All questions about salmonellosis - symptoms, treatment, how not to get infected. Symptoms and treatment of salmonellosis in adults and children Pathogenic pathogens of salmonellosis

The health of the gastrointestinal tract and the whole body depends on many factors. Various infections can significantly affect a person's activity and well-being. What is salmonellosis? What are the symptoms and treatment of the disease? What are the first signs of infection? What are the causes of the disease? From this article you will learn everything about salmonellosis and methods of dealing with pathology.

What is salmonellosis

Salmonellosis is an acute infectious disease caused by infection with bacteria. Mostly different parts of the intestine are affected.

The causative agent of salmonellosis is a bacterium of the genus Salmonella. There are about 2,000 varieties, but only about 500 species are capable of causing the disease. All of them are very resistant to aggressive environmental conditions, therefore, they actively multiply and are difficult to destroy.

In pathology, organs are most often affected digestive system. The disease is equally diagnosed in both women and men. More often doctors, since it is not always possible to keep track of what they eat and with what hands. It is possible to cure salmonellosis completely, but it is necessary to identify the pathogen in a timely manner and undergo an appropriate course of therapy.

Important! Some forms of Salmonella are resistant to antibiotics.

Features of the pathogen life cycle

Salmonella remains viable:

• in animal feces - 3 years;
• in the reservoir - 4 months;
• in soil - up to 18 months;
• in meat - up to 6 months;
• in milk - 20 days;
• in kefir - 1 month;
• in butter - 4 months;
• in cheese - up to 12 months;
• in egg powder - up to 9 months;
• on egg shells - up to 24 days.

Salmonella Enteritidis (or Gertner's bacillus) is able to remain viable even for some time during boiling. For example, if the source of infection is in a large piece of meat, then short-term cooking will not be able to get rid of the pathogen.

Salmonella dies at a temperature of 70 degrees for 5-10 minutes. To destroy the infection, dousing the product with boiling water may not be enough.

The life cycle of Salmonella begins after entering the body through oral cavity. However, gastric juice is very acidic environment in most cases, neutralizes the action of the pathogen. If the infection has not died completely, salmonella enters the duodenum and then into the small intestine. Next, the bacterium penetrates the blood and lymph. Although the pathogen is absorbed by macrophages, it is not destroyed, but, on the contrary, actively multiplies inside. Salmonella releases toxins. As a result, after a short incubation period, symptoms of intoxication begin to appear in a person.

Salmonellosis is transmitted through:

• animal meat;
• raw or fried eggs;
• dairy products;
• not thermally processed fish;
• unboiled water;
• fresh vegetables.

You can get infected directly from a person who already has salmonellosis. However, this requires close contact. It is not uncommon for the infection to be transmitted from an infected animal.

Note! Salmonellosis in animals can occur both with obvious signs and asymptomatically.

Some people have strong immunity, so they themselves may not get sick, but be a carrier of the bacteria. Most susceptible to infection Small child, and in infants up to a year of patients, very severe forms of the disease may develop. Basically, it has to do with immaturity. immune system.

If someone in the family has been ill with salmonellosis, it is important not to share hygiene items or utensils with them. For a long time, the patient can excrete bacteria, although he himself is no longer sick and the tests are negative. Reasonable quarantine will keep the rest of the family healthy.

Disease classification

Salmonellosis in adults and children is classified into several forms of the course:

• gastrointestinal;
• typhoid;
• septic;
• erased;
• subclinical.

In the gastrointestinal stage of salmonellosis, the patient's problems arise from the digestive system. The main symptoms are concentrated in this area, and the first signs resemble a picture of food poisoning.

The pathogenesis of a typhoid-like form of salmonellosis includes an increase in the liver, a rash over the body as with, the periodic occurrence of fever.

Most of all complications at a septic salmonellosis. This type of disease occurs in people suffering from diseases of the immune system, with HIV and after severe infections. Immunity in such people is unable to recognize the bacterium as a foreign organism, so infection occurs quickly, and the infection actively multiplies. In the septic form, purulent inflammatory foci can form throughout the body.

Important! There is a high risk of developing complications in the brain if the infection penetrates through this membrane.

With an erased picture of salmonellosis, the patient does not show any symptoms except for loosening of the stool, which makes it difficult to make a diagnosis and makes it impossible to start treating the disease in a timely manner.

