Salmonellosis: symptoms and treatment. Salmonellosis: how it is transmitted, the incubation period, ways of infection with salmonellosis

Coli intestinal salmonella is an insidious and very viable bacterium. Having settled in any protein product (eggs, meat and dairy food), it begins not only to live, but also actively multiply in a nutrient medium, especially under favorable conditions. temperature conditions(from +6 to +45 degrees). When these products are cut into a salad and dressed with mayonnaise, and then it will stand on the festive table for several hours, an explosion intestinal infection- salmonellosis - will be inevitable.

Salmonellosis - what is it?

This infectious disease is characterized by severe damage nervous system, in severe cases leading to cerebral edema, coma and even death. It develops as a result of severe intoxication of the body with a pathogen - salmonellosis bacteria, accompanied by severe dehydration (dehydration) and a violation of the water and electrolyte balance.

The insidiousness of salmonellosis lies in the fact that neither the appearance nor the smell of products infected with a salmonella bacillus in any way indicates the danger lurking in them. And the clinical picture of the disease is extremely difficult to differentiate from typhoid or septic manifestations.

pathogens

The causative agents of Salmonellosis infection are intestinal gram-negative motile rods of the genus Salmonella, numbering several varieties and subspecies.

Most of them are pathogenic for both animals and humans, but not all of the several thousand serotypes (species groups) pose an epidemiological hazard to humans.

The most common and causing salmonellosis in adults and children in 85-90% of cases worldwide include:

• Salmonella London;
• S/agona;
• S/newport;
• S/infantis;
• S/panama;
• S/enteritidis;
• S/typhimurium.

The incubation period, regardless of the form and variant of the disease, ranges from several hours to 3 days. The period of incubation depends on the form and subspecies of salmonellosis. Previously, it was customary to designate its varieties by groups in the diagnosis, but, due to their insignificant symptomatic differences, today such clarifications as, for example, “group D salmonellosis” or “group C” are not indicated. Only clinical forms of the disease with the serotype of the detected Salmonella are designated to establish the source of infection.

The impact of salmonellosis on the body

The development of intoxication due to poisoning by products affected by bacteria occurs according to several patterns, depending on the form of the disease.

Gastroenteric form

It is considered the most common. It is characterized by an acute rapid development, literally within a few hours from the moment of infection. First, the disease manifests itself:

• body aches;
• chills elevated temperature body;
• headache.

Then the following symptoms join:

• spastic pains with localization in the navel and epigastrium;
• nausea and then repeated vomiting;
• frequent stools, turning into diarrhea with watery, foamy, often greenish stools, emitting a specific stench;
• against the background of high body temperature, the skin is pale, sometimes cyanosis (blue discoloration) is observed;
• dryness and coating of the tongue;
• bloating, palpation - soreness and intestinal rumbling;
• muffled heart sounds, tachycardia, lowering blood pressure, over time - weakening of the pulse;
• decreased urinary function;
• the urge to defecate is always productive.

Severe cases of this form of salmonellosis are accompanied by clonic convulsions (involuntary twitching), usually in the lower extremities.

Gastroenterocolitic form

At first, the symptoms are similar to the gastroenteric form, but by 2-3 days there is usually a decrease in the volume of feces and the appearance of mucus or blood in them. The abdomen is spasmodic on palpation and painful in the colon. There are unproductive urges to defecate (tenesmus). Clinical signs, thus, are similar to indicators of the dysentery variant of the same name.

gastritis form

This is one of the rare variants, characterized by an acute onset, repeated vomiting and epigastric pain. Intoxication is weak, diarrhea is not observed, the course of salmonellosis is short, with a favorable prognosis.

typhoid form

• severe weakness;
• insomnia;
• headache;
• undulating or constant increase in temperature;
• pallor of the skin.

On the 3-5th day, an outbreak of hepatolienal syndrome (a sharp increase in the size of the liver and spleen), a decrease in blood pressure, and a decrease in heart rate (signs of bradycardia) may occur. The main features of the clinical picture are very similar to the symptoms of typhoid fever, which makes clinical differentiation of the diagnosis difficult.

septic form

This form can begin with manifestations of gastroenteritis, followed by feverish conditions with chills and profuse sweating, myalgia and tachycardia. Hepatosplenomegaly (enlargement of the liver and spleen) may also develop. This form of the disease is characterized by a complicated clinic - the appearance of secondary purulent foci:

• in the kidneys (cystitis, pyelitis);
• in muscles and subcutaneous tissue (phlegmon, abscesses);
• in the heart (endocarditis);
• in the lungs (pneumonia, pleurisy), etc.

In addition, the development of iritis and iridocyclitis (inflammatory eye diseases) is often observed. The septic form is characterized by a long course of the disease.

Typhoid and septic forms are generalized forms of salmonellosis.

Pathogenesis

The pathogenesis of the development of the disease in any of its forms is due to the extreme toxicity of pathogens, or rather, the products of their vital activity. Resistant to gastric microflora, Salmonella bacilli quickly penetrate the mucous membrane small intestine and attach to the cell membranes of enterocytes (cells of the intestinal epithelium). As a result of the active life of Salmonella, a large amount of cytotoxins, enterotoxins and endotoxins is released. They provoke pain, diarrhea and other intoxication symptoms, leading to dehydration and catastrophic loss of electrolytes.

A past infection, as a rule, contributes to the development of immunity in a person, but only for a certain form of the disease.

At-risk groups

• First of all, people with weakened or underdeveloped immunity - the elderly over 60 years old and children under 1 year old. Infection in healthy people occurs when 107 bacterial agents enter the body. And for people with weak immunity or its deficiency (for example, those with AIDS or weakened chronic pathologies), this amount can be several times less.
• Workers of poultry farms and livestock complexes, as well as people who breed pigeons and other domestic animals (taking into account the sources and methods of transmission of salmonellosis).
• Those who do not follow the basic rules of personal hygiene, and also often eat semi-finished products or products from street vendors.
• Lovers of homemade food, but cooked with minimal heat treatment (meat with blood, homemade raw smoked sausages, eggnog from raw eggs).

