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Salmonella

The document provides an overview of Salmonella, detailing its classification, morphology, cultural characteristics, and pathogenicity, particularly focusing on typhoidal and paratyphoidal Salmonellae. It discusses the clinical features, epidemiology, laboratory diagnosis, and treatment options for infections caused by Salmonella, including the importance of sanitation and vaccination for prevention. Additionally, it highlights the biochemical reactions and serological tests used for diagnosis and the challenges posed by drug resistance.

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Aleemath Sana
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5 views54 pages

Salmonella

The document provides an overview of Salmonella, detailing its classification, morphology, cultural characteristics, and pathogenicity, particularly focusing on typhoidal and paratyphoidal Salmonellae. It discusses the clinical features, epidemiology, laboratory diagnosis, and treatment options for infections caused by Salmonella, including the importance of sanitation and vaccination for prevention. Additionally, it highlights the biochemical reactions and serological tests used for diagnosis and the challenges posed by drug resistance.

Uploaded by

Aleemath Sana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Salmonella

Introduction

• Genus Salmonella consists of bacilli that


parasitize intestines
• Large number of vertebrate species

• Over 2000 serotypes or species of


Salmonellae
• Potentially pathogenic
Clinically 2 groups

• Typhoidal Salmonellae
– Human
– Enteric fever group
Enteric fever

• Salmonella Typhi
• Salmonella Paratyphi A
• Salmonella Paratyphi B
• Salmonella Paratyphi C
Morphology

• Gram negative bacilli

• 1-3µm x 0.5µm

• Motile by peritrichous flagella

• Noncapsulated

• Nonsporing
Cultural characteristics

• Aerobic and facultative anaerobe

• pH 6-8

• 370C (15-410C)

• Grow on ordinary media

• MacConkey’s agar- non lactose fermenting


Cultural characteristics
MacConkey agar
Cultural characteristics

• Deoxycholate citrate agar(DCA)


• Xylose lysine deoxycholate(XLD)
– Black due to H2S production
Cultural characteristics

• Wilson and Blair bismuth sulphite medium- jet


black
Cultural characteristics

• Selenite F broth
enrichment media
• Tetrathionate broth
Biochemical reactions

• Catalase Positive
• Oxidase negative
• Ferment sugars- glucose, mannitol,
maltose
• Citrate
• H2S production
Glucose Citrate H2Sproduction

S.Typhi Acid Not utilised Speck of H2S

S.Paratyphi A Acid and Not Utilised Not produced


gas

S.Paratyphi B Acid and Utilised Abundant H2S


gas
Enteric fever

• Typhoid fever - Salmonella Typhi

• Paratyphoid fever - Salmonella Paratyphi


A, B, C
Typhoid fever
Pathogenesis of typhoid fever
Acquired by
ingestion
Seed liver, Multiply
spleen, bone
Penetrate small marrow, lymph
intestine node Massive
bacteremia
Bloodstream
Phagocytosed via thoracic
by duct Clinical
macrophage, disease
neutrophils Multiply
Reach
Resist Mesenteric back to
intracellular lymph ileum via Typhoid
killing node bile ulcers
Clinical features

• Incubation period 7-14 days


• Onset gradual with headache, malaise, anorexia,
coated tongue, abdominal discomfort
• Stepladder pyrexia
• Soft palpable spleen
• Hepatomegaly
• Rose spots
Complications
• Intestinal perforation
• Haemorrhage
• Circulatory collapse
Paratyphoid fever

• Paratyphoid fever resembles typhoid fever but is


generally milder
Epidemiology

• Source of infection: patient or carrier


• Mode of infection: ingestion of contaminated food
and drink

• Faeces of carriers are important source

• “Mary Mallon”(Typhoid Mary)


Antigenic structure

• 3 important antigens

– Flagellar antigen H

– Somatic antigen O

– Surface antigen Vi
Laboratory diagnosis
• Specimen
• Isolation Blood Culture
Clot culture
Faeces culture
Urine culture
Bone marrow, bile
• Serology
• Demonstration of circulating antigen
• PCR
• Other laboratory tests
Specimen

