be carefully processed to protect against possible contamination. It is unacceptable, for example, to consume raw meat or eggs, especially in the summer, when Salmonella activity is greatest.

Why is salmonellosis dangerous?

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.

When the brain swells, bradycardia, short-term hypertension, cyanosis and redness of the skin on the neck and face, and rapid muscle paresis appear. Then a growing pain occurs, and a cerebral coma sets in.

If the patient has obvious anuria and oliguria, we may be talking about the onset of acute renal failure against the background of severely low blood pressure. Further signs characteristic of uremia increase.

Acute cardiovascular failure is accompanied by the formation of collapse, a decrease in body temperature, the appearance of pale skin, cyanosis, and cooling of the extremities. Then 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 inflammation of the joints, abscesses of the kidneys, liver, spleen;
• endocarditis;
• dehydration;
• urinary tract infections;
• brain abscess;
• peritonitis, pneumonia, appendicitis.

In general, the prognosis is favorable if treatment is started in a timely manner.

The disease does not cause the formation of specific immunity, so it is absolutely possible to get sick again.

During pregnancy

Pregnant women may develop similar complications - dehydration, dryness, tachycardia, convulsions, toxic infectious shock, liver, kidney and adrenal failure, as well as pathologies of the cardiovascular system. The liver and spleen may enlarge, pain in the joints and in the heart area may 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, and miscarriage. A severe state of intoxication and high temperature can lead to spontaneous abortion, since it is known that a body temperature of 37.7 or higher in an expectant mother significantly increases the risk of miscarriage for up to 12 weeks.

In the second and third trimester, salmonella provokes the development of placental insufficiency and placental abruption against the background of severe general intoxication of the mother’s body. The child does not receive enough nutrients and oxygen, which causes developmental delays. Fetal malnutrition can also lead to premature birth.

Dehydration of the mother, which is accompanied by acute salmonellosis, negatively affects the unborn child, he does not receive the minerals necessary for growth. Constant vomiting and diarrhea lead to depletion of available reserves of nutrients and vitamins. Because of this, at up to 22 weeks it is possible to terminate the pregnancy, or to give birth to a premature baby with a low weight.

FAQ

What is the death temperature of salmonella

Salmonella is a fairly resistant group of microorganisms to external influences. 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.

Salmonella is not afraid of low temperatures; for example, in a freezer or refrigerator, bacteria are able to remain viable for a long time, without the ability to reproduce. As soon as the temperature becomes positive, microorganisms begin pathogenic activity. The optimal temperature for salmonella reproduction is from 10 to 40 degrees; colony growth 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 in 12 minutes. If the temperature reaches values ​​above 70 degrees, death occurs in 60 seconds. This principle is used to pasteurize milk - the product is brought to a temperature of 63 degrees and kept at this level for half an hour. During such a period of time, all pathogenic flora dies, except for the causative agents of botulism, while milk retains its beneficial properties.

Eggs that are boiled in boiling water for 3-4 minutes can be considered safe only if the infection has not penetrated inside the shell.

With meat the situation is more complicated; minced meat and frozen meat are especially dangerous in this regard. The pathogen can survive in a frozen piece of meat or poultry for up to a year. In the depths of a piece of meat, salmonella can withstand heat treatment by boiling, as well as baking in the 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 after 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, and organs, causing their damage. Typical symptoms of salmonellosis (nausea, vomiting, fever, weakness, tachycardia) may be similar to heart failure, appendicitis, food poisoning, dysentery or typhoid fever, so if you experience a severe deterioration in health and the described signs, it is better to consult a doctor immediately. If the disease takes a mild form, it will probably be possible to do without hospitalization. However, if the patient has a moderate or severe course with high fever, severe symptoms and increasing intoxication, hospitalization in a hospital is mandatory.

Salmonellosis is a polyetiological infectious disease caused by various serotypes of bacteria of the genus Salmonella, characterized by a variety of clinical manifestations from asymptomatic carriage to severe septic forms. In most cases, salmonellosis occurs with primary damage to the digestive tract (gastroenteritis, colitis).

The causative agent of salmonellosis is a large group of Salmonella (family Enterobacteriaceae, genus Salmonella), currently numbering more than 2200 serotypes. The sources of infection are mainly domestic animals and birds, but humans (patient, carrier) also play a certain role as an additional source.

The main route of infection for salmonellosis is nutritional, caused by eating foods that contain large amounts of salmonella. This is usually observed due to improper cooking.

What it is?

Salmonellosis is an acute intestinal infection of animals and humans caused by salmonella and characterized, in general, by the development of intoxication and damage to the gastrointestinal tract.

Pathogen

What is salmonella? This is a special type of bacteria that, when entering the human body, leads to inflammation of certain parts of the digestive system and severe intoxication.

They are motile gram-negative rods with flagella. The causative agent of salmonellosis (Salmonella) belongs to the family of intestinal enterobacteria, which is associated with the ability of this type of microorganisms to infect the intestines, although there are other forms of the disease.

Salmonella has certain characteristics.

1. The causative agent of salmonellosis lives in animal feces for up to four years.
2. They are resistant to salting, smoking and freezing.
3. On surrounding objects at normal room temperature, bacteria can be viable for up to three months.
4. They are resistant to many environmental factors: they can survive at a temperature of -82 ºC and remain on the surface for a long time in a dried form.
5. To destroy bacteria in products, they have to be subjected to long-term heat treatment. At what temperature does salmonella die? - not less than 50 ºC. For example, to kill salmonella in a small piece of meat weighing about 500 mg, you will have to cook or stew it for 2.5 hours.
6. Salmonella lives in the meat of domestic and wild animals, poultry, milk, and bird eggs. The peculiarity of these bacteria is the ability to multiply in milk and ready-made meat dishes for a long time, while they do not change their appearance, that is, it is not visually possible to distinguish contaminated products from clean ones.
7. Salmonella can produce or produce exotoxins: enterotoxin and cytotoxin.
8. When the bacterium is destroyed, endotoxin is released into the body of an infected person, which leads to the development of severe intoxication.

Where else does salmonella live? - in water, if it gets there with feces or through contaminated objects, they can remain for up to two months.

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Incubation period

The incubation period for salmonellosis varies from 6 hours to 3 days, averaging 12-24 hours.

Symptoms of salmonellosis

The disease develops 6-72 hours after Salmonella enters the body. Symptoms of salmonellosis may be pronounced, or they may not appear at all. In the latter case, a person is a source of infection for others, but does not suffer himself (bacteria carrier).