Products dangerous in terms of contamination

As already mentioned, the best nutrient medium for salmonella is protein products. Therefore, most often carriers of salmonellosis sticks are products of animal origin:

• milk and dairy products;
• meat and meat products;
• eggs.

The stick can also be found in plant sources - vegetables and berries, especially if manure or chicken manure is used as fertilizer when growing them.

The longer the product is stored, the more likely the occurrence of Salmonella colonies in it. For example, it is known that after 1 month of storage of chicken eggs in the refrigerator, the bacteria located on the surface of the shell are able to penetrate inside and, having reached the yolk, form a real crowd in it.

In other environments, the viability of Salmonella can vary:

How can you get infected

Salmonellosis can be contracted in several ways:

• food way;
• waterway;
• contact-household way.

food way

As you can see from the list of the main sources of infection, the easiest way to get a deadly infection is to get infected through food.

The food way is the most frequent cause of illness and hospitalization of a large number of victims.

Waterway

A certain number of sticks can fall into water resources, for example, when feces, including infectious ones, get into water bodies due to damage to sewer mains. Untreated effluents from poultry farms can also serve as a source of infection if they penetrate into natural waters.

Contact household way

Much less often, salmonellosis is transmitted by contact-household way from person to person. This is possible only with a gross violation of the rules of personal hygiene:

• if salmonella-infected patients do not wash their hands after using the toilet (and the infection persists for several months);
• if they do not wash their hands after contact with animals that may be carriers of the stick;
• if personal items of patients in the infectious diseases department of the hospital do not undergo sufficient sanitization - children's pots, dishes, towels.

Preventive measures

Knowing how dangerous salmonellosis is and how it is transmitted, you should try to prevent infection with this infection. Preventive measures should cover not only social and domestic areas, but also the production conditions of enterprises engaged in breeding animals and birds.

Thus, it is necessary:

1. Comply with the regime and veterinary and sanitary requirements when slaughtering poultry and livestock, processing carcasses, preparing, transporting and storing meat and fish products.
2. To prevent contaminated dust from entering the Airways and on the cornea of ​​the eyes, poultry workers should wear goggles and respirators when working.
3. At home, observe sanitary and hygienic standards when cooking - ensure separate processing of raw and boiled meat, wash and wipe the egg shells before storing them, do not store them for too long in the refrigerator, thoroughly heat treat meat, fish, eggs.
4. Be sure to wash your hands before eating and after contact with animals (including domestic turtles, iguanas and other exotics).
5. Carefully handle utensils and cutting boards used for butchering raw meat. It is known that at temperatures above 70 degrees Salmonella dies in 3-4 minutes, and when boiled - almost instantly.
6. Inside large pieces of meat, the boiling temperature may not reach 100 degrees, so you need to observe the cooking time for certain types of meat: pork - at least 2 hours, beef - at least 1.5 hours, poultry - 50-60 minutes.
7. Do not store meat salads and other dishes with a combination of cooked and raw foods for a long time.

Given the danger of infection and what complications of salmonellosis can lie in wait for the carrier of the stick (abscesses, endocarditis, purulent arthritis, peritonitis, appendix and even meningitis), do not neglect simple rules hygiene and safe food preparation technologies. In this way, you can not only protect yourself from an insidious disease, but also not put the people around you at risk of infection.

Update: September 2019

Salmonellosis is a common intestinal infection, the main source of infection of which is contaminated food. The causative agent of salmonellosis is various bacteria of the genus Salmonella. In our country, there are almost 500 species of them, the most common of which are S. typhimurium, S. Heidelberg, S. enteritidis, S. derby, S. newport, S. Anatum, S. cholerae suis, etc., the susceptibility to which varies in humans .

The minimum dose for human infection is from 1.5 million to 1.5 billion microbial cells. Usually, after suffering salmonellosis, strong immunity remains, however, repeated diseases occur when they are caused by other types of Salmonella bacteria.

Salmonella is very stable and can persist in the external environment for a long time:

In food:

• in milk - 20 days
• in sausage products - 2-4 months
• in kefir - 2 months
• in frozen meat - from six months to a year
• v butter– 120 days
• in beer - 2 months
• in cheese - almost a year.

Meat and dairy products are able not only to retain Salmonella, but in them it successfully multiplies, while neither the appearance nor the taste of the products changes. This is the insidiousness of salmonellosis. How is this intestinal bacterium transmitted?

• One of the most common routes of Salmonella infection is eggs, dairy and meat products.
• Neither smoking nor salting kills salmonella
• Freezing only helps to prolong the survival of these microorganisms in products.
• Only heat treatment can destroy it, at 60 degrees salmonella dies in an hour, and 80 degrees kill it in 3 minutes.
• All disinfectants, even at normal concentrations, quickly kill salmonella germs.

Salmonellosis - incubation period

Usually, after bacteria enter the body, the disease begins to progress within 6-72 hours. That is, in salmonellosis, the incubation period lasts from several hours to three days. With timely treatment, recovery occurs in 6-10 days. Clinically, salmonellosis can manifest itself either very brightly, or there may be no symptoms of poisoning at all. Even in the absence of signs of salmonellosis, a person becomes a bacteriocarrier, that is, he may not get sick, but be a source of infection for other people.

Ways of infection with salmonellosis

After infecting a person, salmonella begin to multiply rapidly, toxins are released in the body, the action of which leads to disruption of the nervous system and loss of fluid through the intestines. Therefore, an infected person experiences severe intoxication, which is expressed by: diarrhea, fever, weakness, vomiting, headache.
There are several ways to get infected with salmonellosis:

Infection through food

Salmonella infection is possible through almost all food products. For a disease to occur, a massive infection must occur, and the causative agent of salmonellosis multiplies better and faster in protein foods. Moreover, the share of meat products among all cases of infection is about 70 percent. Then there are dairy products, fish and egg products. Plant-based foods do not often cause disease, since they practically do not multiply bacteria. During heat treatment, the number of salmonella is drastically reduced, so the use of hot or warm dishes is absolutely safe. Even if a small amount of bacteria is still preserved, there are not enough of them to develop salmonellosis. With long-term storage, the amount of the causative agent of salmonellosis increases and, accordingly, the risk of infection with salmonellosis also increases.

