View
228
Download
4
Category
Preview:
Citation preview
Sumitr Sutra
Salmonellosis
ป ร ะ ชุ� ม วิ ชุ า ก า ร ค ณ ะ แ พ ท ย ศ า ส ต ร� ม ห า วิ ท ย า ลั� ย ข อ น แ ก� น วิ� น ท�� 10 14– ต� ลั า ค ม 2548
DIARRHEATravelTravel
Immunocom promised
Immunocom promised
Foodborneor
waterborne
Foodborneor
waterborneChild care
CentersChild care
Centers
HospitalizationHospitalization
Antimicrobiolagents
Antimicrobiolagents
ACUTE INFLAMMATORY DIRRHEA
Salmonella spp.
Shigella spp.
Vibrio parahemoliticus
Aeromonas hydrophila
Plesiomonas shigelloides
Campylobacter jejuni/coli
Enterohemorrhagic Escherichia coli
Yersinia enterocolitica
Entamoeba histolitica
Strongyloides stercolalis
Vibrio parahemoliticus
Trichinella spiralis
Cryptosporidium parvum
Balantidium coli
Schistosoma
Bacteria ParasiteCytomegalovirus
Enterovirus
Virus
DIAGNOSIS: FOOD AND WATER BORNE INFECTION
MICROBIAL CAUSES
Nausea, Vomiting or Diarrhea within 1-16 hours
• Staphylococcus aureus• Bacillus cereus• Clostridium perfringens
Diarrhea and Abdominal Cramps within 16-48 hours• Viruses• Vibrio• Enterotoxogenic E. coli
Fever, Diarrhea, Abdominal Cramps within 16-48 hours• Salmonella• Shigella• C. jejuni• Yersinia
Abdominal Cramps, Bloody diarrhea, no fever 72-120 hours• Enterohemorrhagic E. coli O157 : H7
ชุนดของเชุ"#อ จำ%านวินต�วิอย�าง เปอร�เซ็'นต�
Non-typhoidal Salmonella
Typhoidal Salmonella
Shigella
Other Bacteria
No growth
7,329
228
728
147
26
8,458รวิม
84.53
2.70
8.62
1.74
6.31
( คั�ดลอกจาก WHO National Salmonella and Shigella center : NSSC โดย อรุ ณ บ่�างตรุะก�ลนนท์�)
ผลัการเพาะเชุ"#อจำากอ�จำจำาระของผ)*ป+วิยจำากรายงานของ NSSC ป,พ.ศ.2544
Complete Name CDC Designation
Common Clinical Usage
S. enterica subsp. enterica ser. Typhi
S. enterica subsp. enterica ser. Typhimurium
S. enterica subsp. enterica ser. Enteritidis
S. enterica subsp. enterica ser. Dublin
S. enterica subsp. arizonae ser. 18:z4, Z23:-
S. enterica subsp. houtenae ser. Marina
Salmonella ser. Typhi
S. ser. Typhimurium
S. ser. Enteritidis
S. ser. Dublin
S. IIIa 18: Z4, Z23:-
S. ser. Marina
S. typhi
S. typhimurium
S. enteritidis
S. dublin
Arizona hinshawii ser. 7a, 7b:
1, 2, 5:-
S. marina or S. IV 48: g, Z51:
Salmonella Nomenclature
Salmonella
Bacteremia
Metastaticfocal
infection
Enteric fever
Gastroenteritis
AsymptomaticCarrier
PATHOGENESIS
INGESTION Salmonella
INVADE M cells
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MOST NON-TYPHOIDALSALMONELLA
SURVIVAL IN BLOODSTREAM
PRODUCE ENTEROTOXIN
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. TyphiS. Typhimurium
PATHOGENESIS
INGESTIONINGESTION SalmonellaSalmonella
INVADE M cellsINVADE M cells
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MOST NON-TYPHOIDALSALMONELLA
MOST NON-TYPHOIDALSALMONELLA
SURVIVAL IN BLOODSTREAM
SURVIVAL IN BLOODSTREAM
PRODUCE ENTEROTOXINPRODUCE ENTEROTOXIN
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. TyphiS. TyphimuriumS. TyphiS. Typhimurium
FACTORS PREDISPOSING TO SALMONELLOSIS & DISSEMINATION
• Dose and Serotype
• Hypochlorhydria
• Inflammed Bowel
• Alter Gut Flora
• Defected CMI
• Defected RE System
Bacterial Isolation In Khon Kaen 2000-2002
Organisms2000
Year
2001 2002
Salmonella spp.