There are several clinical forms of salmonellosis, each of which has its own characteristics:

1. Gastrointestinal (with it, disorders of the gastrointestinal tract predominate).
2. Typhoid-like (in patients, some time after the onset of the disease, a roseola rash appears, the fever becomes wavy, the liver and spleen become enlarged).
3. Erased (in which the symptoms of the disease are weakly expressed - the clinic may be limited to mild diarrhea for 1-2 days).
4. Subclinical and bacterial carriage (with these forms of the disease there are no symptoms at all, and the presence of infection in the body can only be confirmed by a test for salmonellosis).
5. Septic (infection spreads throughout the body and causes the formation of purulent foci in many internal organs). This form of the disease develops mainly in people with immunodeficiencies, in which the immune system cannot localize the infection in the intestines. Sometimes, with this course of the disease, signs of meningeal syndrome appear, which is associated with the penetration of infectious agents into the membranes of the brain. This picture is most typical for young children, since their protective barrier between the brain and blood is highly permeable.

The most common form of salmonellosis is the gastrointestinal one, so let’s take a closer look at how it develops and manifests itself.

Diagnostics

To confirm the diagnosis of salmonellosis, bacteriological and serological studies are necessary. The material for bacteriological research is blood, feces, urine, vomit, gastric lavage, bile, pus from foci of inflammation. To detect antibodies, an indirect hemagglutination reaction is used. The minimum diagnostic titer is 1:200.

Treatment of salmonellosis at home

Along with drug treatment, bed rest is required. Below is the treatment of salmonellosis in adults in accordance with national standards, but this is only a schematic representation; in life, an individual approach is taken, taking into account age indicators/degree of exicosis/toxicosis and degree of dehydration.

1) Etotropic therapy is aimed at destroying the pathogen and the drugs of choice are: enterix, chloroquinoldol, ciprofloxacin, salmonella bacteriophage, sanguiritin.

2) Pathogenetic therapy:

• Sorbents: Smecta (to remove Salmonella waste products).
• Enzyme therapy: mezim forte, oraza.
• Antidiarrheal drugs: calcium gluconate, indomethacin.
• Antispasmodics (painkillers): no-spa or its analogues.
• Rehydration therapy is aimed at restoring water-salt metabolism using rehydron and trisone.
• Detoxification therapy is aimed at eliminating dehydration and the volume of fluid administered depends directly on the degree of dehydration. In this case, glucose and rheopolyglucin are used.
• Eubiotics and biological products: bactisuptil, linex, acipol, bifidum-lactobacterin.

In outpatient settings, patients with suspected salmonellosis are not usually treated. Patients are sent to a hospital for specialized medical care.

Nutrition for salmonellosis

The diet for salmonellosis in adults is especially important for treatment, as it facilitates its course. If the patient is in the clinic, he follows therapeutic diet No. 4. During home hospitalization after diagnosis, you must follow the rules and precautions to prevent complications:

• add a little lemon to your food;
• eat crushed, quickly digestible food in small portions, avoiding overeating;
• It is healthy to eat bananas, apples, carrots, potatoes;
• You need to drink three liters of liquid per day - water, green tea, compote, jelly;
• light broths, chicken soups, semolina porridge, rice, buckwheat;
• porridge is boiled in water without oil and salt, mashed potatoes are also made without milk;
• drink fermented milk drinks, eat blueberries, cranberries;
• lean fish and meat, it is better to make steamed cutlets from them;
• It is allowed to eat watermelons and white crackers;
• In the first days, only water is drunk, then boiled or baked foods are included.

How to speed up healing and restore intestinal microflora?

Some tips that are easy to follow at home will help you recover faster from illness:

1. Enzymes (Festal, Mezim Forte) can be taken from the first day of illness to 2 weeks.
2. A gentle diet after suffering from salmonellosis should be followed for a month. Spices, smoked foods, canned food, fatty meats and fish, sweets, whole milk, raw vegetables and fruits, and mushrooms are excluded.
3. For persistent vomiting, you can take Motilium or Cerucal, for abdominal pain - papaverine or No-shpa, and for flatulence - simethicone (Espumizan, Meteospasmil).
4. Treatment can be supplemented with herbal medicine. In the first days, astringents are preferred - oak bark, pomegranate peels, walnut septa, bird cherry fruits, and then anti-inflammatory ones: chamomile, plantain, calendula, strawberries, sage and mint.
5. After the diarrhea stops, you can start taking drugs that normalize the microflora - Acipol, Bifidobacterin, Linex, Enterol. The course should be quite long - at least 3 weeks.

Possible consequences

Complications of salmonellosis are numerous and varied:

• Vascular collapse with the formation of acute cardiac and renal failure;
• The most dangerous complication for others is carriage, which occurs due to incomplete phagocytosis.
• Septic complications with the development of purulent foci in various organs and tissues and the formation as a result of this: arthritis, osteomyelitis, endocarditis, abscesses of the brain, spleen, liver and kidneys, meningitis, peritonitis, appendicitis, urinary tract infections, infectious-toxic shock.

Prevention

There are some rules that many people follow at home to prevent any intestinal infections, including salmonellosis:

1. A separate knife for raw meat and fish - this also applies to the cutting board, which, together with the knife, should be thoroughly washed and rinsed with boiling water after use.
2. Wash your hands before eating - the most important rule, familiar from childhood, but for the prevention of salmonellosis and other intestinal infections it is the most effective.
3. Do not eat eggnog and do not drink raw eggs; boil them for 20 minutes; if you need to use a raw egg, wash it thoroughly with soap.
4. Do not eat undercooked meat—meat and poultry should be cooked for at least 1 hour.
5. Avoid catering in dubious establishments in the summer.
6. Drink only boiled milk - and also avoid eating cheese like “Adygei” and cottage cheese in the summer, purchased from dubious retail outlets.

Salmonellosis is not a disease that can be taken lightly; it is classified as a deadly disease. At the first signs of illness, you should immediately consult a doctor to take emergency measures.

Salmonellosis is an acute infectious disease caused by salmonella. This infection is widespread, affecting both adults and children. In most cases, salmonellosis occurs with gastrointestinal disorders, symptoms of dehydration and intoxication.

What is salmonellosis?

Salmonellosis is a bacterial infection that affects humans and animals, transmitted by the fecal-oral route (the pathogen is excreted in feces and enters the body through the mouth), usually affecting the stomach and small intestine.

Humans are highly susceptible to salmonellosis. The severity of the developed infection depends on a complex of factors, both external (the number of pathogens that have entered the body, their antigenic composition and biological characteristics) and internal (the state of the human body’s defense systems, associated pathologies, in particular the digestive system).

The infection is most severe in infants (especially premature infants) and the elderly. Post-infectious immunity is unstable and lasts no more than a year.

Salmonella: what is it?

The causative agent of intestinal infection (salmonellosis) belongs to the genus salmonella (Shigella, salmonella) and is a gram-negative enterobacterium that does not form spores. In appearance, the microorganisms resemble a longitudinal rod with slightly rounded edges. The length of salmonella spp is 1–5 µm, the width is from 0.33 to 0.7 µm.

