Salmonellosis - classic, oral, acute infectious disease of animals and humans, is characterized by the development of gastrointestinal, typhoid and less septic forms.
Etiology .According to current generally accepted view, the term « salmonellosis » brings together a group of diseases characterized by a variety of clinical manifestations caused by multiple serovars (about 2000), and the combined bacteria in the genus Salmonella Sem.Enterobacteriaceae.
whole group of bacteria divided into subgenera, serovars, biovars and fagovary.
Salmonella - gram-negative small rods (2-4 x 0.5 mm), motile due to the presence of flagella, with exception of S. gallina-rum and S. pullorum, and inactive mutants.
salmonella Pathogens are a broad group of bacteria, of which the most common bacteria Breslau (the causative agent of murine typhus), Gertner (the causative agent of murine typhus), suipes-tifer (germ found when swine fever).The whole group of Salmonella belongs to the same family as the bacteria of typhoid f
Salmonella quite stable in the environment.In dry faeces they can survive up to 4 years, in the muck - up to 3 months.When cooking meat infected for 2.5 hours salmonella only die in small pieces (less than 200g).In milk, they not only remain but also reproduce, and it does not change its appearance and taste.
Resistant to physical and chemical factors (moisture, low and high temperatures, UV rays, disinfectants, etc.), Among which the most viable S. typhimurium and S. enteritidis.Optimum growth - 35-37 ° C, are inhaled.
II.The severity of the process:
III.The course of the disease:
Examples registration diagnosis:
Complication: subcompensated intestinal dysbiosis.
variety of clinical forms of salmonellosis can be explained by the peculiarities of the pathogenesis of this disease.In particular, the tropism of the pathogen to all sections of the gastrointestinal tract, with the development of invasive diarrhea, as well as the presence of bacteremia with the defeat of immune system and internal organs.
incubation period lasts from 6 to 14 hours, at least 1-2 days.Disease begins acutely.
In mild disease during nausea, sometimes vomiting, watery stools several times a day, the pain in the abdomen.The general condition of the patients a little broken, the temperature is normal or low-grade.Recovery occurs within 1-2 days even without treatment.
In severe prevalent symptoms of acute gastroenteritis with pronounced symptoms of intoxication due to the toxins poisoning: severe abdominal pain, profuse vomiting, diarrhea, dehydration phenomena, general weakness, anuria, limb spasms;blood pressure falls, rapid pulse, weak filling and tension.The stools, initially watery and smelly, with severe disease may lose fecal character and resemble rice water.The temperature of 38-39 °.Sometimes in severe patients appears uncontrollable vomiting, profuse diarrhea;decreased blood pressure and body temperature, there is cyanosis, convulsions, anuria, the voice becomes hoarse that resembles the current cholera.
In some cases, salmonellosis occurs in the form of generalized (typhoid) and septic forms.Generalized form can begin with the phenomena of gastroenteritis or fever with no signs of the disease and the clinical course resemble the condition in typhoid fever or paratyphoid.
Because complications are possible gastritis, pancreatitis, cholecystitis, cholangitis, chronic colitis.
In addition, the possibility of formation of generalized forms of salmonellosis influence age, the presence of background immune deficiency, as well as the unfavorable premorbid factors (perinatal CNS, exudative diathesis, fermentopathy, intrauterine infections, and others.).
In addition, the likelihood of developing severe forms of the disease affect the virulence of Salmonella.
largest share are children with gastrointestinal form of the disease - 90%.Tifopodobnaya version recorded in 1.8% of patients, septic - at 0.6% of children.The share of atypical forms of documented accounts for about 10% of patients with salmonellosis.
main clinical manifestations of gastrointestinal form of salmonellosis can be grouped into the following syndromes:
gravity salmonёlleza criteria are:
I. General manifestations:
Gastrointestinal salmonellosis recorded in 90% of children.
older patients more likely to develop gastroenteritis in patients with infant - enterocolitis.Depending on the degree of severity of intoxication, toxemia and exsicosis, stool frequency emit light, moderate and severe forms of the disease.
Mild salmonellosis usually develops in older children and is caused mainly by Salmonella rare groups and S. enteritidis.