Infection with salmonellosis through household contact

What to do if a family member or close friend is struck by salmonellosis? How is the infection transmitted from person to person? Infection with salmonellosis through contact with the patient occurs in the same way as with other intestinal infections. A bacillus carrier can only excrete salmonella through faeces.

Therefore, salmonellosis is transmitted from person to person very rarely, it happens only through contact, if the rules of personal hygiene are not followed, simply through dirty hands. In addition, a massive lesion in this case is unlikely, and only especially susceptible people get sick. Particularly susceptible to infection are people weakened by other diseases, young children, the elderly, for whom the causative agent of salmonellosis, even in small quantities, is dangerous. Contact-household infections usually occur in hospitals in premature and debilitated children.

Infection through water

If the feces of infected people and the excrement of sick animals get into the water, salmonellosis is also possible in water. But the reproduction and accumulation of the pathogen does not occur in the aquatic environment, respectively, and the number of bacteria in the water is small. Such ways of infection with salmonellosis are very rare.

Airborne

Airborne intestinal infections, including salmonellosis, are not transmitted.

Air-dust way

It is believed that when spraying the excrement of pigeons living on the roofs of buildings, Salmonella may enter the premises. In hospital rooms with small children, salmonella is sometimes found in the air. This is possible in cases where there are violations of ventilation in the premises.

Over the transmission of salmonellosis puzzle. The route of transmission from animals, man to man, has long been described, but there are no fewer patients. The incubation period is short. It is possible to determine the source of infection by history. The incidence is increasing every year. Scientists are trying to invent a vaccine against the disease. In Africans, the bacillus is superimposed on other infections - mortality from salmonellosis is significant.

The microbe dies during pasteurization. Problems arise with chicken eggs - disinfection measures are not taken against them. You can get salmonellosis by eating scrambled eggs. This is the main reason for the spread of epidemics in the United States. Israeli owners of public catering establishments at the entrance hang a warning that lovers of fried eggs take the risk of infection.

The source of Salmonellosis infection is a bacillus of small size (a few microns). The routes of transmission are similar to helminthiasis - the fecal-oral method. We need to find an intermediate environment. Doctors talk about possible ways of infection:

• Food. Salmonella likes to nest in milk, eggs. Animals also suffer - you can get infected from a sick animal (bird) by trophic routes.
• Water outbreaks (on public beaches) are rarely recorded.
• Specific public, closed institutions (hospitals) become sources of nosocomial infection. A feature of the path is a relatively long incubation period, which increases the risk of infection spreading.

The list of public and closed institutions is extremely long. The source of human infection can be another person, an animal. 100 thousand units of bacteria should enter the oral cavity of an adult.

Infection with salmonellosis is more often possible in the autumn-summer period. There is no strict division by season. Do not guess about the contagiousness of the product - take note of the list of dangerous elements of the diet:

1. Eggs. Rumors vary regarding the safety of quail eggs.
2. Chicken meat. Few people eat meat and semi-finished products raw - they should be cooked well. It is easier for salmonella to take root and survive in meat.
3. Fish, seafood.
4. Less commonly, unwashed fruits and vegetables become the cause.

Pork and beef are rarely contagious. Sometimes transmission occurs through egg cream confectionery. In hospitals, the microbe is transmitted through clothing, tools, and household items. Distinctive feature hospital strains is highly resistant to antibiotics.

If the contact-household, water and alimentary ways of spreading the infection are not disputed, then the air-dust is ambiguous. Emphasize the information of infection of the infant through the lungs. Babies get the infection from the mother through the placenta, during childbirth.

path within the body

Regardless of the chances of transmission of salmonellosis from a person or animal, with food or drink, the bacteria enter the stomach. The pH factor is low, the stick does not multiply, but does not die. Salmonella has a relatively high resistance to gastric juice. If it is not possible to destroy the pathogen, its number exceeds one hundred thousand, infection occurs.

Dying, sticks secrete into environment endotoxin that weakens the immune system. Depending on the quantitative ratio of living and dead units, the process of infection development is considered local or generalized. Toxins predominate in the local area - poisoning quickly passes. With a generalized course of the course of the disease, complications are possible - a trip to the doctor should not be postponed.

The introduction of the pathogen into the body is carried out mainly in the small intestine.

adhesion to the epithelium

Salmonella moves with flagella randomly, enters the epithelium. The microbe is resistant to the bactericidal action of the mucosa. It is introduced into enterocytes due to the fimbrial apparatus.

Infection of the lymphatic system

The ability to invade is determined by pathogenicity islands (SPI) 1, 2 and 4. Through the folded cells, the microbe enters the lymphatic system, affecting the nearest nodes (thoracic, mesenteric), from here the blood vessels become infected with salmonella. Affected M-cells die after a while.

Phagocyte infection

The wand can infect different types cells. The SPI-1 islet is responsible for infection. A feature of Salmonella is the ability to survive inside phagocytes and multiply there. Islets SPI 2 and 4 are responsible for the processes. The phagocyte dies over time due to the activation of apoptosis by the causative agent. This is a factor in the spread of infection throughout the body - generalization.

bacteremia

After the death of the phagocyte, salmonella can enter the bloodstream. Dies under the action of specific serum factors. Otherwise, the act of transferring salmonella to organs and tissues occurs, where it is not easy to destroy it. Existing methods are reduced to taking antibiotics.

Intoxication

When the rod dies, the patient receives a dose of endotoxin (a poison secreted by salmonella). Toxins cause symptoms: vomiting, nausea, colic. The process is accompanied by malfunctions of the immune system. Salmonella causes the body to generate antibodies unrelated to the fight. Man cannot win.