The favorable temperature for existence is 35–37 degrees above zero. Salmonella are also able to survive during cold weather (from +7) or significant warming (+45). Bacteria are resistant to external factors, and their life cycle can last a very long time in environments such as:

The infectious origin not only persists, but is also capable of reproduction. The taste of the products and appearance do not change. Smoking, salting, freezing food does not lead to the death of the infectious principle.

Once in the stomach and intestines, the Salmonella bacterium reaches the small intestine, where it is captured by epithelial cells and penetrates the mucous membrane. This is where it multiplies, which causes inflammatory changes in the mucous membrane, and the bacterium spreads further into the blood and lymph nodes.

As the outlived salmonella die, the body becomes permanently intoxicated. Blood microcirculation and ion transport are disrupted, which leads to a sharp release of water and electrolytes into the intestinal lumen from the cells.

Causes of salmonellosis

Experts classify the transmission factors of the salmonellosis pathogen as follows:

• Fecal-oral. If a grocery store worker or cafe employee is infected, there is a high probability that a visitor to these outlets will soon become infected.
• Water. Drinking raw water often causes infection in a significant number of people.
• Domestic. The causative agent of salmonellosis is transmitted from person to person by shaking hands or using personal hygiene items that carry the bacteria.

Sources of pathogenic salmonella can be:

• Sick people and carriers (the pathogen is excreted in the feces).
• Infected animals (poultry, pigs, cattle, cats, dogs).
• Contaminated water (when it contains human or animal feces).
• Food (raw eggs, meat, unpasteurized milk, green vegetables contaminated with manure).

An important feature is that salmonella, once found directly in food products, does not contribute to a change in their appearance, which only increases the risk of possible infection.

Outbreaks of salmonellosis usually last quite a long time, moreover, they are characterized by a fairly high mortality rate. Often these outbreaks occur during the warm season.

First signs

When the first symptoms of salmonellosis appear, call a doctor who can provide assistance. Signs include:

• heat;
• nausea, vomiting;
• pain in the abdomen, it growls, is swollen;
• the stool is liquid, watery, mucus-like, if the large intestine is affected - with blood;
• frequent feeling of the need to defecate;
• weakness, headache;
• low blood pressure, rapid heartbeat.

Symptoms of salmonellosis in adults

After Salmonella enters the body, there is an incubation period that usually lasts for 12 to 24 hours. Less commonly, it can last 6–12 hours or 24–48 hours. Further symptoms of the disease develop.

Gastrointestinal salmonellosis

The form is localized (gastrointestinal), the course of the disease occurs in

• gastric;
• gastroenteric;
• in the gastroenterocolitic variant.

Gastrointestinal forms are the most common. The disease begins within a few hours, maximum 2 days after infection.

• Fever.
• Nausea, vomiting.
• Abdominal pain, rumbling,...
• The stool is loose, watery, mixed with mucus; if the large intestine is involved, there may be blood in the stool and a false urge to defecate.
• Headaches, weakness, but there may also be severe damage to the nervous system, including delirium, convulsions and loss of consciousness.
• Palpitations, decreased blood pressure.

Gastroenteric form of salmonellosis

This form is characterized by a combination of signs of disruption of the gastrointestinal tract and general intoxication of the body:

• fever, chills, cold sweat;
• headache;
• aches throughout the body;
• tremor of the upper and lower extremities;
• decreased tactile, tendon and muscle reflexes;
• nausea and vomiting.

After an hour, the clinical picture of salmonellosis is aggravated by diarrhea, sometimes mucus and fresh blood are found in the stool. Character of the stool: foamy and watery structure, color changes from brown to greenish. A person’s skin becomes pale and the mucous membranes become dry.

A characteristic symptom of gastroenteric salmonellosis is cyanosis of the nasolabial fold. There is rumbling in the abdomen, and the victim has a feeling of fullness and bloating.

Gastroenterocolitic salmonellosis:

• The onset of the disease is characterized by the manifestation of conditions accompanying the previous, gastroenteric variant of its course, but by the 2-3rd day of the disease there is a decrease in the volume of feces, and mucus, and in some cases, blood, already appears in them.
• Palpation (feeling) of the abdomen allows you to determine the presence of spasm of the colon and its general soreness.
• Often the act of defecation is accompanied by false urges with pain (tenesmus). In this case of the disease, its clinical picture is similar in many ways to the acute form of the disease.

Generalized salmonellosis

The generalized form can occur in a typhoid-like form, with gastrointestinal phenomena often observed initially.

• Subsequently, as nausea, vomiting and diarrhea subside, fever and signs of intoxication (headache, severe weakness) increase, while the fever becomes constant or wave-like.
• When examining a patient, elements of a hemorrhagic rash on the skin may sometimes be noted; on days 3-5, hepatosplenomegaly is detected.
• Characterized by moderate arterial hypotension, relative.
• The clinical picture resembles that of typhoid fever.

Typhoid-like form

Typhoid-like – fever for a week, intoxication, delirium, hallucinations. A rash is visible on the abdomen, the tongue is gray-brown, the skin is pale, the abdomen is swollen, and the internal organs are enlarged. It goes away in 1.5 months.

Septic salmonellosis

Septic type of disease: observed extremely rarely, mainly in elderly people, young children under one year old, and also in those with weakened immunity. It occurs with high fever, chills, heavy sweating, jaundice appears, and the most dangerous thing is the development of purulent inflammation in the internal organs and tissues. This form of salmonellosis has a high mortality rate.

Bacteria-carrying species

The form of the disease is characterized by the absence of clinical symptoms of salmonellosis, but in bacteriological clinical studies of blood and feces, salmonella is detected:

Asymptomatic form: occurs if the body has been affected by a small amount of bacteria. In people with high immunity, symptoms of salmonellosis do not appear and the body is able to fight the disease itself.

If the disease occurs in the form of damage to the stomach and intestines, or in the form of typhus, then the prognosis is favorable - with proper and timely treatment all patients recover. If the disease occurs in the form, then 0.2 - 0.3% of patients die.

Diagnostics

A preliminary diagnosis is made on the basis of the clinical picture inherent in salmonellosis and evidence of the group nature of the disease, and laboratory tests are carried out to confirm the diagnosis:

1. Bacteriological examination of feces, vomit, as well as analysis of suspicious products consumed by the patient.
2. Serological diagnostics (determination of antibodies to salmonella in the patient’s blood).

Types of bacterial excretion:

• acute – persists for up to 3 months, while the person is healthy, but tests reveal salmonella;
• chronic – lasts longer than 3 months;
• transient - some time after recovery, the patient is diagnosed with salmonella, and after that all tests are negative.

People near the bacteria eliminator must strictly observe the rules of personal hygiene. There should be no shared personal items.

Treatment of salmonellosis

Children and the elderly, as well as patients in critical condition, require hospitalization. Other categories of patients can be treated for salmonellosis at home (following the doctor’s recommendations), but do not forget about secondary prevention measures to prevent infection of others.

