Salmonella enterocolitis

Definition

Salmonella enterocolitis is an infection in the lining of the small intestine caused by Salmonella bacteria.

Alternative Names

Salmonellosis

Causes, incidence, and risk factors

Salmonella enterocolitis is one of the most common types of food poisoning. It occurs when you swallow food or water that is contaminated with the salmonella bacteria. Any food can become contaminated if food preparation conditions and equipment are unsanitary.

You are more likely to get this type of infection if you have:

• Eaten improperly prepared or stored food (especially undercooked turkey or chicken, unrefrigerated turkey dressing, undercooked eggs)
• Family members with recent salmonella infection
• Had a recent family illness with gastroenteritis
• Been in an institution
• Eaten chicken recently
• A pet iguana or other lizards, turtles, or snakes (reptiles are carriers of salmonella)
• A weakened immune system

Approximately 40,000 people develop salmonella infection in the United States each year. Most patients are younger than 20. The highest rate occurs from July through October.

Symptoms

The time between infection and symptom development is 8 - 48 hours. Symptoms include:

• Abdominal pain or cramping or tenderness
• Chills
• Diarrhea
• Fever
• Muscle pain
• Nausea
• Vomiting

Signs and tests

The doctor will perform a physical exam. You may have signs of a tender abdomen and tiny pink spots on the skin called rose spots.

Tests that may be done include:

• Stool culture for salmonella
• Complete blood count with differential
• Blood culture
• Febrile/cold agglutinins (test for specific antibodies)

Treatment

The goal of treatment is to replace fluids and electrolytes lost by diarrhea. Electrolyte solutions are available without a prescription. Antidiarrheal medications are generally not given because they may prolong the infection. If you have severe symptoms, your doctor may prescribe antibiotics.

People with diarrhea who are can't drink anything due to nausea may need medical attention and intravenous fluids. This is especially true for small children. Fever and aches can be treated with acetaminophen or ibuprofen.

If you take diuretics, you may need to stop taking them during the acute episode, when diarrhea is present. Ask your health care provider for instructions.

Changing your diet while you have diarrhea may help reduce symptoms. This may include avoiding milk products and following a BRAT diet. BRAT stands for bananas, rice, applesauce, and toast. These are binding foods that make the stools firmer.

Infants should continue to breastfeed and receive electrolyte replacement solutions as directed by your health care provider.

Support Groups

Expectations (prognosis)

The outcome is usually good. In otherwise healthy people, symptoms should go away in 2 - 5 days.

The acute illness lasts for 1 - 2 weeks. The bacteria is shed in the feces for months in some treated patients. Some people who shed the bacteria have a carrier state for 1 year or more after the infection.

Complications

Dehydration from diarrhea, especially in young children and infants, is a dangerous complication. Life-threatening meningitis and septicemia may also occur. Food handlers who become carriers can pass the infection along to the people who eat their food.

Calling your health care provider

Call your health care provider if there is blood in the stools, or if there is no improvement after 2-3 days. Also call if any of the following occurs:

• Severe vomiting or abdominal pain
• Signs of dehydration: decreased urine output, sunken eyes, sticky or dry mouth, no tears when crying
• Unresponsiveness

Prevention

Proper food handling and storage can help prevent Salmonella enterocolitis. Good hand washing is important, especially when handling eggs and poultry.

If you own a reptile, wear gloves when handling the animal or its feces because animals can easily pass Salmonella to humans.

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References

Pegues DA, Miller SI. Salmonella Species, including Salmonella Typhi. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 223.

Giannella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 104.