Vibrio cholerae
V. paraheamolyticus
Aeromonas spp.
Plesiomonas spp.
Shigella spp.
Others
Total
345 (62.8)
50 (9.1)
73 (13.3)
29 (5.3)
15 (2.7)
29 (5.3)
8 (1.5)
112 (29.5)
35 (9.2)
204 (53.6)
12 (3.2)
1 (0.3)
7 (1.8)
9 (2.4)
336 (32.0)
235 (22.4)
188 (17.8)
120 (11.4)
94 (8.9)
29 (2.8)
49 (4.7)
549 380 1,051
Community
Specimens
Food
SalmonellaIsolation(%)
1
2
3
4
5
Total 74 (18.4) 82 6 (7.3)
84
74
69
105
71
Specimens
Drinking water
SalmonellaIsolation(%)
12 (14.3)
14 (18.9)
16 (23.2)
20 (19.0)
12 (16.7)
16
18
16
14
18
2 (12.5)
0
0
2 (14.3)
2 (11.1)
403
Salmonella isolated from food and drinking water in five communities in Khon Kaen, 2002.
Specimens
Food handlers
SalmonellaIsolation(%)
Sex
Males
Females
Age (year)
< 30
31 - 40
41 - 50
51 - 60
> 60
Total 10 (11.0) 403 19 (4.7)
14
76
14
20
35
21
-
Specimens
Healthy population
SalmonellaIsolation(%)
6
4 (3.3)
2 (14.3)
4 (20.0)
3 (8.6)
1 (4.8)
-
90
2.5
168
96
170
95
32
10
11 (4.7)
8 (4.8)
0
12 (7.1)
5 (5.3)
2 (6.3)
0
Salmonella isolated from food handlers and others in Khon Kaen, 2002.
Salmonella isolated from pork and chicken from fresh markets in Khon Kaen.
February
June
October
Total
Specimens
Pork
Salmonella
Positive (%)Month Specimens
Chicken
Salmonella
Positive (%)
32
34
25
29 (90.6)
34 (100)
24 (96.0)
28
30
26
28 (100)
28 (93.3)
25 (96.2)
91 87 (95.6) 84 81 (96.4)
Salmonella serovars isolated from pork and chicken (fresh market)
Port Chicken
S. Anatum
S. Rissen
S. Panama
S. Albany
S. Amsterdam
S. Derby
S. Subspecies 19, 12: 1 V:-
S. Worthington
S. Subspecies 14, 15, 12:I:-
S. Saintpaul
Others
Total
57 (47.1)
30 (25.1)
17 (14.1)
2 (1.6)
2 (1.6)
2 (1.6)
2 (1.6)
2 (1.6)
2 (1.6)
2 (1.6)
3 (2.5)
121 Total 114
Serovar Strains(%)
S. Virchow
S. Enteritidis
S. Panama
S. Hadar
A. Anatum
S. Blockley
S. Agona
S. Albany
S. Saintpaul
S. Typhimurium
Others
31 (27.2)
21 (18.4)
9 (7.9)
9 (7.9)
7 (6.1)
6 (5.2)
4 (3.5)
3 (2.7)
3 (2.7)
3 (2.7)
10 (15.7)
Serovar Strains(%)
Port Chicken
S. Anatum (E)
S. Rissen (C)
S. Panama (D)
S. Weltevreden (E)
S. Worthington (G)
S. Derby (B)
S. Stanley (B)
S. Virchow (C)
S. Cerro (K)
S. Albany (C)
S. Scwarzengrum (B)
S. Typhimurium (B)
43 (32.6)
34 (25.8)
10 (7.6)
5 (3.8)
5 (3.8)
4 (3.0)
4 (3.0)
3 (2.5)
3 (2.5)
2 (1.5)
2 (1.5)
2 (1.5)
Serovar(serogroup) Strains(%)
S. Rissen (C)
S. Virchow (C)
S. Anatum (E)
S. Panama (D)
S. Stanley (B)
H. Hadar (C)
S. Havana (G)
S. Enteritidis (D)
S. Scwarzengrun (B)
S. Blockley (C)
S. Senftenberg (G)
12 (15.8)
12 (15.8)
12 (15.8)
5 (6.6)
4 (5.3)
4 (5.3)
3 (3.9)
2 (2.6)
2 (2.6)
2 (2.6)
2 (2.6)
Serovar(serogroup)
Strains(%)
Salmonella serovars and serogroups isolated in 2002 from pork and chicken from Khon Kaen supermarkets