If hospitalization is refused due to a mild form of the disease, treatment of salmonellosis in adults consists of:

• gastric lavage;
• taking the antidiarrheal drug Enterofuril;
• cleansing enema;
• taking sorbents - activated carbon, Filtrum, or Enterosgel;
• refusal of sudden movements, adherence to diet;
• if diarrhea is prolonged, dehydration occurs, then drink solutions of Regidron, Oralit;
• to cure digestion - take tablets, Mezima;
• treatment to normalize the microflora - taking probiotics;
• drinking natural herbal decoctions.

Drink

Preference should be given to saline solutions. The pharmacy sells powders for their preparation - rehydron, oralit, citroglucosolan.

Standard composition – for 1 liter of water:

• 20 g glucose (8 teaspoons);
• 1.5 g of potassium chloride (sold in a pharmacy, as an alternative - compote of raisins or dried apricots);
• 2.5 g of soda (half a teaspoon);
• 3.5 g table salt (flat teaspoon).

You need to drink little by little, but often; ideally, take a few sips every 5-10 minutes. It is advisable to drink 300–400 ml during the first 4–6 hours. per hour, and then about a glass after each bowel movement.

Diet

For patients suffering from salmonellosis, a special diet is prescribed (referred to as treatment table No. 4). Its main task is:

• in reducing the chemical and mechanical effects of consumed food on the inflamed tissues of the intestinal mucous membranes;
• in restoring the functioning of normal intestinal microflora.

A feature of the first days of the therapeutic diet is its energy deficiency, which prescribes the consumption of a normal amount of protein and a minimum (at the level of the lower limits of the norm) amount of fats and carbohydrates. As the patient's general condition improves, the list of permitted products gradually increases.

What should you not eat?

During the illness and at least two more weeks after the disappearance of all symptoms of salmonellosis, it is necessary to completely exclude the following products:

• Citrus.
• Fatty meat and fish.
• Smoked, fried and pickled foods.
• Baking and sweets.
• From cereals, exclude pearl barley, millet, barley and oatmeal.
• Strong tea and coffee, as well as soda.
• Coarse fiber - cabbage, legumes, radishes, radishes, etc.

Authorized Products

What can you eat if you have salmonellosis:

• Lean fish and meat
• White bread, dried or crackers.
• Porridges – rice, semolina and buckwheat with water and without oil.
• Dairy products
• Fruits – apples, bananas
• Fresh fruit and vegetable puree
• Classic mashed potatoes with water
• Compotes
• Kiseli.

The duration of the diet after salmonellosis depends on many factors:

• general condition of the body;
• type of infection;
• features of the clinical picture;
• patient's age.

As a rule, for adults with a well-functioning immune system, a month's stay on a gentle diet is enough.

When the first signs of salmonellosis appear, be sure to seek help from an infectious disease specialist or gastroenterologist. With proper treatment, the disease will quickly pass and leave no complications.

The content of the article

Salmonellosis- an acute infectious disease that belongs to the bacterial zoonoses, caused by bacteria of the genus Salmonella, transmitted most often through food, characterized mainly by damage to the digestive tract, less often typhoid-like or septic.

Historical data on salmonellosis

In 1876, A. Bollinger drew attention to the connection between septicopyemic diseases of farm animals and food poisoning in people who consumed the meat of sick animals. In 1885, American veterinarians D. Salmon and Th. Smith isolated B. sipestifer from the internal organs of dead pigs (according to modern terminology, S. Cholerae suis), and the scientist A. Gartner in 1888 p. - From the meat of a forcedly killed cow and from the spleen of a person who died from eating the meat of this animal, an identical microorganism was named B. enteritidis Gartneri (S. enteritidis). In 1892 p. F. Loffler isolated a microorganism from sick mice, which he named B. typhimurium (S, typhimurium). The discovery of new pathogens of “meat poisoning” continued. The generic name Salmonella for this group of bacteria (after D. Salmon) was approved in 1934 by the International Association of Microbiologists. At the same time, the term “salmonellosis” was adopted for diseases caused by these pathogens.

Etiology of salmonellosis

The causative agents of salmonellosis belong to the genus Salmonella, family Enterobacteriacea. Salmonella are rods 1-3 microns long and 0.5-0.8 microns wide. Most Salmonella are motile due to the presence of peritrichial flagella and are facultative anaerobes. Salmonella are gram-negative and do not form spores or capsules. They grow well on ordinary nutrient media at temperatures of 8-44 ° C (optimum 37 ° C).
About 2000 Salmonella serovars have been described, which, based on their enzymatic properties, are divided into 4 subgenera. According to the O-antigen, Salmonella are divided into groups A, B, C, D, E and others (about 60 groups in total). Each group includes serovars that differ from each other in flagellar H-antigen. In our country, salmonellosis among humans is caused by about 500 salmonella serovars, among which the most common are S. typhimurium, S. enteritidis, S. Heidelberg, S. derby, S. anatum, S. newport, S. cholerae suis, etc. All salmonella produce enterotoxin, and when the bacterial cell is destroyed, endotoxin is released.
Salmonella is quite resistant to environmental factors. In open reservoirs they are stored for about 4 months, in animal feces - up to 3 years, in milk at a temperature of 6-8 ° C - about 3 weeks, in waterfowl eggs - up to 1 year. Salmonella are resistant to low temperatures; in meat at 0 ° C they survive for about 140 days, retaining the ability to reproduce. Most Salmonella strains are resistant to antibiotics, but highly sensitive to conventional disinfectant solutions (bleach, chloramine, etc.).

Epidemiology of salmonellosis

The main source of infection for salmonellosis is a variety of agricultural animals (cows, calves, pigs, sheep, horses, etc.). And wild animals, birds, especially waterfowl, in which the disease is often asymptomatic. Animals can release pathogens into the external environment for a long period (years) through feces, urine, milk, nasal mucus, and saliva. The source of infection can be a person with salmonellosis or a bacteria carrier.
The mechanism of transmission of infection is predominantly fecal-oral, rarely contact-nobutovial. Transmission factors are most often food, primarily animal and poultry meat. It is possible for meat to become infected (during illness of animals), as well as during the processing of carcasses, their transportation, processing and storage. The infection can also be transmitted through fish and fish products, ready-made dishes that are not subject to heat treatment (salads, vinaigrettes), as well as through fruits, confectionery, milk, and water. Cases of illness caused by the consumption of eggs, especially from waterfowl, have been described; Recently, cases of salmonellosis caused by the consumption of chicken eggs have become more frequent as a result of the intensification of the growing process and unsatisfactory conditions for keeping poultry. The contact and household route of infection occurs when caring for the sick, as well as in crowded groups, especially in preschool institutions, maternity wards, and children's hospitals . In these cases, the disease is caused predominantly by S. typhimurium, outbreaks are characterized by high contagiousness, speed of spread, duration of existence, as well as a significant number of severe clinical forms.
Children of the first year of life are most susceptible to salmonellosis, among whom severe generalized forms of the disease are more often observed. As children age, their susceptibility to salmonellosis gradually decreases.
Salmonellosis, like other intestinal infections, is characterized by a summer-autumn seasonality, although the incidence is recorded in all seasons. Group outbreaks and sporadic cases are possible, the proportion of which has been increasing in recent years.
Salmonellosis is common on all continents.