The subclinical form is otherwise called carriage. The person does not experience any symptoms, sometimes even clinical analysis unable to detect the presence of salmonella in the body.

Who is at risk

Given the etiology of salmonellosis, it is possible to distinguish groups of people who are more susceptible to infection than others:

• children under 5 years old;
• people whose activities require close contact with animals: veterinarians, farm workers and poultry factories;
• those who have had their stomach removed;
• travelers;
• people who do not follow the rules of hygiene;
• elderly;
• immunocompromised patients;
• people with cancer;
• lovers of raw foods, especially eggs.

However, even if you are at risk, simple preventive measures can significantly reduce the risk of Salmonella infection.

Symptoms of salmonellosis

To quickly provide first aid, it is important to be able to identify the signs of the disease immediately after they occur. All symptoms can be divided into general and specific, which are characteristic only when a certain area of ​​the gastrointestinal tract is affected.

Common symptoms of salmonellosis are:

• nausea and vomiting;
• abdominal pain;
• bloating;
• rumbling;
• subfebrile temperature about 37 degrees;
• possible development of pancreatitis;
• heart rate changes;
• arterial pressure decreases.

In order for the diagnosis to be accurate, it is important to classify the complaints.

Symptoms of a stomach ache

If salmonellosis has affected the stomach, the following features of the disease will appear:

• weakness and dizziness;
• a slight increase in temperature;
• pain in the projection of the stomach - at the top of the abdomen in the center;
• repeated vomiting.

With lesions of the stomach, stool disorders do not occur.

Symptoms of damage to the small intestine

The signs are:

• frequent vomiting;
• a sharp jump in temperature;
• liquid stool greenish color with lumps;
• bloating and rumbling;
• painful palpation of the intestine.

The pain syndrome can persist up to 10 days. All this is accompanied by weakness and dizziness.

Symptoms of intestinal involvement

The following signs of salmonellosis join:

• high temperature;
• feces contain blood and mucus;
• defecation is painful;
• false positives are possible.

Treatment folk remedies impossible. Need medical diagnosis and the use of medications.

Symptoms of typhoid-like salmonellosis

Symptoms of the disease resemble typhoid fever:

Against the background of salmonellosis, exacerbation of obstructive pulmonary and bronchial diseases is possible.

Symptoms of septic salmonellosis

The type of disease is considered the most dangerous, as it can have serious consequences. Has the following symptoms:

• rapid onset of the disease;
• temperature increase and its jumps;
• chills;
• headache;
• muscle pain;
• hallucinogenic phenomena;
• discoloration of the skin up to greenish-yellow tones;
• multiple rash;
• inflammatory processes in different organs.

Septic-type salmonellosis can affect the health of the lungs, pleura, bronchi, eyes, skin, heart, bones, kidneys, and other organs. Only health can be protected timely treatment.

Possible Complications

Treatment at home without consulting a doctor can lead to the spread of infection throughout the body and the development of such complications:

Some of the diseases can occur in a purulent form. Only timely treatment protects against serious complications.

Diagnostics

First, the doctor will examine the patient and find out what symptoms of the disease have manifested. The doctor can feel the abdomen, examine the skin, measure the temperature and blood pressure. After that, the specialist will decide which laboratory methods diagnostics are necessary to clarify the disease and its causative agent. These studies may include:

• coprogram;
• sowing on salmonellosis;
• antibiogram;
• serological examination.

Most often, in order to issue a prescription for treatment, it is enough for the doctor to familiarize himself with the results of bacteriological culture. Blood, urine, bile and even vomit can be taken for research.

Treatment

Treatment of salmonellosis with drugs is carried out only as prescribed by a doctor. It is extremely important for adults and children not only to use the prescribed funds, but also to follow a diet.

With salmonellosis, the following drugs can be prescribed:

• in severe cases, antibiotics;
• antimicrobial medicines;
• sorbents;
• saline solutions;
• beneficial bacteria.

In no case should you choose a drug for yourself with salmonellosis, especially an antibiotic.

Note! Often doctors prescribe the drug "", because it active substance is active against salmonella.

Nutrition for salmonellosis should be balanced. The diet should contain:

• cottage cheese;
• boiled meat and fish;
• cutlets or meatballs.

The photo of a suitable diet shows that it is better to exclude everything fatty and rich in carbohydrates from the menu. It is not advisable to consume whole milk.