• Blood, urine, stool, serum, bone marrow

• Specimen depends on duration of illness


Blood culture

• Bacteremia occurs early in disease

Week of illness specimen

1st blood

2nd serum

3rd stool

4th urine
Blood culture
Method

• 5-10ml in 50-100ml of 0.5% bile broth


• Incubate at 37oC
Subcultured on MacConkey’s agar

Pale nonlactose negative


fermenting colonies
repeat subculture for
10 days
Biochemical reactions
Other specimens

• Clot culture:
– 5ml of blood is withdrawn and allowed to clot
– Serum is separated and clot is broken, added to
bile broth
• Faeces: enrichment media and selective media is
used.
Morphology

• Gram negative bacilli

• 1-3µm x 0.5µm

• Motile by peritrichous flagella

• Noncapsulated

• Nonsporing
Cultural characteristics

• Aerobic and facultative anaerobe

• pH 6-8

• 370C (15-410C)

• Grow on ordinary media

• Large, circular, low convex, smooth, translucent

• MacConkey’s agar- non lactose fermenting


Cultural characteristics
MacConkey agar
Cultural characteristics

• Deoxycholate citrate agar(DCA)


• Xylose lysine deoxycholate(XLD)
– Black due to H2S production
Cultural characteristics

• Wilson and Blair bismuth sulphite medium- jet


black
Cultural characteristics

• Selenite F broth
enrichment media
• Tetrathionate broth
Biochemical reactions

• Catalase positive
• Oxidase negative
• Ferment sugars- glucose, mannitol, maltose
• Citrate
• H2S production
Glucose Citrate H2Sproduction

S.Typhi Acid Not utilised Speck of H2S

S.Paratyphi A Acid and Not Utilised Not produced


gas

S.Paratyphi B Acid and Utilised Abundant H2S


gas
Serotyping by slide agglutination with O
and H antisera
Serology – Widal test

• Tube agglutination test

• For measurement of O and H antibodies for


typhoid and paratyphoid bacilli in the serum

• 2 types of tubes
– Felix tube- round bottom for O agglutination
– Dreyer’s tube- conical bottom for H
agglutination
Widal test

• Equal volumes of serial dilutions of serum(1/20-


1/640)

• Mixed with O and H antigens of S.Typhi and H


antigens of S. Paratyphi A and B

• Incubate at 370C overnight


Widal test

• Aggutination titres are read


– H suspensions agglutinate rapidly – large, loose,
fluffy clumps
– O antigen suspensions- compact, chalky,
granular clumps
Widal test
Widal test
Widal test

• Agglutination titre depends on stage of disease


• Demonstration of rise in titre
• Results of single test – interpret with caution
– Antibodies may be present on account of prior
disease, infection, immunisation
– H antibodies persist longer than O
– Anamnestic response
– Cases treated early with antibiotics may show
poor titre
PCR

• Sensitive
• Not widely available
Demonstration of antigen

• In early phase of disease

• In blood and urine

• Staphylococcal coagglutination test


Other laboratory tests

• WBC count- leucopenia with relative


lymphocytosis
Diagnosis of carriers

• Epidemiological and public health purpose

Methods
• Isolation from faeces and bile
• Vi antibody detection
• Sewer swab technique
• Filtration of sewage through millipore membrane
and culture on Wilson and Blair media
Prophylaxis

• General measures- improvement in sanitation ,


protected water supply

• Specific measures- vaccines


Vaccines

• TAB vaccine
– Heat killed vaccine

– S.Typhi 1000 million, S.Paratyphi A and B 750


million

– 0.5ml subcutaneous

– 2 doses 4-6 weeks apart


Vaccines

• Typhoral vaccine
– Live oral vaccine
– Stable mutant of S.Typhi strain Ty21a, lacking
enzyme UDP-galactose-4-epimerase
– Enteric coated capsule
– 109 bacilli
– 1 hour before food on days 1,3,5
Vaccines

• Vi vaccine
– Injectable vaccine (Typhim-Vi)

– Purified polysaccharide Vi antigen of S.Typhi


strain Ty2

– Single subcutaneous or im dose


Treatment

• Chloramphenicol
• Ciprofloxacin
• Ceftriaxone
• Ampicillin
• Amoxycillin
• Cotrimoxazole

• Problem of drug resistance

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