Pathogenesis and pathomorphology of salmonellosis

The entry point for infection, almost without exception, is the digestive canal. In case of massive ingestion of the pathogen, manifest forms of salmonellosis develop.
The development of the disease most often occurs according to the following scheme: 1) penetration of the pathogen into the digestive canal,
2) destruction of part of the bacterial cells in the upper intestines, primary bacteremia,
3) reproduction of the pathogen in the small intestine (primary localization) - enteral phase with impaired peristalsis and intestinal secretion
4) secondary bacteremia,
5) secondary localization of the pathogen with subsequent elimination during fairly intense immunogenesis (acute cyclic form) or persistence of the pathogen against the background of incomplete immunogenesis (chronic form).
The bulk of salmonella that enter the stomach dies under the influence of an acidic environment and enzyme systems, as a result of which a large amount of endotoxin is released, absorbed into the blood and causing an intoxication syndrome that determines the clinic of the initial period of the disease (fever, nausea, vomiting, abdominal pain ). At this stage, the infectious process may end. With insufficient tension of factors of nonspecific protection of the digestive canal, a massive dose of the pathogen and its high pathogenicity, the latter enters the small intestine, multiplies intensively, is phagocytosed by neutrophil granulocytes and macrophages, as a result of which not only salmonella, but also some phagocytes die. Pathogen endotoxin and biologically active substances (histamine, serotonin, etc.) are released, which leads to the development of an inflammatory process in the mucous membrane of the small intestine, a pathological effect on its neurovascular system, vasomotor paralysis, impaired thermoregulation, vascular disorders in the form of hypotension, ko Lapsa. Salmonella endotoxin activates adenyl cyclase of enterocytes, as a result of which the amount of cyclic adenosine monophosphate (cAMP) in the enterocytes increases, which causes increased secretion of isotonic fluid. Patients experience diarrhea, which over time leads to dehydration of the body and disruption of electrolyte homeostasis. Hypoxia occurs with disorders of cellular metabolism, acidosis develops. In case of insufficient tension of the immune defense, in some cases a breakthrough of the intestinal and lymphatic barrier occurs, which causes secondary bacteremia, the introduction of the pathogen into various organs and lymphatic formations (generalization of the process), a typhoid-like course of the disease or the formation of septicopyemic foci. An important role in the development of the infectious process is played by the penetration of the pathogen into enterocytes and macrophages, where it can multiply with long-term persistence.
After suffering from salmonellosis, type-specific immunity remains, which lasts for 5-7 months. Both humoral and cellular components of immunity are involved in the destruction of the pathogen and its toxins. It is believed that humoral antibodies ensure the neutralization of Salmonella endotoxin, while their effect on the pathogen itself is limited due to the presence of the latter in enterocytes and macrophages, which cause a slower elimination of the pathogen from the body, possible exacerbations, relapses of the disease, and also chronic bacterial carriage.
Morphological changes in salmonellosis depend on the form of the disease. With the frequent gastrointestinal form, hyperemia, edema, hemorrhages in the mucous membrane of the small and partially large intestine, and hyperplasia of the lymphatic follicles are observed. In severe cases, inflammatory changes affect the submucosal layer and are accompanied by significant vascular disorders, cellular infiltration, and the formation of erosions and ulcers. In the case of generalized forms of salmonellosis, phenomena of dystrophy and foci of necrosis in the internal organs are observed. Multiple metastatic abscesses are detected in the liver, spleen, kidneys, adrenal glands, and lymph nodes. Possible purulent meningitis, endocarditis, focal pneumonia, osteomyelitis.