TO folk ways treatments can include:

• home gastric lavage (which is prohibited for the elderly and children);
• application saline solutions and infusions of chamomile and calendula;
• use of plantain infusion.

Traditional medicine for the treatment of salmonellosis is contraindicated during pregnancy. This can harm not only the fetus, but also the woman.

Prevention

You can protect yourself by doing the following:

• thorough hand washing;
• high-quality processing of vegetables and fruits before serving;
• Sufficient frying or boiling of meat and fish.

Following these simple steps will help protect against salmonellosis.

When the first negative symptoms appear, it is important to consult a doctor. The specialist will tell you what drugs to take and how best to eat in order to get rid of salmonellosis as soon as possible. If acute symptoms appear, you should call an ambulance.

Watch the video:

Salmonellosis is an acute infectious disease caused by bacteria of the genus Salmonella, with a fecal-oral transmission mechanism, occurring with a predominant lesion of the gastrointestinal tract. The nature of the course of the disease differs in each case, from asymptomatic lesions to severe forms with toxic and dehydration shock. Pathogenic pathogens enter the body, most often, after eating contaminated food, due to improper culinary processing of food.

Salmonellosis has its own disease code according to the ICD 2010 (International Classification of Diseases of 2010) - A02.

Prevalence and poor outcome

The source of infection are animals and humans (patients and carriers). The main role in the spread of salmonellosis belongs to animals in which the infection can be asymptomatic (bacteriocarrier), or with pronounced manifestations. For humans, domestic animals, as well as livestock intended for slaughter, cattle, and pigs pose the greatest danger. With the development of epidemic forms, the infection rate among poultry can reach more than 50%, pigs - 2.8-20%, sheep and goats - 1.8-4.4%.

It should be noted that not only sick animals with bright symptoms of salmonellosis are dangerous for people, but also outwardly healthy carriers without a pronounced clinic of symptoms. As soon as the body is exposed to stress or hypothermia, weakens and can no longer restrain the development of salmonella, active inflammation begins in the intestines with a generalization of the process by blood flow throughout the body, where salmonella invades various organs and tissues.

Salmonellosis is one of the most common intestinal infections. Over the past 10 years, there has been an upward trend in the incidence of various groups of patients. Often, intestinal infections are considered diseases that are more typical for disadvantaged areas, for disadvantaged and polluted areas. settlements. This does not apply to salmonellosis, since it is equally common in large comfortable cities and in less civilized areas, that is, wherever there are animals or food of animal origin.

An increase in the prevalence of the disease is facilitated by the intensification of animal husbandry, when the cultivation, slaughter and sale of poultry and cattle increases every year. An important role for the development of the disease is played by active migration processes, urbanization, globalization and the resulting increase in the volume of movement of food products across the borders of states.

Salmonellosis is dangerous because it quickly acquires the character of an epidemic, it is recorded as sporadic cases and epidemic outbreaks, and it is usually quite difficult to decipher their origin.

Cases of the disease associated with oral infection in the body from poultry meat, eggs, as well as from products and dishes prepared from them are especially often recorded. If the infection enters the poultry farm, most of the livestock is infected already on the first day due to the ability of the pathogen to transovarial transmission. Adults are more likely to be infected through food, children early age sensitive to the domestic route of infection.

The epidemiological danger of outbreaks increases in warm seasons: the end of spring and summer are considered the most suitable time for the active spread of the pathogen.

In addition, salmonellosis can be nosocomial, that is, spread among patients in medical institutions. The spread of infection in hospitals is facilitated by overcrowding of wards, unreasonable movement of patients from ward to ward, lack of necessary auxiliary facilities, reuse of disposable instruments, and poor-quality bedding. In infectious diseases hospitals, contact-household transmission of antibiotic-resistant strains of S. typhimurium or S. haifa occurs. Due to the fact that these pathogens exist in hospitals, they develop resistance to disinfectants and antibiotics. In general, outbreaks of nosocomial salmonellosis are typical for children's hospitals.

A child can become infected with salmonellosis from a sick mother in utero, during childbirth, and also through breast milk.

Salmonellosis is a dangerous infectious disease from which you can die. The overall mortality rate from salmonellosis is 1-3%. Children get sick with it somewhat more often and endure more severely, therefore, among babies under the age of 2-3 years, the percentage of deaths reaches 3-5%. In addition, at acute form disease, death occurs in 1-2% of patients, while up to 20% of those infected die from an asymptomatic course.

