Salmonella Enterocolitis

Definition

Salmonella enterocolitis is an infection in the lining of the small intestine caused by the bacteria Salmonella.

Alternative Names

Salmonellosis

Causes, incidence, and risk factors

Salmonella enterocolitis can range from mild to severe diarrheal illness. The infection is acquired through ingestion of contaminated food or water. Any food can become contaminated during preparation if conditions and equipment for food preparation are unsanitary.

The incubation period is 8 to 48 hours after exposure, and the acute illness lasts for 1 to 2 weeks. The bacteria is shed in the feces for months in some treated patients. A carrier state exists in some people who shed the bacteria for 1 year or more following the initial infection.

The risk factors include:

• Ingestion of improperly prepared or stored food (especially undercooked turkey or chicken, unrefrigerated turkey dressing, undercooked eggs)
• Family members with recent salmonella infection
• Recent family illness with gastroenteritis
• Institutionalization
• Recent poultry ingestion
• Owning a pet iguana or other lizards, turtles, or snakes (reptiles are carriers of salmonella)
• Old or young age
• Patients with impaired immune systems

Approximately 40,000 people develop salmonella infection in the U.S. each year. Two thirds of patients are less than 20 years of age. The highest incidence occurs from July through October.

Symptoms

• Abdominal pain or cramping or tenderness
• Diarrhea
• Nausea
• Vomiting
• Fever
• Chills
• Muscle pain

Signs and tests

• Tender abdomen
• Rose spots - tiny pink spots on the skin
• Stool culture for salmonella
• Febrile/cold agglutinins (test for specific antibodies)

Treatment

The objective of treatment is to replace fluids and electrolytes (salt and minerals) lost by diarrhea. (Antidiarrheal medications are generally not given because they may prolong the infectious process.)

Self care measures to avoid dehydration include drinking electrolyte solutions to replace fluids lost by diarrhea -- these are available without a prescription. Antibiotic therapy may be indicated for those with severe symptoms.

People with diarrhea who are unable to take oral (by mouth) fluids due to nausea may need medical attention and intravenous fluids. This is especially true for small children. Fever and aches can be treated with acetaminophen or ibuprofen.

People taking diuretics may need to stop taking them during the acute episode, when diarrhea is present. Ask your health care provider for instructions.

Dietary modifications during diarrhea may be helpful: restrict milk products; give bananas, rice, apples, and toast (BRAT diet). Infants should continue to breastfeed and receive electrolyte replacement solutions as directed by your health care provider.

Expectations (prognosis)

The probable outcome is usually good. Symptoms subside in normal individuals in 2-5 days.

Complications

Dehydration from diarrhea, especially in young children and infants, is a dangerous complication. Life-threatening meningitis and septicemia may also result. Food handlers who develop the carrier state can pass the infection along to the people who eat their food.

Calling your health care provider

Call your health care provider if blood is noted in the stools, or if there is no improvement after 2-3 days. Also call if any of the following occurs:

• Vomiting or abdominal pain is severe
• Signs of dehydration are present: decreased urine output, sunken eyes, sticky or dry mouth, absent tears when crying
• Unresponsiveness

Prevention

Proper food handling and storage are preventive measures. Good hand washing is important especially when handling eggs and poultry.

If you own a reptile, wear gloves when handling the animal or its feces because Salmonella is easily passed from the animal.

•	Acute
•	Viral gastroenteritis
•	Meningitis
•	Septicemia