Salmonellosis clinic

The incubation period for salmonellosis lasts from 6 hours to 3 days (usually 12-24 hours). Clinical manifestations of salmonellosis are characterized by polymorphism, which is reflected in the clinical classification.
1. Gastrointestinal (toxicoinfectious) form:
a) gastric variant (5-10%),
b) gastroenteric (80-90%), including cholera-like
c) gastroenterocolitic variant (5-8%).
2. Typhoid-like form.
3. Septic form with septicopyemic variant, including other extraintestinal forms (pneumonia, meningitis, endocarditis, etc.).
4. Subclinical (asymptomatic) form.
5. Bacterial carriage:
a) acute (up to 3 months),
b) chronic (over 3 months)
c) transient - short-term.
The gastrointestinal form of salmonellosis is most often observed. The disease begins acutely, often with chills, an increase in body temperature to 38-39 ° C and higher with severe intoxication (headache, weakness, dizziness). Signs of damage to the gastrointestinal tract, pain in the epigastric region and near the navel, and repeated vomiting quickly appear. Vomit initially looks like undigested food, and later becomes watery and stained with bile. In most cases, diarrhea appears somewhat later than vomiting. The feces quickly become watery, foamy, and in the case of the gastroenterocolitic variant, mixed with mucus and sometimes blood. Sometimes the feces may resemble rice water.
During an objective examination of the patient, attention is drawn to a dry, white-coated tongue, a moderately swollen abdomen, rumbling upon palpation, pain in the epigastric region, and sometimes in the iliac region on the right (Salmonella triangle). From the first days of illness, the liver and spleen enlarge in most patients.
Diarrhea, as a rule, lasts 2-4 days, in some cases longer, which can lead to dehydration, loss of mineral salts by the body, microcirculation disorders, and metabolic acidosis. Some patients may experience tonic spasms of certain muscle groups (dehydration). Cardiovascular disorders increase, blood pressure drops to 10.7/5.3 kPa (80/40 mm Hg) and below, tachycardia appears, heart sounds are muffled, and in severe cases, collapse develops. As a result of endotoxinemia, patients often experience varying degrees of nervous system disorders - dizziness, fainting, and, less commonly, toxic encephalitis. A blood test usually reveals moderate leukocytosis with a shift in the leukocyte formula to the left, and a slight increase in ESR. With dehydration, possible thickening of the blood, an increase in hemoglobin levels. In typical cases, the duration of the disease does not exceed 3-5 days, but normalization of the functional state of the intestine occurs later than clinical recovery.
The course of the gastrointestinal form salmonellosis can be mild, moderate or severe. In the case of a mild form of intoxication, almost no or moderate intoxication is observed. Patients complain of slight weakness, fatigue, and abdominal discomfort. Body temperature is subfebrile or normal. Vomiting occurs once or not at all, stool is liquid, stool 1-2 times a day with a rapid tendency to normalize. As a rule, the illness lasts 1-3 days and ends with complete recovery.
In case of moderate form body temperature rises to 38-39 ° C, chills, headache, weakness, and pale skin appear. Intense pain in the abdomen, worse near the navel, repeated vomiting, stool up to 10 times a day, stool is liquid, foamy, foul-smelling, with mucus admixtures. Recovery occurs in 3-6 days.
Severe form of gastrointestinal salmonellosis begins rapidly with an increase in body temperature to 39-40 ° C or more. Fever persists for several days with slight daily fluctuations. Vomiting is repeated, profuse, stools 10-20 times a day or more, watery stools, often in the form of rice water. Dehydration rapidly increases, skin and muscle turgor decreases, facial features become sharpened, cyanosis of the lips and extremities appears, tachycardia appears, heart sounds are sharply weakened, blood pressure drops to 8/5.3 kPa (60/40 mm Hg) and below, the voice weakens to the point of aphonia, convulsions are possible. Proteinuria and oligo-anuria are observed. The level of residual nitrogen and creatinine in the blood increases. Signs of thrombohemorrhagic syndrome and infectious-toxic shock progress. In severe cases, collapse and extrarenal coma develop.
For the gastroenterocolitic variant of the gastrointestinal form, in addition to gastroenteritis, the characteristic symptom complex is colitis, so the disease is in many ways reminiscent of dysentery.
Typhoid-like form salmonellosis in the initial period, as a rule, is similar to the gastrointestinal form, but later acquires a course that resembles typhoid fever. In some cases, the disease may initially occur without gastroenteric syndrome. Long-term steel fever (38-40 ° C) and severe intoxication are observed. Patients are apathetic, adynamic, their consciousness is clouded, delirium and hallucinations are possible. The skin is pale; on the 4-10th day, in some patients, single elements of a roseolous rash appear in the abdomen and lateral surfaces of the chest, which disappear after 1-3 days. The tongue has teeth marks on the lateral surfaces and is coated with a gray-brown coating. From the first days of the illness, the abdomen is swollen, in most patients the liver and spleen are enlarged, sometimes other symptoms characteristic of typhoid fever appear (palpable crepitus, relative bradycardia, dicrotia, etc.). At the onset of the disease, neutrophilic leukocytosis is detected, which within 3 -5 days is replaced by leukopenia with relative lymphocytosis.
Typhoid-like form of salmonellosis, as a rule, has a moderate or severe course with a febrile period of 2 weeks or more. Recovery in most patients is slow, lasting 3-5 weeks.
Septic form Salmonellosis is rare, mainly in newborns and the elderly. The disease has a long, severe course with exacerbations and remissions, significant polymorphism of clinical manifestations, prolonged hectic fever, repeated chills, heavy sweating, hepatosplenomegaly, jaundice, and sometimes multiple purulent foci in various organs and tissues. The initial period of the disease has many common manifestations with the typhus-like form - a slow increase in clinical symptoms, prolonged fever of a constant type, hepatolienal syndrome, etc. Later the disease acquires a septic course. The scalp is pale, subicteric, often with petechiae, in some patients with extensive hemorrhages, sometimes with a small pustular (pustular) rash. At the height of the disease, dysfunction of the circulatory system, decreased blood pressure, muffled heart sounds, and extrasystole are observed. On examination - neutrophilic leukocytosis (20-30-109 in 1 l) with a shift in the leukocyte formula to the left, a decrease in hemoglobin levels, an increase in ESR to 20-60 mm/year. The typical variety of locations of secondary purulent foci (septicopyemic variant) in organs and tissues (lungs, pleura, liver, spleen, kidneys, endocardium, meninges, bones, etc.), on which the clinical picture of this form of salmonellosis depends. The septic form of salmonellosis is characterized by high mortality. The development of a chronic form of sepsis with local damage to individual organs is possible.
In children of the first year of life who have a corresponding premorbid background (artificial feeding, prematurity, trauma during childbirth, etc.), septic forms of salmonellosis in the form of meningoencephalitis, osteomyelitis, pneumonia, pyelonephritis, etc. are relatively more often observed. The course of salmonellosis is especially severe. with high mortality occurs when infected with S. typhimurium in maternity hospitals, children's hospitals and other children's institutions. Complications. In patients with salmonellosis, collapse, infectious-toxic shock, acute heart failure, kidney failure, cerebral edema, hemorrhagic syndrome, etc. are possible. Superinfection and dysbiocenosis are often observed. The consequences of dangerous secondary localization of foci of infection are often caused by the septicemic form of salmonellosis. Salmonellosis can be complicated by pneumonia, ascending urinary and biliary tract infections.
The prognosis depends on the form of salmonellosis, clinical course, age of the patient, premorbid condition, timeliness of diagnosis, adequacy of treatment. In patients with gastrointestinal form, the prognosis is usually favorable. In general, the legality of salmonellosis is 0.1-0.4% and is mainly due to the development of typhoid-like, especially septic forms.

Diagnosis of salmonellosis

The main symptoms of clinical diagnosis of the gastrointestinal form of salmonellosis are acute onset, chills, high body temperature, pain and rumbling in the abdomen, nausea, repeated vomiting, enlarged liver and spleen, profuse watery greenish stools. When making a diagnosis, one should take into account the epidemiological history.

Specific diagnosis of salmonellosis

For laboratory confirmation of the diagnosis, bacteriological and serological methods are used. Bacteriological examination is subject to feces, vomit, washing water, blood, urine, bile, exudate or pus from inflammatory foci. It is advisable to obtain the material before applying etiotropic therapy. Sowing is carried out on Ploskirev's elective medium, as well as on bismuth sulfite agar (Wilson-Blair medium). As a rule, bacteriological confirmation of the diagnosis can be obtained in 60-70% of cases of salmonellosis, and the higher the rate, the earlier the studies were conducted and the greater their frequency.
From serological studies, RA and RIGA with erythrocyte diagnostics are used. An increase in the dynamics of the titer of specific antibodies by 4 times or more is of diagnostic significance. RA is considered positive when the antibody titer is 1:200, and RIGA is considered positive when the titer is 1:600. An increase in the titer of specific diagnostic antibodies is observed after the fifth day of illness. Serological confirmation of salmonellosis is obtained in 60-80% of cases. For focal outbreaks of the disease, express methods are used - immunofluorescence, etc.

Differential diagnosis of salmonellosis

Depending on the form of salmonellosis, it should be differentiated from food toxic infections of another nature and poisoning, cholera, dysentery, viral gastroenteritis, various surgical and somatic diseases (acute appendicitis, acute pancreatitis, cholecystitis, abdominal form of myocardial infarction, etc.).. With typhoid-like and septic forms of salmonellosis are differentially diagnosed with septic conditions of other origins, typhoid fever, paratyphoid fever A and B, influenza, malaria, tuberculosis, acute pyelonephritis, ersiniosis, viral hepatitis, etc.

