Salmonellosis

1. Salmonellosis is an acute zoo anthroponous
intestinal infection caused by various serotypes
of bacteria of the genus Salmonella, transmitted
mainly by alimentary route, characterized by
damage to the digestive organs with the
development of intoxication syndrome and
water-electrolyte disorders
1
* Salmonellosis

2. 2
Etiology
*Pathogens are a large group of salmonella of the genus
Salmonella of the Enterobacteriaceae family.
*Kaufman-White classification:
by O-antigen (somatic thermostable AG).
H-antigen (flagellated thermolabile).
The most significant for humans are:
S. epteritidis, S. typhimurium

3. 3
Salmonella characterization
*Salmonella - Gram-negative
*Have flagella, are mobile
*Long-term preservation in the external environment:
in water up to 5 months, in meat and sausages from 2 to 4 months, in frozen meat - about 6
months, in milk - up to 20 days, in butter - up to 4 months, in cheeses - up to 1 year, in egg
powder - from 3 to 9 months
*Salmonella die at 100 ° C, and at 70 ° for 30 minutes. The stability of the
pathogen is also noted to low temperatures, up to - 80 ° C; resistance to
UVR.
*In some products (milk, meat products, cakes), salmonella not only
persist, and multiply without changing the appearance and taste of the
products.
Salmonella pathogenicity factors:
1.endotoxin (lipopolysaccharide)
2.enterotoxin (exotoxin).
3.invasion of the colon epithelium.

4. 4
Epidemiology
*The source of infection can be people - patients and bacteria carriers
*The main route of infection in salmonellosis is alimental, due to the
consumption of foods that contain a large amount of salmonella.

5. 5
*Pathogenesis
*Salmonella, entering through the mouth and bypassing the
"gastric" barrier, enter the small intestine. In the intestines
occurs:
*1)adhesion of the exciter on the surface of enterocytes
followed by
*2)colonization - as a result of salmonella multiplication
*3)Enterotoxin is produced, under the action of which
activation of adenylate cyclase and the development of
secretory diarrhea occurs.
*4) Invasion of the pathogen into the submucous layer of the
intestine then occurs.
*5)Activation of lympho-macrophage and neutrophil units of
immunity leads to death of the pathogen with release of
endotoxin.

6. 6
*Endotoxin ingress into the vascular bed causes
the development of intoxication syndrome.
*It is possible to colonize the underlying
gastrointestinal tract with the development of
the colitis clinic and increased intoxication. With
incomplete phagocytosis, the pathogen drifts
into the regional lymph nodes.
*The failure of the immune response at the level
of regional lymph nodes causes hematogenic
and lymphogenic dissemination of the pathogen
with the development of generalized forms.

7. *Clinical classification.
1. gastrointestinal form:
a) gastritic variant;
b) gastroenteritic variant;
c) gastroenterocolytic variant.
2. Generalized form:
a) typhus-like variant;
b) septicopyemic variant.
3. Bacterial carrier:
a) acute (excretion of the pathogen up to 3 months);
b) chronic (excretion of the pathogen for more than 3 months);
c) transient
4. The following are distinguished along the stream:
light, moderate and heavy forms.

8. *Clinical manifestation
*Gastritic variant: acute onset, nausea, repeated vomiting
and epigastric pain. Intoxication syndrome is mild, and
diarrhea is absent at all. The course of the disease is
short-term, favorable. The diagnosis is more often made
"Food toxicoinfection" and only when isolated from
vomiting masses, feces Salmonella-Salmonellosis.
*Gastroenteritic variant (90% pl) - acute onset,
manifested: fever, chills, headache, body aches. Then
there are abdominal pain (more often of a spastic
nature), localized in the epigastric and umbilical regions,
nausea, repeated vomiting. Diarrhea quickly joins. Urine
production is reduced. Stools are feces at first, but
quickly become watery, foamy, fetid, sometimes with a
greenish tint. Physical data: pallor of the skin, cyanosis
develops in more severe cases. The tongue is dry,
overlaid with plaque. The abdomen is swollen, with its
palpation - spilled soreness and rumbling of the
intestines. In more severe cases, the development of
clonic convulsions, more often in the muscles of the lower
extremities (symptoms of hypokalemia).