Inhibition of the secretion of chloride ions by the epithelium leads to the development of diarrhea. The process is made possible by the activity of the SPI-5 island. At the same time, an inflammatory reaction develops. An additional role is played by enterotoxin, which increases the level of cAMP - a separate factor in the accumulation of fluid in the lumen.

Prevention

Doctors are not sure which foods cause salmonellosis. Nothing can be said about the smell. The wand is not very contagious, differs in survival. Killed by heat treatment. The chicken egg is the main source of danger. Doctors say: it is unsafe to use fried eggs. Eggs are not pasteurized.

Be sure to wash foods that can cause illness. Scald vegetables and fruits with boiling water. In products, give preference to those that are sold in packaged form. The product, devoid of wrapping, must be wrapped in polyethylene, or a package should be issued upon sale.

The usual rules are less fast food in unfamiliar places. Unwanted contact with the patient. Follow the rules of hygiene. Follow their example and get a chance to live longer. The creators of the Old Testament washed the pews after use. Read more useful books instead of detectives.

Health ecology: Since recently, chicken protein has been considered one of the optimal products. It is necessarily included in the diet of people who want to lose weight or just get rid of unnecessary health problems. This dietary and cheap product is now very fashionable. But everyone forgot that chicken meat is the cause of the spread of a serious infection - salmonellosis.

salmonellosis

Recently, chicken protein has been considered one of the best products. It is necessarily included in the diet of people who want to lose weight or just get rid of unnecessary health problems. This dietary and cheap product is now very fashionable. But everyone forgot that chicken meat is the cause of the spread of a serious infection - salmonellosis.

What is the causative agent of this infection? What is salmonellosis and how to fight it? How is the disease transmitted and why is it dangerous? What are the symptoms of the disease and its possible consequences? Are there any features of the course of salmonellosis in children? How does intoxication manifest itself in this disease and what can be done to reduce it?

The causative agent of salmonellosis

What is salmonella? This is a special type of bacteria that, when it enters the human body, leads to inflammation of some parts of the digestive system and severe intoxication.

They are motile Gram-negative rods with flagella. The causative agent of salmonellosis (Salmonella) belongs to the family of intestinal enterobacteria, which is associated with the ability of this type of microorganisms to infect the intestines, although there are other forms of the disease.

Salmonella have certain characteristics.

1. They are resistant to many environmental factors: they can survive at -82 ºC and remain dry for a long time on the surface.

2. On surrounding objects at normal room temperature, bacteria can be viable for up to three months.

3. In the feces of animals, the causative agent of salmonellosis lives up to four years.

4. They are resistant to salting, smoking and freezing.

5. Salmonella live in the meat of domestic and wild animals, birds, milk, eggs of birds.A feature of these bacteria is the ability to multiply in milk and ready-made meat dishes for a long time, while they do not change their appearance, that is, they cannot visually distinguish infected products from clean ones.

6. Where else does salmonella live? - in water, if they get there with feces or through contaminated objects, they can stay up to two months.

7. Salmonella can produce or produce exotoxins: enterotoxin and cytotoxin.

8. When a bacterium is destroyed, endotoxin is released into the body of an infected person, which leads to the development of severe intoxication.

9. To destroy bacteria in products, they have to be subjected to prolonged heat treatment. At what temperature does salmonella die? - not less than 50 ºC. For example, to kill salmonella in a small piece of meat weighing about 500 mg, you will have to boil or stew it for 2.5 hours.

History of Salmonella Discovery

Throughout the history of medicine, bacteriologists have repeatedly described diseases that resemble salmonellosis in the course. Pathogens were periodically found in the meat of dead animals. At the end of the 19th century, American scientists D. E. Salmon and J. Smith isolated and described the causative agents of animal salmonellosis, but called the disease swine fever. A few years later, the same bacteria were sown from the intestines of dead people.

Over the next 40 years, data on similar infections and the bacteria that caused them regularly surfaced in medicine. All this led to the isolation of a separate type of intestinal infections, and their pathogens were named after the scientist who first described Salmonella bacteria.

Causes of salmonellosis

Salmonellosis is an acute infectious disease caused by salmonella. What animals can be the source of infection?

Almost any animal can get sick and infect others:

horses, pigs, sheep;

cattle;

even pets, cats and dogs, are sick with salmonellosis;

wild animals are often a source of infection: foxes, wolves, arctic foxes, beavers, bears;

but the main place in the transmission of infection is occupied by poultry, especially waterfowl, salmonellosis can be in chicken eggs, in chicken meat, ducks and geese, even dry egg powder made from infected eggs may contain the pathogen;

wild birds carry the infection - pigeons, gulls and sparrows;

cases of development of salmonellosis among lizards, turtles, crabs and frogs have been recorded;

the source of infection in salmonellosis can be a person (carrier) during the development of the disease.

That is, salmonellosis is found everywhere, everywhere, but more often in the household.

Salmonella infection is also varied.. Sick animals may appear healthy and shed the bacteria into the environment in feces, saliva and urine, sneezing mucus, milk and eggs. After the death of an infected animal, the causative agent of salmonellosis persists in the meat.

Salmonellosis is most commonly transmitted, possibly via the fecal-oral route. Ways of transmission of infection are as follows.

1. One of the main ways of infection is alimentary through products, which include meat of animals and birds, as well as eggs and milk.

2. There are cases when food becomes infected during processing or preparation through contact with contaminated surfaces.

3. How else is salmonellosis transmitted? - by household contact through unwashed hands, after contact with infected people and pets in case of non-compliance with sanitary and hygienic standards.

4. One of the possible ways of spreading the infection is water when ingesting water with bacteria.

5. How else can you get infected with salmonellosis? - through dust, when inhaling its particles, a pathogen can also enter the human body.