Treatment of salmonellosis

Hospitalization of patients with salmonellosis is carried out according to clinical and epidemiological indications in an infectious diseases hospital. Treatment measures are determined by the clinical form of salmonellosis, as well as the individual characteristics of the body (patient’s age, concomitant diseases, period of the infectious process).
For gastrointestinal form Salmonellosis, first of all, you need to rinse the stomach with a 2% solution of sodium bicarbonate or a weak solution of potassium permanganate. Washing is carried out until the wash water is clean, after which saline laxatives and adsorbents are prescribed. During the height of the disease, bed rest is prescribed. On the first day, a gentle diet is recommended (mucus soups, tea, crackers), and then diet No. 4 is used.
In patients with gastrointestinal form of salmonellosis, the main thing is pathogenetic treatment, which covers measures aimed at detoxification, rehydration, and stabilization of hemodynamics. If the disease has a mild course, they are limited to the administration of saline solutions orally (“Oralit”). In moderate and especially severe forms of the disease, the administration of isotonic saline solutions is mandatory.
Emergency rehydration therapy covers initial rehydration, which is carried out within the first hours of the start of treatment, and fluid and electrolyte replacement, which continues. Before prescribing rehydration therapy, you need to decide: what solutions to administer; in what quantity; in any way. In case of significant dehydration, treatment measures are similar to those taken for cholera. Isotonic polyionni solutions are injected in a stream - “Kvargasil”, Phillips No. 1 and No. 2, “Acesil”, “Chlosil”, “Lactosil”, etc. The number of injected solutions is calculated based on the body weight deficit, Phillips formula and blood plasma density. If the patient loses 6-10% of body weight, treatment begins with the introduction of an isotonic sodium chloride solution at a rate of 80-120 ml per minute in a heated state (39-40 ° C). Subsequently, as compensation for fluid loss continues, they resort to drip administration of solutions, which is completed after the cessation of vomiting, stabilization of hemodynamic parameters, and the advantage of the amount of urine over the amount of feces.
In cases of infectious-toxic shock Glycocorticosteroids (prednisolone 60-300 mg per day, hydrocortisone 125-750 mg per day or more), dopamine are added to infusion solutions. Prescribing pressor amines (mesaton, norepinephrine) to patients with gastrointestinal salmonellosis is contraindicated due to their ability to cause spasm of the renal vessels.
In acute kidney failure, cerebral edema, diuretics (Lasix, mannitol) are used, and in case of circulatory failure, cardiac glycosides (strophanthin, corglycone) are used.
In cases of mild and moderate gastrointestinal forms of salmonellosis, antibacterial therapy is ineffective; it often slows down the normalization of the gastrointestinal tract, inhibits the elimination of the pathogen, and contributes to the formation of intestinal dysbiosis.
Antibacterial agents are used in the treatment of patients with severe forms, as well as young children with all forms of salmonellosis. In order to treat children with mild and moderate forms, nitrofuran drugs (for example, furazolidone), as well as 8-hydroxyquinoline derivatives (enteroseptol, mexaform), are widely used. Patients with severe gastrointestinal form are prescribed broad-spectrum antibiotics (chloramphenicol, ampicillin, gentamicin, cephalosporin, etc.). The course of treatment lasts 5-6 days.
In the case of a protracted gastrointestinal form of salmonellosis, importance is attached to enzyme preparations (panzinorm, festal, mexaza, pancreatin, etc.), and immunostimulating agents (methyluracil, pentoxyl). In some cases, a polyvalent Salmonella bacteriophage is used.
With typhus-like form salmonellosis, along with intensive pathogenetic therapy, broad-spectrum antibiotics are prescribed - chloramphenicol 0.5-1.0 g every 6 hours for 10-12 days, ampicillin 0.5-1.0 g every 6 hours for 10 days and etc.
Patients with septic form salmonellosis, it is advisable to administer antibiotics parenterally in maximum doses: chloramphenicol succinate - 70-100 mg / kg per day, ampicillin - 250-300 mg / kg per day. In case of formation of secondary septic foci, surgical intervention is performed.

Prevention of salmonellosis

Veterinary, sanitary-hygienic, sanitary-technical anti-epidemic measures are applied. They provide for the improvement of the health of farm and domestic animals, strengthening the sanitary regime at meat processing plants, catering establishments, food and processing industries, and dairies.
Great importance is attached to the timely isolation of the source of infection from among patients and bacteria carriers, and to carrying out final disinfection. Patients with salmonellosis are allowed to be discharged from the hospital after a single negative bacteriological examination of stool, which is carried out no earlier than on the third day after the end of antibacterial treatment, and a person from the number of maternity leave - after three-fold bacteriological examination (every other day) with negative results. Persons on maternity leave who continue to excrete salmonella are not allowed to work for 15 days. During this period, a three-time bacteriological examination of stool is carried out, which, based on positive results, is repeated for another three months. If bacterial carriage is detected after this period, persons such as chronic bacterial carriers are not allowed to work for a year, after which a three-time bacteriological examination of stool and a single test of bile are repeated. If they receive at least one positive result, these persons are completely released from work in their specialty and are registered with the SES.
Children who are chronic carriers of salmonella are not allowed into nurseries and kindergartens, and children who are carriers of an antibiotic-resistant strain of S. typhimurium are not allowed to attend preschool institutions, etc.
It is prohibited to use waterfowl eggs in catering establishments. There is no specific prevention of salmonellosis.

Salmonellosis is an infectious disease that primarily affects the gastrointestinal tract. The causative agent of salmonellosis is 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.

Salmonellosis - what is it?

Salmonellosis is predominantly a zoonotic disease. This is the name for 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 domestic birds, fish) and animal products - meat, milk, eggs.

Bacteria of the genus Salmonella are classified as gram-negative. They are highly resistant to adverse influences. Bacteria can live for weeks or months in water, on the surfaces of objects, and in the meat and milk of animals at room temperature. They can also withstand significant (down to -80ºС) temperature drops. Boiling and heating to +100ºС quickly kills microorganisms, but in water with temperatures up to +70ºС they can live for several tens of minutes.

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Neither salting nor canning kills these bacteria. Their only Achilles heel is the impact of disinfectants - most of them quickly kill salmonellosis bacilli. Salmonella bacteria are also highly resistant to most antibiotics.

Mechanism of disease development

Infection usually occurs after contact with infected animals or after eating food containing salmonella. Infection by airborne droplets, water, and everyday objects is also possible. The source of infection may also be other people who are carriers of salmonellosis bacilli.

Not every time bacteria enters the body through the mouth, illness occurs. First, the bacteria enter the human stomach, which contains gastric juice. Salmonella is sensitive to acidic conditions, so gastric juice containing hydrochloric acid can kill some of the bacteria. Therefore, people who have problems with the secretion of gastric juice are most sensitive to bacteria.

If the gastric barrier has been successfully passed, then bacteria colonize the intestines and begin their destructive activity. They can attach well to the intestinal mucosa and penetrate into superficial tissues. In this case, bacteria can release various toxins that poison the body and cause malaise, vomiting and diarrhea. Dying salmonella also release dangerous toxins.