Salmonella isolated from pork and chicken and internal organs from the Khon kaen abattoir 2002
Strains (%)
Salmonella
Serovars
Meat
Internal organ
Total 31 (77.5)
S. Derby,
S. Virchow,
S Blockley
S. Enteritidis,
S. Panama
S. Agona,
S. Virchow,
S. Rissen,
S.Entritidis
40
Specimens
Chicken
20
20
14 (70)
17 (85)
Strains (%)
Salmonella
Serovars
S. Rissen,
S. Anatum
S. Derby
S. Anatum
S. Anatum
S. Senftenberg
Specimens
Pork
20
20
20
17 (85)
14 (70)
11 (55)
Meat
Liver
Internal organ
Total 42 (70)60
Regional 6 Khon Kaen
Serovar Serogroup Strains (%)
S. Anatum
S. Rissen
S. Virchow
S. Enteritidis
S. Panama
S. Hadar
S. Derby
S. Amsterdum
S. Saintpaul
S. Welteredenl
31 Other serovars
E
C
C
D
D
C
B
E
B
E
120
62
46
32
29
17
10
9
9
8
87
(27.9)
(14.4)
(10.7)
(7.4)
(6.7)
(3.9)
(2.3)
(2.1)
(2.1)
(1.8)
(20.2)
Serovar Serogroup Strains (%)
S. Rissen
S. Weltevreden
S. Enteritidis
S. Anatum
S. Derby
S. Stanley
S. Panama
S. 14, 12, I
S. Braenderup
S. Virchow
23 Other serovars
C1
E1
D1
E1
B
B
D1
B
C1
C1
22
12
11
10
9
9
7
6
5
5
37
(16.5)
(9.0)
(8.2)
(7.5)
(6.7)
(6.7)
(5.2)
(4.5)
(3.7)
(3.7)
(2.7)
Total 429 Total 133
Salmonella isolation of diarrheal cases from hospitals in Khon Kaen and Region 6 2002.
Salmonellosis CureChildren
Carrier
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality
3 - 10 %
8-24 %
2 - 45 %
Cycle of Salmonellosis
Intrafamily
• Carrier• Prior diarrhea
Supplement foods
• Orange• Iron• Under cooked meat
Day care
Pets
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality
3 - 10 %
8-24 %
2 - 45 %
Carrier
Cycle of Salmonellosis
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality
3 - 10 %
8-24 %2 - 45 %
•Gall stone
•Immuno compromised •Serotype
PermanentConvalescent
•Antibiotic
Cycle of Salmonellosis
CarrierIntrafamily
• Carrier• Prior diarrhea
Supplement foods
• Orange• Iron• Under cooked meat
Day care
Pets
Host• Infant• Immuno compromised
Stereotypes
• S. Typhimurium• S. Choleraesuis • S. Enteritidis
• Immunocompromised• Age < 3 Mo.
Cycle of Salmonellosis
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality
3 - 10 %
8-24 %2 - 45 %
• Antibiotic• Gall stone
• Immuno compromised • Serotype
PermanentConvalescent
Carrier
Intrafamily
• Carrier• Prior diarrhea
Supplement foods
• Orange• Iron• Under cooked meat
Day care
Pets
TREATMENT
Gastroenteritis Infant : ??Children : NoImmunocompromised : ?
Bacteremia Ceftriaxone, cefotaxime
14 Days
Focal Infection4 - 6 Weeks
4 Weeks
Osteomyelitis
Meningitis
Chronic carrier Fluoroquinolone Cholecystectomy
การป-องก�นระด�บครอบคร�วิ
ระด�บชุ�มชุน
•ลั*างม"อ•อาหารเสรมใน
ทารก• เข�ยงปร�งอาหาร•ระบบส�ขาภิบาลั
ตลัาด• โรงฆ่�าส�ตวิ�• โรงเลั�#ยงส�ตวิ�• อาหารส�ตวิ� / ยา
Recommended