Salmonellosis

Sumitr Sutra

ป ร ะ ชุ ม วิ ช า ก า ร ค ณ ะ แ พ ท ย ศ า ส ต ร ม ห า วิ ท ย า ล ัย ข อ น แ ก น วั น ที่ 1 0 – 1 4 ตุ ล า ค ม 2 5 4 8

DIARRHEATravelTravel

Immunocompromised

Immunocompromised

Foodborneor

waterborne

Foodborneor

waterborneChild care

CentersChild care

Centers

HospitalizationHospitalization

Antimicrobiolagents

Antimicrobiolagents

ACUTE INFLAMMATORY DIRRHEA

Salmonella spp.Shigella spp.Vibrio parahemoliticusAeromonas hydrophilaPlesiomonas shigelloidesCampylobacter jejuni/coliEnterohemorrhagic Escherichia coliYersinia enterocolitica

Entamoeba histoliticaStrongyloides stercolalisVibrio parahemoliticusTrichinella spiralisCryptosporidium parvumBalantidium coliSchistosoma

Bacteria ParasiteCytomegalovirusEnterovirus

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

ผลการเพาะเชื้อจากอุจจาระของผูปวยจากรายงานของ NSSC ป พ.ศ.2544

ชนิดของเชื้อ จํานวนตวัอยาง เปอรเซน็ต

Non-typhoidal Salmonella

Typhoidal Salmonella

Shigella

Other Bacteria

No growth

7,329

228

728

147

26

84.53

2.70

8.62

1.74

6.31

รวม 8,458

(คัดลอกจาก WHO National Salmonella and Shigella center : NSSC โดย อรุณ บางตระกูลนนท)

Salmonella Nomenclature

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:

SalmonellaBacteremia

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

Salmonella spp.

Vibrio cholerae

V. paraheamolyticus

Aeromonas spp.

Plesiomonas spp.

Shigella spp.

Others

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)

Organisms2000

Year

2001 2002

Total 549 380 1,051

Salmonella isolated from food and drinking waterin five communities in Khon Kaen, 2002.

CommunitySpecimens

FoodSalmonellaIsolation(%) Specimens

Drinking waterSalmonellaIsolation(%)

1

2

3

4

5

84

74

69

105

71

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)

Total 74 (18.4) 82 6 (7.3)403

Salmonella isolated from food handlers and others in Khon Kaen, 2002.

Specimens

Food handlers

SalmonellaIsolation(%) Specimens

Healthy population

SalmonellaIsolation(%)

SexMalesFemales

Age (year)< 3031 - 4041 - 5051 - 60> 60

1476

14203521

-

64 (3.3)

2 (14.3)4 (20.0)3 (8.6)1 (4.8)

-

11 (4.7)8 (4.8)

012 (7.1)5 (5.3)2 (6.3)

0

2.5168

96170

953210

Total 10 (11.0) 403 19 (4.7)90

Salmonella isolated from pork and chicken from fresh markets in Khon Kaen.

Specimens

Pork

SalmonellaPositive (%)

Specimens

Chicken

SalmonellaPositive (%)

Month

February

June

October

32

34

25

29 (90.6)

34 (100)

24 (96.0)

28

30

26

28 (100)

28 (93.3)

25 (96.2)

Total 91 87 (95.6) 84 81 (96.4)

Salmonella serovars isolated from pork and chicken (fresh market)

Port Chicken

Serovar Strains(%) Serovar Strains(%)

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)

S. VirchowS. EnteritidisS. PanamaS. HadarA. AnatumS. BlockleyS. AgonaS. AlbanyS. SaintpaulS. TyphimuriumOthers

S. AnatumS. RissenS. PanamaS. AlbanyS. AmsterdamS. DerbyS. Subspecies 19, 12: 1 V:-S. WorthingtonS. Subspecies 14, 15, 12:I:-S. SaintpaulOthers

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)

Total 121 Total 114

Port ChickenSerovar(serogroup) Strains(%)

Serovar(serogroup) Strains(%)

Salmonella serovars and serogroups isolated in 2002 from pork and chicken from Khon Kaen supermarkets

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)

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)

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)

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 BlockleyS. Enteritidis, S. PanamaS. Agona, S. Virchow,S. Rissen, S.Entritidis

40

Specimens

Chicken

20

20

14 (70)

17 (85)

Strains (%)

Salmonella

Serovars

S. Rissen,S. AnatumS. DerbyS. AnatumS. Anatum

S. Senftenberg

Specimens

Pork

20

20

20

17 (85)

14 (70)

11 (55)

Meat

Liver

Internal organ

Total 42 (70)60

Salmonella isolation of diarrheal cases from hospitals in Khon Kaen and Region 6 2002.

Regional 6 Khon Kaen

Serovar Serogroup Strains (%) Serovar Serogroup Strains (%)

(27.9)(14.4)(10.7)(7.4)(6.7)(3.9)(2.3)(2.1)(2.1)(1.8)(20.2)

(16.5)(9.0)(8.2)(7.5)(6.7)(6.7)(5.2)(4.5)(3.7)(3.7)(2.7)

120624632291710998

87

22121110997655

37

ECCDDCBEBE

C1E1D1E1BBD1BC1C1

S. AnatumS. RissenS. VirchowS. EnteritidisS. PanamaS. HadarS. DerbyS. AmsterdumS. SaintpaulS. Welteredenl31 Other serovars

S. RissenS. WeltevredenS. EnteritidisS. AnatumS. DerbyS. StanleyS. PanamaS. 14, 12, IS. BraenderupS. Virchow23 Other serovars

Total 429 Total 133

Carrier

Children Salmonellosis Cure

Extraintestinal

BacteremiaFocal Infection

• Meningitis• Osteoarthritis• Pneumonia• Cholangitis

8-24 %

2 - 45 %

Case Fatality

3 - 10 %

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 Fatality3 - 10 %

8-24 %2 - 45 %

•Gall stone

•Immunocompromised

•Serotype

PermanentConvalescent

•Antibiotic

CarrierIntrafamily

• Carrier• Prior diarrhea

Supplement foods• Orange• Iron• Under cooked meat

Day care

Pets

Cycle of Salmonellosis

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 Fatality3 - 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

OsteomyelitisMeningitis

Chronic carrier FluoroquinoloneCholecystectomy

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