Classification by type of salmonellosis

Depending on the degree and direction of the lesion in the body, on the external manifestations of the disease, all forms and types of the course are displayed in the following classification:

• localized (gastrointestinal): takes place in the gastritis, gastroenteritis or gastroenterocolitis variant;
• generalized in a typhoid-like or septic variant;
• carriage (bacterioexcretion): it can be acute, chronic or transient.

Gastrointestinal (localized) form

It is considered a relatively mild type of disease, in which the pathogen practically does not go beyond the intestines. It occurs in the form of acute gastritis, acute gastroenteritis or gastroenterocolitis. Accompanied by spastic pain in the abdomen, nausea and profuse loose stools. In some patients, only fever and signs of general intoxication are noted at first, and changes in the gastrointestinal tract join somewhat later. They are most pronounced by the end of the first and on the second and third days from the onset of the disease. The incubation period does not exceed 72 hours, and in children and people with a weak body, the disease manifests itself 2-4 hours after the ingestion of salmonella with food. The severity and duration of the manifestations of the disease depend on the severity.

gastritis variant

It is less common than the other two options. It is characterized by an abrupt onset with recurrent vomiting and severe pain in the epigastric region. Intoxication symptoms are mild, no, the course of the disease is short-term - up to 3-4 days. The prognosis is favorable - after the start of taking the medication, the pathogen quickly dies, without having time to cause serious harm to the body.

If the process goes into a generalized course, the patient develops a typhoid-like form, similar in clinical picture to a typhoid-paratyphoid lesion, or a septic form.

Gastroenterocolitic variant

It develops acutely, already a couple of hours after infection with the pathogen, signs of the disease appear. The patient has characteristic symptoms intoxication, dehydration, can reach 40-40.5 degrees. Then spastic pains appear in the epigastric and umbilical zone of the abdomen, nausea and repeated vomiting. After each vomiting, there is no relief, the person continues to feel sick. Diarrhea joins after one and a half to two hours, initially the bowel movements look like characteristic feces, and then they become watery, frothy and acquire a greenish tint. After 2-3 days, the volume of bowel movements decreases, mucus appears in them, sometimes streaks of blood. The large intestine is painful and spasmodic on palpation. In the process of defecation, tenesmus appears - sharp cutting pains in the rectum, not dependent on fecal excretion. Symptoms are similar to acute dysentery.

Gastroenteric variant

The most common form, which also begins acutely, 2-3 hours after the pathogen enters. Against the background of a violation of the water-electrolyte balance, the patient develops a temperature, nausea and vomiting, cramps and pain in the abdomen, intense diarrhea with a liquid greenish frothy stool appear. The severity of the lesion is determined not by the frequency of acts of defecation and vomiting, but by the loss of fluid in this case. Tenesmus during defecation is absent.

The skin of the patient has a pale color, in difficult cases, cyanosis is noticeable. The tongue is dry, covered with a whitish or yellow coating. The intestine is swollen, palpation responds with soreness and rumbling. On auscultation of the heart, tachycardia is noticeable, a decrease in blood pressure. Urine output is markedly reduced. In severe cases, clonic convulsions appear.

Generalized form

This form of flow is characterized by the release of the pathogen from the intestine. There is a generalization of the lesion. With the blood stream, salmonella are carried throughout the body and are introduced into various organs and tissues. Infection becomes extensive, which is why such a course is considered severe. It proceeds in a septic and typhoid form.

septic form

The most severe variant of the generalized form of salmonellosis. The disease begins acutely, in the first days it has a typhoid-like course. In the future, the condition of patients worsens. Body temperature becomes abnormal - with large daily swings, repeated chills and profuse sweating. The patient is tormented by chills, and during periods when the fever recedes, he feels increased sweating, tachycardia, myalgia. Further, hepatosplenomegaly is formed - a syndrome of pronounced enlargement of the liver and spleen at the same time.

The duration of the course of the disease is long, torpid, the general condition is characterized by malaise, disability.