Disease begins acutely, accompanied by a slight malaise, decreased appetite, increase in body temperature up to 37,2-38 ° C.Patients may disturb small abdominal pain.In this form of the disease is not single or vomiting.Quickens Chair to 3-5 times a day, it is pasty or liquid without pathological impurities or with a small amount of slime and greens.Changes in the internal organs missing.
patient's condition quickly (3-5 days) is normalized.
moderate form is the most common variants of Salmonella.
Disease begins acutely - 6 hours - 3 days after eating infected or product in 3-7 days when the contact path of infection.
include weakness, lethargy, weakness, loss of appetite, abdominal pain, which are localized in the epigastric and umbilical areas, moderately expressed Among the first symptoms of the disease.
By early signs of the disease are also nausea, vomiting.Repeated vomiting is characteristic of the way the food infection.In this case, it is often the first sign of disease, but is stored for long - 1-2 days.With the development of gastroenterokoliticheskogo option vomiting may occur in 1-2 days, it is infrequent - 1-2 times a day, but it lasts for 2-3 days or more, ie, is stubborn...
moderate forms of salmonellosis associated with fever.It is not possible to identify any patterns.Possible increase in body temperature to 38-39 ° C on the first day.However, it is possible to a maximum temperature rise of digits to 2-3-th day.The elevated temperature is maintained for 4-5 days.
Increased stool usually begins on the first day, but the most pronounced diarrheal syndrome for 2-3 day from the beginning of the disease.The nature of the chair depends on the types of the course of gastrointestinal form of salmonellosis.So, when enteriticheskom embodiment abundant stools, watery, frothy, foul-smelling, with greens (often of the "pond scum").With the development of enterocolitis in a rich chair appear mucus, blood.
In moderate form of the disease incidence chair reaches 7 to 10 times, and diarrhea duration of 7-10 days.
When abdominal palpation in patients defined diffuse pain, rumbling along the large intestine, abdominal.
patients first year of life, a slight enlargement of the liver.
dehydration due to development are often found in children decreased tone tissue, skin elasticity, mucosal dryness, decreased urine output, the body weight loss of 7.3%.
moderate forms of the disease usually occurs without serious complications, and after 7-12 days of recovery ends.
Severe Salmonellosis is more common in young children, the adverse factors of premorbid condition in hospital acquired infections, and mainly caused by S. typhimurium.
disease begins rapidly, accompanied by a sharp increase in body temperature to 39-40 ° C, often marked chills.
The condition of patients is much worse, they become very lethargic, drowsy, reduced reaction to the surroundings.The children refuse to eat or drink.Patients concerned about the painful nausea, repeated, sometimes uncontrollable vomiting.
stool frequency is generally greater than 10 times a day.It is abundant, fetid, green.The majority of patients are found in the stool mucus and blood.
Skin in children is very pale, cold extremities possible the appearance of cyanosis.Tissue turgor and elasticity of the skin sharply reduced, dry mucous membranes, tongue dry, covered with a thick white coating.
Infringements of cardiovascular activity developed in all patients.Variable frequency, voltage and filling rate, decreases arterial and central venous pressure.Cardiac significantly muted.Perhaps the development of infectious-toxic shock I-II degree.
often affects the nervous system, which is manifested by headache, dizziness (in older children), drowsiness or sleep disorders, convulsions (in young children).
Children determined bloating, can not exclude the possibility of intestinal paresis.The majority of patients show an enlarged liver and spleen (rarely).
In young children develop dehydration II-III degree of hypotonic or isotonic type.
In severe complications of salmonellosis occur in the majority of patients, and recovery occurs within 2-3 weeks.
typhoid salmonellosis form occurs in older children and 1.8% of the total number of patients with salmonellosis.
This form may have a beginning, similar to gastrointestinal form, t. E. Start with the deterioration of general condition, fever, appearance of abdominal pain, vomiting, loose stool.However, the disease does not stop recovery after 3-7 days, and acquires the features characteristic of typhoid fever.
undulating fever or the wrong type to 38-39 ° C, lasts 10-14 days or more.Boosts lethargy, weakness, sleep disturbances occur, headache.Stably marked bloating, increase liver, spleen.Sometimes the skin of the abdomen appears scant roseolous rash.Develops bradycardia, systolic murmur is detected, decreases blood pressure.
In other cases, the disease may begin with symptoms of intoxication and gastroenterocolitis syndrome is weak or absent.Recurrences are rare.
duration of this form of Salmonella infection - 3-4 weeks.
