Salmonella

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  • Pattern of fever
  • Salmonella

    1. 1. Salmonella species Prof. Dr. Abbas Hayat
    2. 2. Non Lactose fermenters Colorless colonies on Mac Conkeys • Shigella species:  (diarrhea dysentery) • Salmonella species:  ( enteric, typhoid fevers, enterocolitis and septicemia) • Proteus species wound infections, UTI's in anatomically obstructed urinary tract otitis media, surgical infections ) • Pseudomonas species: wound infections, UTI's in anatomically obstructed urinary tract, otitis media, surgical infections )
    3. 3. EWINGS CLASSIFICATION • Salmonella typhi: TYPHOID • Salmonella enteritidis: Gastroenteritis • Salmonella Para typhi A,B,C 1800 serovars. Para typhoid Fevers • Salmonella cholerasuis: Septicemia
    4. 4. GENERAL CHARACTERISTICS Gram-negative rods, Motile, peritrichous flagella produce abundant Hydrogen sulfide. Surface antigens "O", "Vi", "H" Phase variation seen in ("H" ) or Flagellar antigen. Endotoxin – Lipopolysaccharide, Exotoxins & Enterotoxins
    5. 5. Pathogenesis of Salmenollosis
    6. 6. Scheme of Pathogenesis Enterocolitis and Diahorrea
    7. 7. Epidemiology • Non-typhoid Salmenollosis worldwide disease of humans and animals. • Animals main reservoir, • Usually food borne, • Spread `` Person to Person ``. • Salmonellae that cause Typhoid fever and other enteric fevers spread mainly by fecal- oral route. • Asymptomatic human carriers ("Typhoid Mary’s") may spread the disease. • Contaminated food: Major mode of transmission for non-typhoid salmonellae,
    8. 8. W 1 Poster
    9. 9. Salmenollosis a zoonosis. • Animal reservoirs : chickens, turkeys, pigs, and cows; dozens of other domestic and wild animals also harbor these organisms. • Animal meat etc. not properly cooked are the main vehicle of transmission. • Reptile’s House hold lizard important reservoirs in homes and hospitals. S. typhmurium isolated from CHIP KALI`S of Paeds ward H.F.H in 1987 unpublished data . • Frozen eggs. ( Siachin outbreak Pak. Army)
    10. 10. DISEASES A. Enteric Fever or Typhoid. • S. typhi S. paratypi A B & C • CLINICAL FINDINGS: 40 days illness.` BARRA BUKHAR` • Temp. Increases in step ladder fashion. • High grade fever with constipation • Rose spots, high fever, enlarged Spleen, Abdominal tenderness by end of first week. • Intestinal Hemorrhage or perforation leading to peritonitis can occur by third week. • Untreated patient dies in 40 days or so, or recovers. Salmonella is the most common causative organism in Sickle cell disease > 80 %.
    11. 11. • Rose spots in Typhoid Fever
    12. 12. LAB. DIAGNOSIS Specimen Collection: • BLOOD CULTURE. 90 % isolation in first week, Bone Marrow culture 100% in First week . • Adults 8 ml to 10 ml. Children 3 ml to 4 ml. • METHOD: Site of Venupuncture swabbed with 70% Alcohol and 1% Iodine for 03 minutes. • 5-10 cc blood collected in Syringe is injected through the stopper aseptically in Blood culture bottle with 50 ml. of BHI (Brain Heart infusion).
    13. 13. • Incubated for 07 days at 37 o C. Subculture on Mac Conkeys medium when turbidity appears or after 3 days to look for. Non Lactose fermenting colorless colonies. • Presumptive identification by T.S.I. medium ALKALINE SLANT ACID BUTT With GAS AND H2S. • Final identification by specific antiserum. • Apply Sensitivity and report organism. With sensitivity results to commonly used antibiotics.
    14. 14. Salmonella enteritidis (serotype typhimurium) can ferment glucose but not lactose as carbon source and produces both hydrogen sulfide and gas.
    15. 15. WIDAL TEST: 2nd week onwards, • 3 cc clotted blood is taken serum separated. Antibodies in patient’s serum against O, H, and Vi (virulence antibody) are looked for by an agglutination reaction known as WIDAL TEST. • ANTIGENS USED ARE: TO, TH. AO, AH. BO, BH. • Serial dilution in 07 test tubes are made of the patients serum: and mixed with antigen to look for agglutination reaction