In some internal organs and tissues begin to form secondary foci of inflammation, as a result of which the clinical manifestations of this variant of salmonellosis are very diverse, and its diagnosis is difficult. The formed purulent focus in the symptomatology comes to the fore. Purulent foci often develop in the musculoskeletal system: osteomyelitis, arthritis. Septic endocarditis, aortitis with subsequent development of aortic aneurysm are sometimes observed. Relatively often there are cholecysto-cholangitis, tonsillitis, cervical purulent lymphadenitis, meningitis (the latter is usually in children). Less often, purulent foci of other localizations are observed, for example, liver abscess, infection of the ovarian cyst, salmonella strumitis, mastoiditis, abscess of the gluteal region.

typhoid

The disease often begins acutely. In some patients, the first symptoms of the disease may be signs of gastroenteritis. Further, nausea, vomiting and diarrhea gradually stop, while the body temperature rises, constantly or in waves. In most patients, the onset and course of the disease is similar to typhoid fever and paratyphoid fever A and B. Symptoms of intoxication are growing - severe, insomnia, a general feeling of weakness. Duration of fever 1-3 weeks.

By the end of the first week from the onset of the disease, the patient has a simultaneous increase in the liver and spleen (hepatolienal syndrome). Arterial pressure is low, there is a noticeable bradycardia. Due to the fact that the pattern of the course resembles typhoid fever in its signs, there is some difficulty in differential diagnosis. Without testing for a specific pathogen, it is quite difficult to make a correct diagnosis.

Bacteriocarrier

After suffering salmonellosis, especially after manifest forms, some of the convalescents become bacterial carriers. With this form, there are no clinical symptoms, and it is detected by bacteriological and serological studies. Salmonella carriers are divided into the following categories: acute bacteria carrier, chronic carrier, transient carrier.

Acute carriage is characterized by the release of Salmonella lasting from 15 days to 3 months. If salmonella is excreted 3 or more months after recovery, we are talking about chronic carriage. Carriage is called transient, in which the sowing of Salmonella from the secretions occurs once or twice, while the clinical manifestations of the disease are not detected, and the formation of significant antibody titers is not observed.

The diagnosis of “carriage of Salmonella” is relevant only if any symptoms of the disease have completely disappeared. The period of carriage is counted from the date of disappearance clinical manifestations, or from the date of the first detection of salmonella during the examination.

Transient carriage is the most unstable condition, since the pathogen can be isolated periodically in acute and chronic bacterial carriage, as well as in the asymptomatic form of salmonellosis, which the specialist needs to differentiate from each other.

Etiology of the disease

The disease is caused by various serotypes of bacteria of the genus Salmonella. The sources of infection are mainly domestic animals and birds, but a person (patient, carrier) also plays a certain role as an additional source. The transmission mechanism is fecal-oral. Ways of transmission: through food products obtained from infected livestock and poultry, as well as contact-household, less often water (Salmonella may be present in, for example, in open water bodies and water supply), air-dust is possible.

Infection of people occurs when caring for animals, in the process of slaughter at meat processing plants, as well as when eating meat infected in vivo or posthumously. Also, dairy products are a source of infection.

Approximately 10% of cats and dogs have salmonellosis. In synanthropic rodents, this figure is higher - up to 40%. Among wild street birds (starlings, pigeons, sparrows, gulls), the disease is widespread. Polluting environmental objects with their droppings, birds thus contribute to the spread of the pathogen.

Over the past 30 years, scientists have observed an increase in the number of outbreaks of salmonellosis in poultry, primarily in.

A person is a source of some types of pathogen - S. typhimurium and S. haifa, especially in a hospital setting. Contagious infection is most dangerous for children under the age of one, who are especially susceptible to salmonella. The duration of the period of contagiousness in a patient directly determines the nature of the course and the duration of the disease. In animals, it can last for months, and in humans - from 2-3 days to 3 weeks. Convalescent, that is, hidden carriage, sometimes lasts for years.

The most dangerous in terms of salmonellosis are considered. The disease is observed with improper cooking, when infected products, mainly meat ( chopped meat, products from it, jelly, meat salads, boiled sausages), were in conditions favorable for the reproduction of Salmonella.

The water way of infection is typical for the defeat of animals by the pathogen in special livestock complexes and farms, poultry farms. In hospitals, especially in children's medical institutions and maternity hospitals, the contact-household method of spreading the disease prevails.

In urban conditions, there is an air-dust distribution path, in which wild birds play the main role, polluting habitats and feeding with their droppings.

