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Salmonella Lecture

Salmonella typhi and paratyphi cause enteric (typhoid) fever in humans. They are transmitted through the fecal-oral route when infected feces contaminate food or water. After an incubation period of 1-2 weeks, they cause nonspecific symptoms like sustained fever, headache, and abdominal pain. Rare complications include intestinal bleeding or perforation. Diagnosis involves blood cultures early in infection or serological tests like the Widal test later. Treatment consists of antibiotics like fluoroquinolones or ceftriaxone. Vaccines can help prevent infection in endemic areas.

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53 views21 pages

Salmonella Lecture

Salmonella typhi and paratyphi cause enteric (typhoid) fever in humans. They are transmitted through the fecal-oral route when infected feces contaminate food or water. After an incubation period of 1-2 weeks, they cause nonspecific symptoms like sustained fever, headache, and abdominal pain. Rare complications include intestinal bleeding or perforation. Diagnosis involves blood cultures early in infection or serological tests like the Widal test later. Treatment consists of antibiotics like fluoroquinolones or ceftriaxone. Vaccines can help prevent infection in endemic areas.

Uploaded by

ghosson01006228961
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Typhoid/ Enteric fever

Dr. Jyotsna Agarwal


Professor, Dept. Microbiology
KGMU

1
Salmonella
• Salmonella is Gram-negative,
rod-shaped
• Facultative anaerobe in family
Enterobacteriaceae
• Motile, Non lactose fermenting
• Over 2400 serotypes

2
 Faeco-oral transmission
 Refrigeration does not kill bacteria, Heat at
600C destroys

3
Clinical Syndromes of Salmonella
Salmonellosis = Generic term for disease

 Enteritis (acute gastroenteritis)


 Enteric fever (prototype is typhoid fever and
less severe paratyphoid fever)
 Septicemia (particularly S. choleraesuis, S. typhi,
and S. paratyphi)
 Asymptomatic carriage (gall bladder is the
reservoir for Salmonella typhi)

4
Enteritis( Food Poisoning)
 Most common form of salmonellosis with
foodborne outbreaks and sporadic disease
 High infectious dose (108 CFU)
 Poultry, eggs, etc. are sources of infection
 6-48h incubation period
 Nausea, vomiting, nonbloody diarrhea, fever,
cramps, myalgia and headache common
 Many species of salmonella can cause this (eg. S.
typhimurium) except S. typhi

5
Pathogenesis
 Bacteria penetrates intestinal cell in
ileocaecal region
 Inflammatory response to bacterial
multiplication in the cell
 Prostaglandins secreted
 Increase in C-AMP

6
Clinical Syndromes- Enteric fever

 S. typhi causes typhoid fever


S. paratyphi A, B and C cause milder form of
enteric fever called paratyphoid fever
 Infectious dose large = 106 CFU
 Fecal-oral route of transmission
 Person-to-person spread by chronic carrier
 Fecally-contaminated food or water
 Food handlers contaminate food
 10-14 day incubation period

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 Virtually non existent in developed world
 In developing countries endemic
 Typhoid more common than paratyphoid

8
Pathogenesis of Enteric fever

M cells on Peyers patches

Invade intestinal lining cells


bloodstream (primary bacteremia)

Phagocytosis
Transported (R E system), continue to replicate

9
Pathogenesis contd…
 Second week: re-enter bloodstream (secondary
bacteremia) endotoxemia

 Second to third week: gallbladder, secreted in


bile, re-infect intestinal tract

10
 Complications: Intestinal haemorrhage,
perforation, cholecystitis
 Less commonly: Bronchopneumonia,
arthritis, osteomyelitis

11
Epidemiology & Clinical Syndromes

Asymptomatic Carriage
 Chronic carriage in 1-5% of cases following S.
typhi or S. paratyphi infection (Temporary
carrier>12 months shedding)
 Gall bladder usually the reservoir

 Chronic carriage with other Salmonella spp.


occurs in <<1% of cases and does not play a
role in human disease transmission

12
Early 1900- Mary Mallon

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Virulence factor
•Encapsulation , antigenic mimicry, masking
•Evasion or incapacitation of phagocytosis
• Mechanisms enabling an invading
microorganism to resist being ingested and lysed
by lysosomes
intracellular survival and multiplication
•Endotoxin

14
Diagnosis of Typhoid Fever
 Clinical:
 For Lab diagnosis, specimen & diagnostic tests
according to duration of fever:

1. Blood for Culture


2. WIDAL
3. Stool culture
4. Urine culture

15
Blood Culture
 In blood culture bottle
 Repeated cultures may be required
 Subculture on MacConkey medium (NLF colony)

 Clot culture- put clot in blood culture bottle, lyse it with


streptokinase in B/C bottle
 Use serum for WIDAL

16
 Selective media for subculture from blood
culture bottle: MacConkey, Wilson Blair,
Tellurite blood agar

 Enrichment broth for culture of stool/urine:


Selenite F broth, Tetrathionate broth

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Serological test- WIDAL
 For detecting antibody
 Agglutination test
1. Endemic titre
2. Paired sera

 For carriers - antibody against Vi antigen


 Rapid test- Typhi dot

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Treatment, prevention & control of
salmonella infections
Enteritis:
 Antibiotics not recommended for enteritis
because prolong duration
 Control by proper preparation of poultry & eggs

Enteric fever:
 Antibiotics- Chloramphenicol, cipriflox,
Ceftriaxone
 Identify & treat carriers of S. typhi & S. paratyphi
 Vaccination can reduce risk of disease for
travellers in endemic areas
19
Salmonella vaccines
 TAB: Salmonella typhi, paratyphi A &B, killed whole
cell
 Oral Ty21-A: Live attenuated, Salmonella typhi
vaccine
 Vi capsular polysaccharide vaccine

20
Summary- Enteric fever
 S. typhi / S. paratyphi
 Mode of spread /Pathogenesis
 Clinical features / Complications
 Laboratory diagnosis
 Treatment/vaccines

21

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