9. *Gastroenterocolytic variant (5%). The
onset of the disease resembles a
gastroenteritic version, but already on
the 2nd-3rd day of the disease, the
volume of bowel movements
decreases. They have mucus,
sometimes blood. When palpating the
abdomen, spasm and soreness of the
colon are noted. The act of defecation
can be accompanied by tenesmas,
resembles dysentery.

10. Degrees of dehydration:
Grade I: dehydration is 1-3% of body weight (mild
course)
Grade II: dehydration of 4-6% of body weight
(moderate severity)
Grade III: dehydration 7-9% body weight (severe),
(compensated)
Grade IV: dehydration: 10% or more
(decompensated).

11. Сальмонеллез. К.А. Аитов, 2007 11

12. *Typhoid-like variant. It can begin with manifestations of
gastroenteritis. In the future, against the background of
subsidence or disappearance of nausea, vomiting and diarrhea,
an increased temperature reaction remains, which acquires a
constant or undulating character. Patients complain of
headache, insomnia, sharp weakness. During examination, the
pallor of the skin is noted, in some cases, separate roseolous
elements appear on the skin of the abdomen and lower chest.
By the 3rd-5th days of the disease, hepatolyenal syndrome
develops. BP decreased, relative bradycardia was expressed.
*Septic variant. In the initial period - manifestations of
gastroenteritis, subsequently replaced by prolonged remitting
fever with chills and pronounced sweating with its decrease,
tachycardia, myalgia. As a rule, hepatosplenomegaly develops.
The course of the disease is long, torpid, characterized by a
tendency to form secondary purulent foci (septicopemia).
*Complications: Infectious-toxic shock, Swelling and swelling of
the brain, Acute renal failure, Acute cardiovascular failure

13. * Laboratory diagnosis
* 1. bacteriological examination. Excretion of the pathogen by
crops of vomiting and feces, gastric and intestinal wash water,
and with generalized blood and urine form. In a septicopyemic
version of the disease, pus or exudate cultures from
inflammatory foci are possible.
*2. serological diagnostics
*Hematocrit, blood viscosity, acid-base state and electrolyte
composition are determined for determination of dehydration
degree and assessment of patient's condition severity, as well as
for correction of rehydration therapy.

14. * Treatment:
*1. Diet;
*2. semi-desert mode;
*3. Gastric lavage to clean washes in gastrointestinal form (2% sodium
hydrogen carbonate solution or 0.1% potassium permanganate solution)
*4. Rehydration therapy: A. Oral rehydration with standard oral rehydration
solutions (ORP) and glucose-salt solutions - "Rehydron," "ORS," chlorosol,
glucosolan, citroglucosolan. It is carried out with a mild course of the disease
and dehydration of the I - II degree. B. During dehydration of Articles II-III -
intravenous administration of salt electrolyte solutions (trisol, lactasol,
acesol, Ringer - Locke) and isotonic glucose solutions (1:1 ratio).
* Two stages are conventionally distinguished: primary rehydration - restoration of water
losses for 1-2 hour. The second stage - correction of continuing losses of water and
electrolytes can last up to 3 days (should be monitored every 2-4 hours).

15. 5. Etiotropic therapy:
The absolute indication for the prescription of
antibacterial therapy is generalized and complicated
forms of salmonellosis (ITN), in the presence of severe
colitic syndrome and especially its prolonged course, as
well as in persons with weakened immunity and severe
concomitant somatic pathology.
1) Ciprofloxacin 500 mg 2 times daily; or norfloxacin 0.4
g 2 p/s; or ofloxocin 0.2 g 2p/s;
2) Cephalosporins of the III generation (Ceftriaxone for
1-2 g/day IM or IV) 7-14 days. 3) Co-trimoxazole 0.96 g 2
times i.c. to 5-7 days.

16. 6. purpose of sorbents:
neosmectin one powder 3 times in advance 5-7 days
7. eubiotics:
linex 2 capsules 3 times a day 2 weeks; bifidumbacterin 5 doses 3
times a day up to 1 month.
8. Enzyme therapy:
Pancreatin 1 powder 3 times a day for 2-3 months; mezim forte 1
tablet 3 times a day 1 month.
9. Antispasmodics:
No-shpa 0.04 g 3 times a day, papaverine 0.04 g 3 times a day.
10. Antipyretic, non-specific anti-inflammatory drugs