Regardless of the state of the body, age and gender, the natural level of human susceptibility to salmonella is very high, that is, the lesion will develop in almost 98% of cases of contact with the pathogen. With regard to the duration and severity of the course, it may differ in people with strong immunity, adults and healthy people, or in small children, premature babies, the elderly. Immunity is type-specific, short-lived (5-6 months).

Symptoms of the disease

Noticeable external manifestations of salmonellosis determine its type of course, and differentiate the disease from others. infectious lesions. The most common variant is gastroenteric, which is accompanied by dehydration, general intoxication, and fever. Signs of intoxication develop progressively, reaching headaches and muscle aches, weakness and disability.

In addition, salmonellosis manifests itself as pain in the umbilical region and upper abdomen, along the large intestine. The pains are spasmodic, undulating, from mild to very intense attacks. Worried about nausea and repeated vomiting, which does not bring relief.

Diarrhea is a characteristic sign of salmonellosis, and attracts attention appearance stools (watery, fetid, frothy, with a greenish color), as well as their number. Against the background of vomiting and diarrhea, dehydration syndrome develops.

On examination, the pallor of the skin is noteworthy. The tongue is heavily coated. Auscultation of the heart revealed tachycardia, the pulse was softly filled. Severe dehydration is accompanied by cramps in lower limbs.

The gastroenterocolitic type of salmonellosis is accompanied by a decrease in the volume of feces by 2-3 days from the onset of the disease. Mucus appears in the feces, blood impurities. The intestine is spasmodic, responds to palpation with pain, tenesmus is present. The gastritis form passes without tenesmus and diarrhea. The temperature ranges from subfebrile to high values.

Symptoms of the generalized form have characteristic differences. For example, a typhoid-like course is very similar to the typhoid fever clinic, when, along with nausea, vomiting and diarrhea, a wave-like or stable fever appears. In this case, there is a noticeable increase in the spleen and liver, a hemorrhagic rash appears on the skin. Blood pressure is low, bradycardia is present.

With a septic course, in addition to the typical gastrointestinal clinic, the patient has a prolonged relapsing fever, chills, tachycardia, severe sweating, enlargement of the spleen and liver. There may be noticeable inflammation of the iris, which determines electrolyte disturbances in the body.

The course of the disease

stages

The onset of the disease is clinically counted from the moment the first symptoms appear, however, in reality, the disease begins from the incubation period, when it still does not manifest itself. Further, after the appearance of the first clinical symptoms, the stage begins active development infectious process. After the concentration of the pathogen in the body begins to decrease, and the acute symptoms gradually subside, we can talk about the beginning of the patient's recovery, but this statement is not true for all forms of salmonellosis.

Incubation period

In children, the course and duration of the incubation period depend on the endurance of the organism. Usually this stage lasts from several hours in case of food infection, up to 3-4 days if the pathogen enters the body by contact-household way. The higher the concentration of infection and microbiological toxins enters the body, the shorter the incubation period of the pathogen, and the more severe the course of the disease is expected.

In adults, the incubation period also lasts from several hours to several days. In general, this category of patients is less susceptible to contact-household infection.

Development period

The age of the child and the state of the immune system determine the severity of the development of salmonellosis. In addition, the course of the disease is influenced by the route of infection, the number and type of Salmonella that have entered the children's body. The main impact of microorganisms falls on gastrointestinal tract, where microbes enter by breaking the barrier in the stomach (hydrochloric acid).

In infants, development is gradual: at first, the baby becomes lethargic and capricious, his appetite disappears, and the temperature rises. Next comes vomiting and loose stools. At first, the discharge has a normal color, defecation occurs 5-6 times a day. Further, the condition worsens, the increase in body temperature reaches more than 38 degrees. The child has frequent diarrhea (more than 10 times a day), while the stools are greenish in color and have a frothy texture. By the 7th day of the course, mucus and streaks of blood appear in them. If during diarrhea there is no replenishment of lost fluid reserves, dehydration begins in the baby, which is noticeable by the dryness of the mucous membranes of the mouth, dryness of the tongue, sinking of the fontanel, the appearance of severe thirst, and reduced urine output.

In newborns, the general symptoms of salmonellosis, most often, prevail over the gastrointestinal picture. The temperature may remain normal, but the child refuses to eat, stops gaining weight. He shows anxiety, suffers from frequent regurgitation, the skin looks pale. The abdomen is swollen.