Salmonella is also very good at evading the body's defenses. Having detected an invasion, the immune system sends special cells - macrophages - towards the pathogens. However, salmonella have learned to use these cells to their advantage. Being absorbed by macrophages, some Salmonella do not die, but move along with them through the bloodstream and thus move to other tissues of the body. Thus, salmonella can affect not only the intestines, but also the liver, kidneys, heart and even the meninges. This feature of the causative agents of salmonellosis is the reason that the disease can lead to severe complications and extend far beyond the gastrointestinal tract.

Anyone can get salmonellosis, regardless of age and gender. However, young children and the elderly are most susceptible to it due to their weakened immune systems. In addition, their disease is more severe.

The disease has a clear seasonal dependence. During the warm season, there is a peak in diseases. However, you can become infected with salmonellosis in any season.

Symptoms of salmonellosis

There are two main variants of the disease - gastrointestinal and generalized. The second, in turn, is divided into typhoid and septic. The gastrointestinal variant is the mildest, and the septic variant is the most severe, with the highest probability of death.

Gastrointestinal form

Typical symptoms for this form of the disease:

• Heat,
• Loose stools with characteristic discharge,
• Abdominal pain
• Nausea,
• Vomit.

This form generally does not extend beyond the gastrointestinal tract. The incubation period of the disease is short. Usually it lasts from 3 to 72 hours. After this, the patient’s temperature rises, stool disorders, nausea and vomiting begin.

Characterized by acute pain in the abdomen, most often in the upper part, in the navel area. Symptoms of salmonellosis also include a very high temperature, which can rise up to + 40 ºC. Stools are frequent - up to 10 times per day and can lead to dehydration. The stool is usually watery and foamy, contains green mucous clumps, and has an unpleasant odor. Bloody discharge may appear a little later, on the third day.

In addition, the patient may experience a drop in pressure, tachycardia, and changes in heart sounds. This form usually lasts no more than a week.

The gastric form is a type of gastrointestinal form. Usually the disease is milder, no diarrhea is observed, only vomiting, pain is localized in the epigastric region. This form is quite rare.

Typhoid form

With typhoid salmonellosis, the symptoms initially resemble those of the gastrointestinal form - vomiting, diarrhea, high fever. However, then the disease takes on features that make it similar to typhus. A rash appears on the skin, many organs increase in size - the spleen, liver. This form is more severe and lasts longer - in some cases more than a month.

Septic form

In most cases, it is typical for people with weakened immune systems, the elderly, and young children. In the septic form of salmonellosis, symptoms are not limited to fever and signs of general intoxication. It is also characterized by infectious processes in various organs, primarily in the lungs, kidneys, and bladder. Damage to the endocardium and meninges may be observed.

Septic salmonellosis is more characterized by life-threatening complications such as pulmonary and cerebral edema, renal and heart failure. With this form of salmonellosis, treatment is extremely complicated.

Diagnostics

Not all symptoms, including diarrhea and fever, mean salmonellosis. Salmonellosis, especially at an early stage, is not always easy to separate from other infectious diseases of the gastrointestinal tract, for example, rotavirus infection, dysentery. Therefore, to determine the pathogen, an analysis of the patient’s stool is necessary. In generalized forms, pathogens can also be detected in the blood. An analysis of the actions that could lead to infection also plays an important role in diagnosis.

How to treat salmonellosis

Only a doctor can decide how to treat the disease. In most cases of salmonellosis, treatment is carried out in a hospital. In case of mild forms of the disease, treatment can be carried out at home. However, this is rather an exception, since salmonellosis is an insidious disease, and its seemingly mild course can give way to an exacerbation at any time.

For mild salmonellosis, treatment is mainly symptomatic. If a person has gastrointestinal salmonellosis, then the main attention is paid to rehydrating the body, that is, restoring lost fluid. For this purpose, water-salt solutions are used. Also, in the first days of the disease, gastric and intestinal lavages are regularly done, sorbents are used that absorb bacteria and their toxins, and deintoxication therapy is carried out using colloidal solutions. To restore digestive functions, enzyme preparations (pancreatin, dry bile) are used.

In addition, it is necessary to take medications - probiotics, which restore normal intestinal microflora.

The patient should drink as much fluid as possible. A starvation diet is not indicated; instead, a gentle diet should be used - boiled dishes, low-fat soups, cereals. It is not recommended to take antidiarrheal drugs, such as Loperamide, as they slow down the removal of toxins from the body and can lead to severe intoxication.

Antibiotics are rarely used for mild forms of salmonellosis. This is due to the fact that salmonella are highly resistant to most antibacterial drugs and because antibiotics can aggravate intoxication. However, for severe salmonellosis, treatment may include antibiotics. Antibiotics are also used in cases where other forms of therapy show low effectiveness. Fluoroquinolones are most often used in the treatment of salmonellosis, but only a doctor can prescribe a specific type of antibiotic. There are also special preparations containing bacteriophage viruses that are active against salmonella.

There is no vaccination against salmonellosis. This is due to the fact that there are a huge number of varieties of bacteria that can cause salmonellosis—several hundred—and in this case it is impossible to develop a universal vaccine. In addition, immunity to salmonellosis in humans is usually unstable and disappears after about a year.

After recovery, there is a recovery period that may take several months. This will help avoid the negative consequences of salmonellosis.

Recovered patients, however, can carry salmonella in their bodies for a long time and can be dangerous to others due to the possibility of infecting them. Also, the consequences of salmonellosis include dysbiosis, which can be treated with probiotic drugs.

Prevention

Prevention of the disease is, in principle, similar to the prevention of other infections and 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. Thus, in order to protect yourself from salmonellosis, you must follow simple rules - do not eat raw, poorly fried 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.

Particular attention should be paid to eggs. Poultry is the most common carrier of salmonella. Therefore, you should avoid eating raw eggs and cook them for as long as possible - at least 6 minutes. It is also necessary to pay attention to the surface of the eggs themselves, since they may contain particles of bird droppings. Therefore, after handling the eggs, hands must be washed thoroughly with soap.

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

You should also pay attention to the cutting procedure for raw meat. Some housewives may use the same knife and cutting board to cut raw meat, poultry and fish and cut foods eaten raw. This should not be done - for these purposes you should use various devices. It is best to wash meat boards and knives after use. You should also not consume raw milk - only boiled or pasteurized milk.

However, salmonella can also live in products that seem to have nothing to do with animals, for example, in confectionery products. This is explained by the fact that contaminated eggs could be used to prepare flour in such products. Therefore, in general, you should make it a rule not to buy questionable food products from street vendors.

The rest of the advice for preventing salmonellosis coincides with standard hygiene rules - wash your hands regularly, especially after visiting the street, contacting animals, do not drink unboiled water, etc. And, of course, strengthen the immune system, treat chronic diseases that can make the body vulnerable to infection.