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Salmonella

Salmonella is a genus of bacteria that can cause two main diseases: gastroenteritis and typhoid fever. There are over 2000 Salmonella serotypes based on surface antigens. S. enterica serovar Typhimurium is a common cause of gastroenteritis, while S. enterica serovar Typhi causes typhoid fever in humans. Yersinia species can also cause intestinal disease like Y. enterocolitica, as well as plague (Y. pestis) which is transmitted by fleas. Diagnosis involves culturing the bacteria from stool or blood, and treatment depends on the species and disease caused.

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119 views

Salmonella

Salmonella is a genus of bacteria that can cause two main diseases: gastroenteritis and typhoid fever. There are over 2000 Salmonella serotypes based on surface antigens. S. enterica serovar Typhimurium is a common cause of gastroenteritis, while S. enterica serovar Typhi causes typhoid fever in humans. Yersinia species can also cause intestinal disease like Y. enterocolitica, as well as plague (Y. pestis) which is transmitted by fleas. Diagnosis involves culturing the bacteria from stool or blood, and treatment depends on the species and disease caused.

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ahmedtwanaahmed
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SALMONELLA

BACTERIOLOGY

• Over 2000 names for various members of this genus


• Rich nomenclature has now been streamlined to a single species, Salmonella enterica
• Large number of LPS O antigens, K antigens (if present), and flagellar H antigens that
undergo phase variation (thus doubling the possible H antigenic states for each strain).
• Antigenic formula O:group B [1,4,12] H:I;1,2—called Salmonella typhimurium. The
proper name for this organism is Salmonella enterica serovar Typhimurium.
BACTERIOLOGY

• Salmonella serotypes host range: some are highly adapted to particular mammals
or amphibians, and others infect a broad range of hosts.
• Strictly adapted to humans: Salmonella enterica serovar Typhi
• Those that infect humans and other animals: S enterica serovar Typhimurium
• Typhi is used for the strictly human species that produce enteric (typhoid) fever.
Unless otherwise specified, S enterica is used for serotypes such as Typhimurium,
which are able to infect animals or humans and typically cause gastroenteritis.
BACTERIOLOGY

• Salmonellae possess multiple types of pili, one of which is


morphologically and functionally similar to E coli type 1 pili.
• Most strains are motile through the action of their flagella.
• Salmonella Typhi has a surface polysaccharide called the Vi
antigen
SALMONELLA GASTROENTERITIS
(S. ENTERICA)
EPIDEMIOLOGY

• The highest rates of infection are in children under 5 years of age, persons aged 20 to 30, and those
older than 70.
• Infecting dose is higher than Shigella
• Infections are transmitted by contaminated foods before ingestion.
• Salmonellae are a leading cause of foodborne intestinal infection.
• Poultry products (Including eggs) are common source
• Eating raw milk have been associated with outbreaks of Salmonella infection.
• Humans can also be the source of disease.
• Fully 5% of patients recovering from gastroenteritis still shed the organisms 20 weeks later.
PATHOGENESIS
• Ingested S enterica cells that pass the stomach acid and reach the small bowel.
• Initial contact with M cells, enterocytes, or both.
• Pili: for initial adherence.
• Upon engagement of S enterica injection (type III) secretion systems, formation of
membrane “ruffles” dramatically alters the normal host cell architecture within minutes
(Figure below).
• The ruffles seem to engulf the organism in an endocytotic vacuole and allow it to transcytose
from the surface to the basolateral membrane.
• Once in the cell, S enterica multiplies in a vacuole, induce a profound inflammatory response
• Then, phagocytosed by neutrophils and macrophages.
• Macrophage apoptosis aids survival
• Persisters may lead to relapse
Figure: Salmonella ruffles.

• S serovar Typhimurium is shown


inducing wave-like ruffles on an
intestinal M cell.
• This leads to induction of uptake of
the bacteria by the M cell.
PATHOGENESIS

• Although some enterotoxins have been described in Salmonella,


• Their role in diarrhea is unclear.
• The best estimate is that: Invasion and inflammation cause
diarrhea
• Process remains localized or invade more deeply, reaching the
bloodstream and distant organs.
ENTERIC (TYPHOID) FEVER
(SALMONELLA SEROVAR TYPHI)
EPIDEMIOLOGY
• Typhoid fever is a strictly human disease
• Some patients become chronic carriers for years
• Source of infection: contaminate drinking water
• Transmission is by the fecal–oral route.
• The infecting dose: is intermediate between Shigella and most S enterica.
• Three serotypes called Paratyphi A, B, and C have features similar to S
Typhi, including the production of an enteric fever syndrome; cases are
likewise traceable to a human source.
PATHOGENESIS
• The invasion and killing of intestinal M cells and macrophages follow the same
pattern as that of S enterica.
• Two differences are the Vi capsular polysaccharide and the extended multiplication
of Typhi in macrophages.
• Vi polysaccharide retards neutrophil phagocytosis by interfering with complement
deposition .
• Bacteria carried through the lymphatic circulation to the mesenteric nodes, spleen,
liver, and bone marrow, all elements of the reticuloendothelial system (RES).
PATHOGENESIS
• At the RES sites, Typhi, infecting new host macrophages.
• Increasing bacterial population begins to reach the bloodstream.
• The entry of gram-negative bacteria and their LPS endotoxin into the blood starts the
fever.
• Results in metastatic infection of other organs including the urinary tract and the
biliary tree; the latter causes reinfection of the bowel.
• This cycle, takes approximately 2 weeks to complete.
SALMONELLOSIS: CLINICAL ASPECTS