A person can get sick with salmonellosis, maybe throughout the year, but, from the point of view of epidemiology, the most dangerous is the summer period. In hot weather, food storage conditions are more often violated. In summer, both outbreaks of the disease and single or sporadic cases are recorded.

The pathogenesis of salmonellosis

Salmonellosis is an anthropozoonotic infection caused by salmonella, leading position in the development of which is assigned to animals. Once in the human body, bacteria pass through the protection system of the upper parts of the digestive organs. Most often, the causative agent of salmonellosis takes root and begins to multiply in the initial section of the small intestine. Here they are partially captured by blood cells called macrophages. This is the first active human defense system, but it is after its work and the destruction of bacteria that more serious changes begin to occur - the release of endotoxin, which affects the nerves and blood vessels of the intestine, which is the cause of the development of severe intoxication of the body with salmonellosis.

Then the bacteria enter the lymphatic vessels and rush through them to the intestinal lymph nodes, which are a powerful immune defense of our body. Reducing protection, the causative agent of salmonellosis rushes into the circulatory system and spreads to all organs and systems, forming secondary foci of infection.

What is the danger of salmonellosis? It consists in the release of toxins, which additionally affect all organ systems. With luck, the infection will pass quickly, and only the intestines will be involved in the inflammatory process. But if there are too many bacteria or a person's immunity is sharply reduced, then salmonellosis ends with the development of complications.

Symptoms

How long is the incubation period for salmonellosis? - Its average duration is from 12 to 24 hours. In rare cases, it is short and lasts about 6 hours, and sometimes the first signs of infection appear only after 2 days.

There are 3 main forms of salmonellosis.

1. Gastrointestinal with a primary lesion of the stomach or intestines.

2. Generalized variant of the development of the disease with the involvement of other organs and systems in the inflammatory process.

3. Bacterial excretion.

The manifestation of the disease depends on the form of infection. How does salmonellosis manifest itself in most cases? - the classic variant of the development of infection - the gastrointestinal form.

The symptoms of salmonellosis are as follows.

1. Gastritis due to the development of the disease is rare. Its manifestations include nausea, pain in the stomach and vomiting.

2. The first signs of salmonellosis with intestinal damage are an acute onset and early development of symptoms of intoxication.

3. Nausea and vomiting, both single and multiple.

4. Abundant frequent loose stools. In appearance, it is foamy, brown, yellow or dark green in color.

5. Pain in the abdomen and bloating, constant rumbling.

6. How long does it take for salmonellosis to appear if all parts of the intestine are affected? - the incubation period is short, and the disease itself is difficult and begins with a rise in temperature, the stool is frequent and liquid with small streaks of blood.

7. Often, manifestations of inflammation of the pancreas join the general classical symptoms, and liver damage is involved in the inflammatory process.

8. Salmonella disrupts work of cardio-vascular system- the pulse rate changes, blood pressure decreases, the heart rhythm becomes irregular.

9. In the absence of timely treatment or in especially severe cases, collapse develops when blood pressure drops sharply and blood circulation in vital organs decreases.

10. Salmonellosis during pregnancy is severe, with all the symptoms and in severe cases can result in a miscarriage.

Mild, moderate and severe course is characteristic of any form of salmonellosis, while the symptoms of infection occur with varying frequency.

Bacterial excretion during the development of salmonellosis is acute and chronic. In the first case, salmonella can be released into the environment within three months after the first manifestations of the disease, in the second - a longer period.

Infection Diagnosis

It is easy to make a diagnosis during an outbreak, but isolated cases require special examinations.

1. How to get tested for salmonellosis? The basis of diagnosis is bacterial research methods, the material for which is blood, urine, stomach contents, vomit, pus. The analysis is most effective in the early stages of the development of the disease.

2. Serological methods of diagnosis include RA and RNHA, they can be carried out a little later on the 7th or 8th day of the disease. RA is positive at a serum dilution of 1:200.

Complications of salmonellosis

Why is salmonellosis dangerous? Not only by its course and the defeat of all organs and systems. In case of unsuccessful or untimely treatment, the infection is accompanied by serious complications.

1. Gastrointestinal or gastrointestinal form of salmonellosis sometimes ends in the development of collapse or hypovolemic shock (decreased blood pressure, blanching of the skin, nausea, dizziness and loss of consciousness).

2. The complications of salmonellosis include acute heart failure.

3. During the development of the disease, numerous septic complications often develop - purulent inflammation of the joints, abscesses of the liver, spleen and kidneys.

4. Sometimes the heart is affected - endocarditis.

5. Inflammatory processes occur in the urinary system - cystitis, pyelonephritis.

6. The consequence of salmonellosis may be an abscess of the brain and inflammation of its membranes or meningitis.

7. Sometimes salmonellosis ends with the development of peritonitis, pneumonia or appendicitis.

More often, salmonellosis ends in complete recovery. Only in no more than 0.2–0.3% of cases, a fatal outcome is possible.

Can you get salmonellosis again?- Yes, with any form of infection, relapses of the disease occur. The body does not permanently produce specific immune cells that protect a person from developing disease in the future.

Treatment

How to treat salmonellosis? Given the variety of clinical manifestations and various variants of the course of the disease itself, treatment should be carried out only under the supervision of specialists in a hospital. Although with mild forms of salmonellosis, home treatment is allowed.

Treatment is always selected individually.

1. In the first hours of the development of salmonellosis, all patients with lesions of the abdomen and intestines are prescribed gastric lavage.

2. To stop diarrhea, calcium preparations are prescribed in therapeutic doses.

3. An important role in the treatment of salmonellosis plays proper diet. With a mild course of the disease, this is the main method of helping patients. During the treatment of a severe infection in the diet, temporary restrictions on many foods are indicated. High-calorie dishes, milk, eggs, fresh vegetables, smoked meats, pickles, marinades, sweets are excluded. Nutrition for salmonellosis in adults at the time of treatment includes gentle processing of products - only boiled, steamed and stewed dishes. The total calorie content of foods during the day should not exceed 2 thousand kcal. Food should be at room temperature, hot dishes are temporarily excluded.