In children with a weakened body, for example, bottle-fed, premature babies, babies with congenital pathologies, the disease quickly takes on a generalized course like sepsis, leading to damage to various internal organs:

• meninges;
• liver;
• kidneys;
• lungs.

The course is very severe, with high fever and enlargement of the liver and spleen.

The disease overtakes older children suddenly - the process begins with a high temperature (more than 38 degrees), then appears headache with dizziness, severe and repeated vomiting, loss of appetite and weakness. Abdominal pains and diarrhoea, with thin, offensive, greenish stools, are next. If you do not start treatment during this period, there is a generalization of the process, with the involvement of the large intestine, with the appearance of mucus and blood in the stool. Pain in the abdomen at the same time acquire a cramping character. The process is accompanied by severe dehydration, toxic shock and renal failure may occur.

Older children usually recover after 1-3 weeks, small children, especially newborns, get sick for longer - up to several months. Accordingly, the recovery process lasts longer for them, and a few months after recovery, salmonella still continues to be excreted in urine and feces.

Digestive disorders in children persist for up to 3 months due to pancreatic insufficiency. In children with an unfavorable allergic background, manifestations may increase food allergies. Symptoms may be mild or accompanied by stool instability, bloating, and abdominal pain, especially associated with dairy foods.

The development of the disease in adults can take place in several ways, the intensity of which depends on general condition organism, and the concentration of the pathogen in it. Initially, salmonellosis is manifested by intoxication, headache, fever, aches and chills. The next stage of reproduction of microbes is accompanied by the appearance of nausea and repeated vomiting, pain in the abdomen. Frequent diarrhea leads to dehydration, the discharge quickly turns into a greenish watery foam with bad smell. This course is characteristic of the gastrointestinal form of the disease. The described symptoms last up to a week, after which there is an improvement in well-being.

If salmonellosis becomes generalized, the patient develops weakness, possibly a wave-like increase in temperature, insomnia, headache, pale skin, muffled heart tones. Relapsing-remitting fever, chills, tachycardia and increased sweating signal the transition of the disease to a typhoid-like form. The duration of this stage is usually at least several weeks. The disease is severe, complications may occur.

flow shapes

Chronic

The chronic course of the disease is possible if a person has a certain concentration of the pathogen in the body, but there are no obvious external expressions of the lesion. The chronic form is also called bacteriocarrier. On average, the period of isolation of bacteria in a person who has had salmonellosis lasts about 3 months, sometimes longer. Transient chronic carriage in a patient is observed if the pathogen is sown from the feces once or twice, after which further test results are negative. At the same time, the subject does not have serological, clinical and colonoscopic signs of damage.

Chronic transient carriage occurs as a result of the ingestion of a very small number of weakly virulent pathogens. In this case, only with an in-depth specific examination, most transient carriers show signs of infectious, subclinical salmonellosis.

At the same time, an infectious disease is the result of the interaction of the host organism with the pathogen in specific environmental conditions. If the response of the carrier's body is absent, then doctors have no reason to talk about an infectious process or disease.

Most often, salmonellosis occurs in the form acute illness, with corresponding clear and sharp manifestations. Duration pathological process, taking into account properly selected treatment, normally does not exceed 1.5 months. However, recently, especially in industrialized regions, doctors have noted an increase in the number of cases of salmonellosis with a protracted course of up to 3 months. The question of whether such a long course of the disease can be considered chronic cannot be decided unambiguously, since in each case the degree of manifestation of the symptoms of the lesion is different.

The increase in the duration of the disease is associated with a sharp decrease in the resistance of the human body, changes in its immunological processes, as well as with a decrease in adaptive abilities under the influence of harmful external factors in particular environmental pollution.

Thus, carriage is considered acute, in which the release of the pathogen lasts from 2 weeks to 3 months. Chronic form salmonellosis lasts from 3 months or longer.

Acute

The classic form of salmonellosis is precisely the acute course with characteristic features and symptoms that constantly, clearly and intensely disturb the patient.

Depending on whether the infection extends beyond the intestines or not, acute salmonellosis occurs as a localized or generalized process. With a localized form of salmonellosis, the patient has all the signs of acute intestinal damage:

• intoxication;
• fever and chills;
• weakness;
• headache;
• nausea and vomiting;
• diarrhea;
• stomach ache.

When expressed electrolyte disturbances, with dehydration, there may be a violation of the heart rhythm, cramps in the limbs.