Septic form is a Salmonella sepsis etiology, the development of which is due to a sharp decline in immunity, so common in infants, newborns, patients with IDS and other "risk groups", is usually caused by highly virulent, multi-resistant strains of S. typhimurium.
The disease begins with the phenomena of gastroenteritis, and then develop a typical pattern septicopyemia.The condition of patients with significantly worsening.Body temperature is the wrong one, with large daily scope, repeated chills, profuse sweating.rash often occurs in the form of petechiae and / or major hemorrhages, pyoderma.From the first days of illness are determined by the signs of damage to the nervous and cardiovascular systems.
secondary septic lesions can form in various organs, with no certain regularity.
purulent lesions often develop in the lungs, in the locomotor system (osteomyelitis, arthritis): Relatively often arise cholecysto-cholangitis, meningitis, tonsillitis, lymphadenitis, urinary tract infection.Sometimes there are bacterial endocarditis, aortitis.
specific nature of multiple lesions confirmed by the detection of Salmonella in the cerebrospinal fluid (purulent meningitis), sputum (pneumonia), urinary (urinary tract infection).Parallel to this, Salmonella sown in blood and feces.
Septic option salmonellosis is characterized by long, severe and can result in lethal.
meningoencephalitic form refers to generalized forms of salmonellosis.It differs from the septic forms that meningoencephalitis is the only secondary septic focus.It occurs in infants, newborns, patients with a background of IDS and damage to the nervous system.
The disease usually begins with the phenomena of gastroenteritis, then the condition worsens due to the intoxication and neurological symptoms.There are a headache or its equivalent (anxiety, monotonous cry), increased vomiting, revealed bulging, voltage ripple of a large fontanelle.Seizures may occur.At a later date revealed meningeal symptoms, focal signs, loss of consciousness.
This form of salmonellosis occurs very hard, it can be fatal, or the formation of intracranial complications.
erased form of salmonella - it is very easy gastrointestinal form of the disease, which usually develops in older children and is caused by S. enteritidis and Salmonella rare groups.
general condition does not suffer When obliterated, the body temperature remains normal.Against the background of a satisfactory general condition appears 1-2 times the liquefied stool without pathological impurities.Sometimes there are intermittent abdominal pain.
disease ends in recovery (often self-healing) in 1-2 days.
Subclinical form is not clinically manifested.This essentially salmonellezonositelstvo.However, the observed increase in antibody titer and specific morphological changes in the intestine (small intestine catarrh mucosa).
Carriage.After suffering an acute salmonellosis may form (from 15 days to 3 months.) Or chronic (more than 3 months.) Bacteriocarrier.It occurs rarely in children than in adults.
Development carriers contribute to adverse premorbid state.The slow release of the body of Salmonella occurs in the event of acute salmonellosis on the background of exudative enteropathy, disfermentozov, intestinal dysbiosis.
In addition, there is a transient or "healthy" carrier.On this form, carrier saying that if the detection of the pathogen in the feces was not preceded by an acute form of salmonella.In addition, the results should be negative serology (IHA) with Salmonella diagnosticum dynamics.
The course of salmonellosis in newborns and infants.
In newborns and infants, has the highest sensitivity to Salmonella.It is for this age group is characterized by nosocomial infection and contact infection path.
Clinical manifestations of salmonellosis in young children are very diverse.
With the development of gastrointestinal form is registered version enterokolitichesky often.In this situation, it is characterized by a gradual increase of all symptoms, severe toxicity, dehydration, frequent development gemolita, hepatomegaly.The disease often runs hard.
It is for these age groups are characterized by a septic form of salmonella.
In young children the disease is often accompanied by the formation of complications. Fermentopathy, intestinal dysbiosis, malabsorption syndrome, pneumonia, otitis media, anemia, urinary tract infections, etc.
in 35% of patients salmonellosis occurs in a mixed infection (with rotavirus gastroenteritis,UPI, shigellosis, acute respiratory infections).
Severe forms are more common in children with a history of pre-morbid condition.Particularly adversely affected by concomitant herpesvirus and Chlamydia infections.In this case, possible death.
Peculiarities of Salmonella serovar depending on the pathogen.Microbial Landscape of Salmonella isolated from humans (patients and carriers), varied.Every year is allocated 15 to 39 Serov-ditch, but is prevalent S. typhimurium - 65% of all isolates, followed by S. enteritidis - 23%.
Diseases caused by different serovars of Salmonella, have their own characteristics.