4. With the development of repeated vomiting and loosening of the stool, dehydration therapy is prescribed - intravenous plasma-substituting solutions are used.

5. As for the prescription of antibiotics for salmonellosis, they are not effective for all forms of the disease. With the intracellular location of bacteria, antibacterial drugs have practically no effect on the pathogen. Generalized variants of the course of the disease require the appointment of antimicrobial agents. They are selected individually, taking into account the sensitivity of bacteria, which is determined during the analysis.

6. A salmonella bacteriophage plays a significant role in the treatment, which acts directly on bacteria, destroying them.

7. As an additional therapy, anti-inflammatory drugs are prescribed. For symptomatic relief, multivitamins, potassium preparations are used to quickly restore the body after an infection.

In the case of bacterial excretion of salmonella in the human body, they are insensitive to many antibiotics. Then the medications are selected individually with a long course of treatment.

Prevention

Prevention of salmonellosis includes a number of anti-epidemic measures and individual measures to protect against infection.

Salmonellosis prevention measures include the following preventive measures.

1. Active work of veterinary and sanitary-hygienic services to identify the disease and carriage among domestic animals and people.

2. A large role in the spread of infection belongs to food industry workers, so they are examined annually for carriage.

3. If a focus of infection is detected, active work with contact persons with their subsequent examination for carriage or mild asymptomatic course of the disease.

4. Prevention of salmonellosis consists in carrying out sanitary and educational work among the population with an explanation of the rules for the heat treatment of products.

5. Personal hygiene plays an important role in reducing transmission factors among people.

6. Preventive measures include active annual monitoring of bacterial excretors and timely treatment.

7. How to prevent salmonellosis at home? - this is a long-term heat treatment of meat products, eggs and dairy products.

Features of the course of salmonellosis in children

Children are a special group of the population. Up to a year, their immunity has not yet been formed in order to fully respond to the presence of bacteria, after a year it is still being formed, therefore, at preschool and school age, babies are difficult to tolerate the infection.

Why is salmonellosis dangerous at this time and how does it proceed in children? What are the features of the course of the disease in childhood?

1. The cause of the development of salmonellosis in infants is often Salmonella typhimurium (Salmonella typhimurium) - this is a nosocomial infection, which, under unfortunate circumstances, babies become infected even in the maternity hospital.

2. The most susceptible to infection are children under the age of one year.

3. In children of senior school age, as a rule, the disease proceeds in the same way as in adults.

4. Toddlers often communicate with animals and birds, so the contact route of infection is of great importance. In addition, the dust route of infection transmission is not in last place.

5. The incubation period of salmonellosis in children in most cases is shortened, no more than 12 hours.

6. For children, the seasonality of the disease is more characteristic - the summer-autumn period of the development of infections.

7. Signs of salmonellosis in infants - general symptoms of intoxication prevail: weakness, lethargy, refusal to eat, the baby constantly spits up, he is sleepy, the child is more capricious, the stool is quickened up to 5-6 times a day, if no help is provided in the first days of development illness may worsen dramatically.

8. At this age, the gastroenterocolitic form of salmonellosis develops more often, that is, occurring with gastric and intestinal symptoms.

9. Symptoms of salmonellosis in older children - severe weakness, weakness, lack of appetite, persistent nausea and repeated vomiting, green stools from 5 to 10 times a day, an increase in body temperature by at least 1.5 ºC, pain and rumbling in the abdomen.

10. A sharp increase in body temperature to 40 ºC and above indicates a generalized infection, when purulent foci have formed in various organs.

11. The consequences of salmonellosis in children, unlike adults, may be slightly different - in addition to all of the above, children often have dysbacteriosis after an infection. Sometimes, after salmonellosis, chronic diseases of the digestive system are formed, including those with limited production of enzymes for food processing - chronic pancreatitis. Allergenic children acquire another unpleasant factor - food allergies.

Treatment of salmonellosis in children

Therapy for this infectious disease in children begins in most cases with detoxification. This is one of the first stages in the treatment of children. The fact is that with a loss of fluid up to 10%, the child may die. Therefore, the basis of the treatment of salmonellosis in children is the replacement of lost fluid. It is calculated by age and body weight.

Otherwise general principles treatments are followed in the same way as in adults. Depending on the indications, antibacterial drugs are prescribed. Symptomatic therapy is carried out with antipyretic, general tonic drugs. Much attention in the treatment of salmonellosis in childhood is given to the appointment of drugs to restore the intestinal microflora.

The diet for salmonellosis in children has its own characteristics:

no need to force children to eat, especially in the early days of the development of the disease;

hard-to-digest foods, including milk and eggs, are temporarily excluded from the diet;

small children, due to a sharp loss of fluid, are recommended to be soldered with water, but it must be given in small portions, one spoonful at a time is enough;

dietary restrictions persist for up to 5 days, then the diet is gradually expanded as needed.

Intoxication with salmonellosis

The syndrome of intoxication in salmonellosis is important. The severity of the disease and the general condition of the patient depend on the degree of its development.

The period of intoxication begins at the moment of destruction of the pathogens of salmonellosis. Bacteria are captured by blood cells and the body destroys them in an attempt to cope with the microorganism. Exotoxin is released into the intestine, which determines the further state of the person.

Signs of salmonella poisoning are as follows.

1. With a mild degree of development of the disease, the symptoms of poisoning are moderate - this is a general malaise, weakness and lack of appetite.

2. The average severity of the infection is characterized by a high temperature of at least 39 ºC, headaches and dizziness, nausea and vomiting, cramps develop in the limbs, and aches all over the body.

3. Symptoms of severe salmonellosis poisoning include chills and high body temperature over 40 ºC, severe weakness, weakness.