clinical patterns of salmonellosis

Gastroenteritis Bacteremia
• With and without focal extraintestinal infection, enteric fever, and the asymptomatic
carrier state
✺S enterica = Gastroenteritis
✺Typhi and related serotypes (Paratyphi) = Enteric fever
SALMONELLOSIS: CLINICAL ASPECTS

ØGastroenteritis
• The episode begins 24 to 48 hours after ingestion
• Nausea and vomiting followed by, abdominal cramps and diarrhea.
• Diarrhea persists, for 3 to 4 days and usually resolves spontaneously within 7 days.
• Fever (39°C) is present in about 50% of the patients.
• The spectrum of disease: from a few loose stools to a severe dysentery-like syndrome.
SALMONELLOSIS: CLINICAL ASPECTS

ØBacteremia and Metastatic Infection


• Bacteremia is most common and severe in the immunocompromised
• Bacteremia occurs in 70% of these patients and can cause septic shock and
death.
• Relapses are common
SALMONELLOSIS: CLINICAL ASPECTS

ØEnteric Fever
• Enteric fever is a multiorgan Salmonella infection characterized by prolonged fever, sustained bacteremia, and
profound involvement of the mesenteric lymph nodes, liver, and spleen.
• Slowly increasing fever lasts for weeks
• Diarrhea is intermittent or absent
• Endotoxin can lead to myocarditis, encephalopathy, or intravascular coagulation.
• Biliary tree infection reseeds intestine
• Urinary tract infection and metastatic lesions in bone, joint, liver, and meninges may also occur.
• The most important complication of typhoid fever is intra-abdominal hemorrhage.
DIAGNOSIS
• Culture of Salmonella from the blood or feces is the primary diagnostic method.
• Early in the course of enteric fever, blood is far more likely to give a positive culture
result.
• The media used for stool culture are the same as those used for Shigella: Failure to
ferment lactose and the production of hydrogen sulfides (H2S).
• Characteristics of biochemical tests are used to identify the genus
• O serogroup antisera are available in larger laboratories for confirmation.
TREATMENT

Ø Gastroenteritis
• The primary therapeutic approach to Salmonella gastroenteritis consists of fluid and electrolyte
replacement
• Control nausea and vomiting.
• Antimicrobials are of limited use in gastroenteritis

Ø Typhoid fever
• Chloramphenicol and then ampicillin were the first antibiotics used and reduced the mortality rate.
• Use of ampicillin is now limited by widespread resistance
• Extended- spectrum cephalosporins (ceftriaxone, cefixime) and ciprofloxacin as preferred first-line
agents.
YERSINIA
YERSINIA

• Yersinia tend to be coccobacillary


• The genus includes 11 species, of which Yersinia pestis, Yersinia
pseudotuberculosis, and Yersinia enterocolitica are the pathogens for
humans.
• Yersinia are primarily animal pathogens, with occasional transmission to
humans through direct or indirect contact.
ü Yersinia pestis: as a cause of plague. The bite of the flea is the first event in the development of a case
of bubonic plague, develop a secondary pneumonia by bacteremic spread to the lungs, causes
pneumonic plague
• Animals, are the most likely source of infection.
• Transmitted by ingestion from animal source.
• Intestinal M cells are invaded Secreted Yersinia outer membrane proteins (Yops) disrupt cellular
function.
• Yersinia enterocolitica also causes enterocolitis, which usually occurs in children. It is characterized by
fever, diarrhea, and abdominal pain, it also causes enteric fever.
ü Y enterocolitica and Y pseudotuberculosis cause acute mesenteric lymphadenitis, a syndrome involving
fever and abdominal pain that often mimics acute appendicitis.
Ø The role of antimicrobial therapy in enteric Yersinia infections: they are usually self-
limiting.
• Yersinia pseudotuberculosis: is susceptible to ampicillin, cephalosporins,
aminoglycosides, and tetracyclines
• Y enterocolitica: is usually resistant to penicillins and cephalosporins through the
production of β-lactamases.
• Y pestis: Gentamicin or streptomycin with or without doxycycline is the treatment of
choice for both bubonic and pneumonic plague. Ciprofloxacin or chloramphenicol (if
meningitis is present) are alternatives.

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