What are the other Names for this Condition? (Also known as/Synonyms)

• Non-Typhoidal Salmonella
• Salmonellosis

What is Salmonella Enterocolitis? (Definition/Background Information)

• Salmonella Enterocolitis is an infection of the small intestine caused by a bacterial organism called Salmonella. It mainly occurs by consuming contaminated beef, poultry, and eggs. It can also be transmitted through contaminated water
• Salmonella Enterocolitis is inflammation and infection of the intestines. It is different from typhoid fever in which the infection enters the lymphatic system of the body. Typhoid fever causes more systemic infection causing systemic salmonellosis
• There are different types of Salmonella species that cause Salmonella Enterocolitis. The most common ones are Salmonella typhi and S. paratyphi, which cause typhoid fever. The other common Salmonella species are S. typhimurium, S. enteritidis (several serotypes such as Heidelberg, Newport, etc.) and S. choleraesuis
• Salmonella Enterocolitis could affect any individual, irrespective of gender, race, or ethnic group. The disease is more prevalent in under-developed countries. Additionally, individuals with low stomach acid, such as the elderly adults, and those on antacid medications are reported to have an increased susceptibility to the infection
• Risk factors for contracting Salmonella Enterocolitis include having had infections (malaria, parasitic, etc.), pernicious anemia, sickle cell anemia, being immune-compromised, handling animals (poultry, hedgehogs, and ducks), and other factors
• The typical symptoms of Salmonella Enterocolitis include fever and chills, watery diarrhea, nausea, vomiting, abdominal pain with cramps, headache, and urinary tract infections (in immune-compromised individuals)
• Some potential complications arising from Salmonella Enterocolitis may include dehydration, meningitis, intestinal perforation, and gallbladder infection
• A healthcare provider might be able to diagnose the infection on the basis of symptoms, stool culture, blood test for checking WBC and eosinophil counts, blood culture, etc. If an individual is already on an antibiotic and shows a negative blood culture, a bone marrow biopsy may be required
• Treatment options available for those with Salmonella Enterocolitis include replenishing the fluids lost because of diarrhea and the administration of antibiotics. The prognosis of Salmonella Enterocolitis is good, as it resolves with appropriate treatment. However, when the infection spreads to blood and other parts of the body, the recovery might take longer
• Maintaining good hygiene is a possible way to prevent infection by Salmonella species. This includes eating well-cooked food, drinking purified water, frequent hand washing, and getting vaccinated for typhoid fever

Who gets Salmonella Enterocolitis? (Age and Sex Distribution)

• Individuals of any age can be affected by Salmonella Enterocolitis
• It can affect both males and females
• The disease has been observed more commonly in some underdeveloped nations

What are the Risk Factors for Salmonella Enterocolitis? (Predisposing Factors)

The following are some factors that could contribute to an individual contracting Salmonella Enterocolitis:

• Handling poultry, ducks, hedgehogs, etc.
• Old age, especially those with low stomach acidity
• Taking antacids and proton pump inhibitors (such as omeprazole)
• Individuals in certain underdeveloped countries 
• Individuals with sickle cell anemia
• Being Infected by the parasite Schistosoma
• Malarial infection
• Infection with Bartonella henselae in immune-compromised individuals
• Pernicious anemia (that leads to reduced acid in stomach)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your health care provider.

What are the Causes of Salmonella Enterocolitis? (Etiology)

• The most common bacterial species involved in Salmonella Enterocolitis are Salmonella typhi and Salmonella paratyphi (which are responsible for causing typhoid fever too)
• Other Salmonella organisms include:
  • S. enteritidis (Heidelberg, Newport, and Montevideo)
  • S. typhimurium
  • S. enteric, serotype Javiana and serotypes I 4,5,12
• Generally, a million bacterial cells are needed to cause infection, which is reduced to a thousand cells under conditions of low acidity. The bacteria have sharp projections on their surface called pili, which help them adhere to the inner layer of the small intestine
• The enterotoxins secreted by the bacteria cause massive efflux of electrolytes from the intestinal cells and cause watery diarrhea. These bacteria enter the circulation and are visible in blood after 14 days of infection. After entering the circulation, the bacteria can reach the liver, spleen and brain, and produce focal abscesses

What are the Signs and Symptoms of Salmonella Enterocolitis?

The symptoms of Salmonella Enterocolitis may start within 6 hours of infection, but sometimes may take up to 48 hours for manifestation. The symptoms persist normally for 48-72 hours. The following are the typical symptoms associated with Salmonella Enterocolitis:

• Fever and chills
• Abdominal pain with cramps
• Watery diarrhea
• Nausea and vomiting
• Dry cough
• Frontal headache, muscle pain, and fatigue
• Skin rashes, called Ross spots, on the trunk or arm
• Urinary tract infections in immune-compromised people

How is Salmonella Enterocolitis Diagnosed?

A healthcare provider may assess the symptoms and may need one or more of the following tests to arrive at an accurate diagnosis of Salmonella Enterocolitis:

• Isolation of organisms from freshly-passed stool sample
• Blood culture
• Check for low WBC count especially neutrophils (neutropenia) count
• Check for high eosinophil count along with elevated ESR (red cell sedimentation rate), which might suggest a concomitant parasitic infection
• Liver function tests

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Salmonella Enterocolitis?

Some potential complications arising from Salmonella Enterocolitis include:

• Dehydration from diarrhea
• Intestinal perforation
• Meningitis
• Sepsis (blood infection)
• Infection of the gallbladder and high concentration of bacteria in bile can cause chronic carrier state. Such individuals can keep spreading the bacteria through their stools

How is Salmonella Enterocolitis Treated?

Salmonella Enterocolitis is generally treated by:

• Improving the hydration status using oral or intravenous fluids along with electrolyte replacement
• Antibiotics such as ciprofloxacin, macrolides (such as azithromycin), and third generation cephalosporin (such as ceftriaxone), which are effective against Salmonella sp infection

Anti-diarrheal agents are generally not recommended, as these medications tend to lengthen the period of time of the symptoms.

How can Salmonella Enterocolitis be Prevented?

Some methods to prevent Salmonella Enterocolitis are:

• Maintaining a good hygiene
• Hand washing before and after mealtimes, and in between too
• Preventing chronic carriers from handling foods or working in the kitchen
• Consuming well-cooked foods and drinking purified water
• Trying not to handle reptiles, hedgehogs, or ducks
• Getting vaccinated against Salmonella typhi and paratyphi bacteria

What is the Prognosis of Salmonella Enterocolitis? (Outcomes/Resolutions)

• The symptoms of Salmonella Enterocolitis usually last for 2-5 days. The acute illness lasts for 1-2 weeks and healthy individual typically recover after this period
• The recovery could take longer, if the infection has spread to blood or other organs
• Overall, the prognosis of Salmonella Enterocolitis with appropriate treatment is excellent

Additional and Relevant Useful Information for Salmonella Enterocolitis:

Some individuals may shed bacteria in feces for about a year after the infection.