4. At the time of development of severe intoxication, the appearance of patients with salmonellosis is characteristic - they look exhausted, the skin is pale, dry, with a bluish tinge, the voice is quiet, weak, numerous cramps appear in the limbs and throughout the body, the amount of urine excreted sharply decreases to its full disappearance.

5. With the development of intoxication during the examination of a person, the doctor additionally notes an increase in the spleen and liver.

In case of salmonella poisoning or intoxication of the body due to an infectious disease, one should not try to help a person on his own. This condition is a direct indication for hospitalization.

Salmonellosis ranks first in the world among deaths from intestinal infectious diseases. And the number of new species of Salmonella is increasing every year. It is impossible to eradicate the pathogen. What can be done to avoid getting sick? It is necessary to properly prepare food, regularly observe basic hygiene rules and teach children how to handle even exotic species of animals.published

Salmonellosis is an acute infectious disease caused by Salmonella. This infection is widespread everywhere, both adults and children suffer from it. In most cases, salmonellosis occurs with gastrointestinal disorders, symptoms of dehydration and intoxication.

What is salmonellosis?

Salmonellosis is bacterial infection, which affects humans and animals, is transmitted by the fecal-oral route (the pathogen is excreted in feces and enters the body through the mouth), usually affects the stomach and small intestine.

Humans are highly susceptible to salmonellosis. The severity of the developed infection depends on a complex of factors, both external (the number of pathogens that have entered the body, their antigenic composition and biological characteristics) and internal (the state of the human body's defense systems, concomitant pathologies, in particular the digestive system).

The infection is most severe in infants (especially premature infants) and the elderly. Post-infectious immunity is unstable, lasts no more than a year.

Salmonella: what is it?

The causative agent of intestinal infection (salmonellosis) belongs to the genus salmonella (shigella, salmonella) and is a gram-negative enterobacterium that does not form spores. In appearance, microorganisms resemble a longitudinal stick with slightly rounded edges. The length of salmonella spp is 1–5 µm, the width is from 0.33 to 0.7 µm.

Favorable temperature for existence is 35-37 degrees above zero. Salmonella can also survive in cold weather (from +7) or significant warming (+45). Bacteria are resistant to external factors, and their life cycle can last very long in environments such as:

The infectious beginning is not only preserved, but also capable of reproduction. The taste of products and appearance does not change. Smoking, salting, freezing products does not lead to the death of the infectious onset.

Once in the stomach with the intestines, the Salmonella bacterium reaches the small intestine, where it is captured by epithelial cells and penetrates the mucous membrane. This is where its reproduction occurs, which causes inflammatory changes in the mucosa, and the bacterium spreads further into the blood and lymph nodes.

With the death of obsolete salmonella, there is a constant intoxication of the body. Blood microcirculation, ion transport is disturbed, which leads to a sharp release of water and electrolytes into the intestinal lumen from the cells.

Causes of salmonellosis

Specialists classify the transmission factors of the pathogen of salmonellosis as follows:

• Fecal-oral. If a grocery store employee or cafe employee is infected, then it is likely that a visitor to these outlets will soon become infected.
• Water. The consumption of raw water often becomes the cause of infection of a significant number of people.
• Domestic. The causative agent of salmonellosis is transmitted from person to person when shaking hands or using personal hygiene items of the bacteriocarrier.

Sources of pathogenic Salmonella can be:

• Sick people and carriers (the pathogen is excreted in the feces).
• Infected animals (poultry, pigs, cattle, cats, dogs).
• Polluted water (when human or animal feces get into it).
• Food (raw eggs, meat, unpasteurized milk, manure-contaminated green vegetables).

An important feature is the fact that salmonella, being directly in food, does not contribute to a change in their appearance, which only increases the risk of possible infection.

Outbreaks of salmonellosis mainly last long enough, moreover, they are characterized by a fairly high mortality rate. Often these outbreaks occur during the warm season.

First signs

When the first symptoms of salmonellosis appear, call a doctor who can help. Signs include:

• heat;
• nausea, vomiting;
• pain in the abdomen, he rumbles, swollen;
• stools are liquid, watery, mucus-like, if the large intestine is affected - with blood;
• frequent feeling of the need to defecate;
• weakness, headache;
• low blood pressure, rapid heartbeat.

Symptoms of salmonellosis in adults

After salmonella enters the body, there is an incubation period, which usually lasts for 12 to 24 hours. Less commonly, it can last 6-12 hours or 24-48 hours. Further, the symptoms of the disease develop.

Gastrointestinal salmonellosis

The form is localized (gastrointestinal), the course of the disease occurs in

• gastritis;
• gastroenteritis;
• in the gastroenterocolitic variant.

Gastrointestinal forms are the most common. The disease begins in a few hours, a maximum of 2 days from the moment of infection.

• Elevated temperature.
• Nausea, vomiting.
• Abdominal pain, rumbling,.
• The stool is liquid, watery, with an admixture of mucus, with the involvement of the large intestine, there may be blood in the feces and false urge to defecate.
• Headaches, weakness, but there may be severe damage to the nervous system, up to delirium, convulsions and loss of consciousness.
• Palpitations, lowering blood pressure.

Gastroenteric form of salmonellosis

This form is characterized by a combination of signs of disruption of the gastrointestinal tract and general intoxication of the body:

• fever, fever, chills, cold perspiration;
• headache;
• aches all over the body;
• tremor of the upper and lower extremities;
• decrease in tactile, tendon and muscle reflexes;
• nausea and vomiting.

An hour later, the clinical picture of salmonellosis is aggravated by diarrhea, sometimes impurities of mucus and fresh blood are found in the feces. Stool character: frothy and watery structure, color changes from brown to greenish. The skin of a person becomes pale, and the mucous membranes dry.

A characteristic symptom of gastroenteric salmonellosis is cyanosis of the nasolabial fold. Rumbling is noted in the abdomen, the victim has a feeling of fullness and swelling.