    16. 16. Patient serum 1:20 1:40 1:80 1:160 1:320 Antigen TO - - - ++ ++ TH _ _ _ _ ++ AO _ _ _ _ _ AH _ _ _ _ _ BO _ _ _ _ _ BH _ _ _ _ _
    17. 17. Interpretation of Widal test: Titer : reciprocal of the dilution. • A significant titer is a titer => 1:160 or a rising titer. • Increase in O titer means active infection. • Increase in H titer means Past infection or vaccination. • In tropical countries H titer arises earlier than the O titer. • Vi antibody is present in carriers.
    18. 18. Faeces & Urine Culture: In 2nd and 3rd week Culture on Mac Conkeys medium, use Enrichment medium like tetraethionite broth or a Selective medium like Salmonella Shigella agar. Isolate organism and report sensitivity. I_______2______3________4_______weeks ,________ Blood ________________________ ______ widal _____________________________ urine and feces. • OTHER TESTS: TYPHIDOT Ig G and Ig M are looked for.
    19. 19. Treatment: Ampicillin/ Amoxil , Chloramphenicol , Trimethoprim- Sulfamethoxazole • Quinolones like Ofloxacin Ciprofloxacin ceftizadime, cefspspan etc. Preferred • Treatment required for at least 10 days to prevent relapse. • Response gradual ~3 to 4 weeks with Ampicillin 4 gm daily may be required •Chronic Carriers may require gall bladder removal
    20. 20. • Resistant to Sulphamethaxazole- Trimethoprim Ampicillin/Amoxil and Chlorophenicol first reported from Pakistan in 1989 from this department. • Drug of choice became Quinolones like Ofloxacin, cannot be safely used in children for reports of cartilage damage so I.V Clafron or Rosephin had to be given.
    21. 21. Non typhi Salmonellae (N.T.S) Bacteraemia, resistant salmonella strains in Rawalpindi Balouch AH, Akhtar MJ and Karamat KA/ Rawal Med J 1989; 17:AFIP, Rawalpindi 2. Multiple Drug Resistant Salmonella Typhi in Northern Pakistan. Pakistan Journal of Pathology vol. 2. No. 1 Jan-June 1991. Abbas et al
    22. 22. B. GASTROENTERITIS. • Salmonella enteritidis 1,500 serotypes • Poultry, Meat, Dairy Products • Contaminated food > 1000 organisms/ml. • Acid-killed • Some penetration of intestinal mucosa • Enterotoxin (Similar to E. coli LT toxin) • Diarrhea and inflammation of intestinal wall • Occasional septicemia
    23. 23. Investigation of Outbreaks • Food and Water Samples • Human carriers esp. Food handlers in kitchens of canteens , hostels, hotels and food caterers. • Specimens of food, water or ice cream are tested, if considered to be implicated in outbreak.
    24. 24. Treatment of Gastrenertis caused by Salmonells species. • Fluid replacement. • Antibiotics not effective rather eradicate protective normal flora leading to overgrowth of resistant and pathogenic bacteria. • Probiotics ( Healthy bacteria) promising results, recent findings.
    25. 25. C. Septicemia • Salmonella cholerasuis • Diagnosis: Blood Cultures. • Treatment: Same as for Typhoid fever.
    26. 26. VACCINATION • Vaccines are available for typhoid fever and are partially effective, especially in children. • Initially TAB Acetone killed vaccine Now oral live attenuated vaccine by brand name VIVOTIF • 4 tabs on alternate days. Protect for 2-3 years. Rx: Advised for all of you and family members.
    27. 27. 19th century epidemic of typhoid fever
    28. 28. PREVENTION AND CONTROL. • Public Health and Personal Hygiene. • Proper Sewage treatment and Chlorination of water supplies. • Salmonellae are difficult to eradicate from the environment. . • Major reservoir for human infection is poultry and livestock. • Animal feed treated with Antibiotics. • .Providing training in hygienic practices for all food-handlers and their routine screening. •"Boil it, cook it, peel it, or forget it"
    29. 29. Spread
    30. 30. Fever pattern of Typhoid Feverpattern of Brucellosis
    31. 31. Fever pattern of Brucellosis
    32. 32. Pattern of Fever in malaria
    33. 33. Person to person spread esp. in children is very common
    34. 34. Thanks

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