Gastroenterocolitic salmonellosis:

• The onset of the disease is characterized by the manifestation of conditions that accompany the previous, gastroenteric variant of its course, however, by the 2nd-3rd day of the disease, a decrease in the volume of feces is noted, and mucus and, in some cases, blood already appear in them.
• Palpation (palpation) of the abdomen allows you to determine the presence of spasm of the colon and, in general, its soreness.
• Often the act of defecation is accompanied by false urges with soreness (tenesmus). V this case disease, his clinic is in many ways similar to the acute form of the course.

Generalized salmonellosis

The generalized form can proceed according to a typhoid-like variant, while gastroenteric phenomena are often noted initially.

• Subsequently, as nausea, vomiting and diarrhea subside, fever and signs of intoxication (headache, severe weakness) increase, while the fever acquires a constant or undulating character.
• When examining a patient, elements of a hemorrhagic rash on the skin can sometimes be noted; hepatosplenomegaly is detected on days 3-5.
• Characterized by moderate arterial hypotension, relative.
• The clinical picture resembles that of typhoid fever.

typhoid form

Typhoid - fever for a week, intoxication, delirium, hallucinations. A rash is visible on the abdomen, the tongue is gray-brown, the skin is pale, the abdomen is swollen, the internal organs are enlarged. Passes through 1.5 months.

Septic salmonellosis

Septic type of the disease: it is observed extremely rarely, mainly in elderly people, small children under one year old, as well as with weakened immunity. It proceeds with high fever, chills, strong sweating, jaundice appears, and the most dangerous is the development of inflammation of a purulent nature during internal organs and fabrics. With this form of salmonellosis, there is a high mortality rate.

Bacteriocarrier species

The form of the disease is characterized by the absence of clinical symptoms of salmonellosis, but at the same time, salmonella is detected in bacteriological clinical studies of blood and feces:

Asymptomatic form: occurs if the body has been affected by a small amount of bacteria. In people with high immunity, the symptoms of salmonellosis do not appear and the body is able to fight the disease itself.

If the disease occurs in the form of a lesion of the stomach and intestines, or in the form of typhus, then the prognosis is favorable - with proper and timely treatment all patients recover. If the disease proceeds in the form, then 0.2 - 0.3% of patients die.

Diagnostics

A preliminary diagnosis is made on the basis of the clinical picture inherent in salmonellosis and evidence of the group nature of the disease, and laboratory tests are carried out to confirm the diagnosis:

1. Bacteriological examination of feces, vomit, as well as analysis of suspicious products that the patient used.
2. Serological diagnostics (determination of antibodies to salmonella in the patient's blood).

Types of bacterial excretion:

• acute - lasts up to 3 months, while the person is healthy, but salmonella is detected in the analyzes;
• chronic - lasts longer than 3 months;
• transient - some time after recovery, salmonella is detected in the patient, and after that all tests are negative.

People who are near the bacterioexcretor must strictly observe the rules of personal hygiene. There should be no shared items for personal use.

Treatment of salmonellosis

Children and the elderly, as well as patients in critical condition, need hospitalization. The remaining categories of patients can be treated for salmonellosis at home (following the doctor's recommendations), while not forgetting about secondary prevention measures to prevent infection of others.

When refusing hospitalization due to a mild form of the disease, the treatment of salmonellosis in adults consists of:

• gastric lavage;
• taking the antidiarrheal medicine Enterofuril;
• cleansing enema;
• reception of sorbents -, Activated carbon, Filtrum, or Enterosgel;
• refusal of sudden movements, adherence to the diet;
• if diarrhea is prolonged, dehydration occurs, then they drink solutions of Regidron, Oralit;
• to cure digestion - taking pills, Mezima;
• be treated to normalize the microflora - taking probiotics;
• drinking natural herbal decoctions.

Drink

Preference should be given to saline solutions. The pharmacy sells powders for their preparation - rehydron, oralit, citroglucosolan.

Standard composition - per 1 liter of water:

• 20 g glucose (8 teaspoons);
• 1.5 g of potassium chloride (sold in a pharmacy, as an alternative - raisin or dried apricot compote);
• 2.5 g of soda (half a teaspoon);
• 3.5 g of table salt (a teaspoon without top).

You need to drink little by little, but often, ideally - take a few sips every 5-10 minutes. It is advisable to drink 300-400 ml during the first 4-6 hours. per hour, and then about a glass after each bowel movement.

Diet

For patients suffering from salmonellosis, it is intended special diet(referred to as treatment table #4). Its main task is:

• in reducing the chemical and mechanical effects of the food consumed on the inflamed tissues of the intestinal mucous membranes;
• in the restoration of normal intestinal microflora.

A feature of the first days of the therapeutic diet is its energy deficiency, which prescribes the use of a normal amount of protein and a minimum (at the level of the lower limits of the norm) amount of fats and carbohydrates. As the general condition of the patient improves, the list of allowed products is gradually increasing.

What can't be eaten?

During the illness and at least two weeks after the disappearance of all symptoms of salmonellosis, it is necessary to completely exclude the following products:

• Citrus.
• Fatty meat and fish.
• Smoked, fried and pickled foods.
• Baking and sweets.
• Exclude pearl barley, millet, yachka and oatmeal from cereals.
• Strong tea and coffee, as well as soda.
• Coarse fiber - cabbage, legumes, radishes, radishes, etc.

Approved Products

What can you eat with salmonellosis:

• Fish and lean meats
• White bread, dried or crackers.
• Kashi - rice, semolina and buckwheat on water and without oil.
• Dairy products
• Fruits - apples, bananas
• Fresh fruit and vegetable puree
• classic mashed potatoes on the water
• compotes
• Kiseli.

The duration of the diet after suffering salmonellosis depends on many factors:

• general condition of the body;
• type of infection;
• features of the clinical picture;
• patient's age.

As a rule, for adults with a well-functioning immune system, a monthly stay on a sparing diet is sufficient.

When the first signs of salmonellosis appear, be sure to seek help from an infectious disease specialist or gastroenterologist. With proper treatment, the disease will quickly pass and leave no complications.