In the event that the disease acquires a generalized form, after some time, symptoms are added to the listed signs that characterize the damage to one or another organ or organ system (cardiovascular, lungs, kidneys, enlarged liver and spleen, disorders of the central nervous system).

Usually, the acute period of salmonellosis passes in 5-10 days, and recovery after it takes up to a month.

Asymptomatic

Asymptomatic salmonellosis is a prolonged bacteriocarrier, in which a person does not have clinical manifestations of salmonellosis, but the causative agent of infection is stably present in his feces. At the same time, a person feels healthy, however, at the same time, he poses an epidemiological danger to others.

Severity

Gastrointestinal and generalized forms of salmonellosis occur in patients in the form of mild, moderate or severe severity. The severity is differentiated by two main factors. First of all, we are talking about the intensity of symptoms: the severity of nausea, the frequency of vomiting, temperature indicators, the presence or absence of pain, seizures. More significant is the determination of the severity by the magnitude of water and electrolyte losses, by the degree of dehydration. From this point of view, for example, the frequency of diarrhea or vomiting is not as important as it is important to pay attention to the volume of fluid that the patient loses. Similarly, according to this indicator, mild, moderate and severe degrees of the disease are also distinguished.

Easy

The most common form of salmonellosis is gastrointestinal. In about 45% of those infected, it proceeds mildly, begins acutely, there is a low-grade fever, general weakness, single vomiting, loose watery stools up to 5 times a day. In total, diarrhea lasts 1 to 3 days. The loss of fluid in this case is no more than 3% of the total body weight.

Generalized salmonellosis, as a rule, does not proceed in a mild form.

Medium

Most often occurs among all patients. The patient's temperature rises, the values ​​\u200b\u200breach up to 39 degrees. The fever lasts 3-4 days, with recurrent vomiting present. Diarrhea lasts up to a week, no more than 10 bowel movements are observed daily. Tachycardia is expressed, arterial pressure decreases. There is a loss of fluid volume of about 6% of body weight. There is a possibility of complications and the transition of the disease to a typhoid-like or septic form.

heavy

There is an increase in temperature above 39 degrees, the patient's fever lasts from 5 days. At the same time, symptoms of intoxication are pronounced. Vomiting is repeated and does not go away from 2-3 days or more. Stool more than 10 times a day, profuse, watery and frothy. The stools may contain mucus and blood. In total, diarrhea lasts a week or longer. The liver and spleen are enlarged, icterus of the sclera and skin is noticeable. In addition, there is cyanosis of the skin, a decrease in blood pressure and tachycardia.

Changes in the work of the kidneys are noticeable: oliguria, erythrocytes and cylinders in the urine, albuminuria, increased content of residual nitrogen. Against this background, acute renal failure may develop. Dehydration of 2-3 degrees is expressed in dry skin, aphonia, cyanosis, convulsions in the lower extremities. There is a loss of fluid in the amount of 7-10% of body weight. Blood test shows blood clotting in the form advanced level hemoglobin, hematocrit and erythrocytes, a moderate shift to the left of the leukocyte formula.

Diagnosis

The main difficulty for the attending physician in the presence of suspected salmonellosis is to make a differential diagnosis with other diseases accompanied by diarrheal syndrome: shigellosis, cholera, escherichiosis, food and chemical poisoning. In some cases, it becomes necessary to differentiate salmonellosis from myocardial infarction, acute cholecystitis, acute appendicitis thrombosis of mesenteric vessels.

For a correct diagnosis, it is necessary to collect anamnesis of the disease and an epidemiological anamnesis and as accurately as possible to establish all the symptoms, the frequency and intensity of their manifestation. Salmonellosis localized in the intestine from the first hours of the disease is accompanied by intoxication, after some time, dyspeptic phenomena are added in the form of nausea, vomiting, and spastic pains in the abdomen. Then there is diarrhea with liquid and frothy, foul-smelling stools of a greenish color. From 2-3 days, tenesmus may appear during defecation, mucus appears in the stool, sometimes blood impurities.

If the typhoid-like and septic form of salmonellosis begin with such manifestations, they are easier to detect, otherwise it is necessary to carry out differential diagnostics in order to discard the variant of typhoid fever and purulent sepsis.

It is possible to reliably establish the diagnosis of “salmonellosis” only by identifying the pathogen in the feces of the affected person. In generalized forms, salmonella is present in blood cultures. In addition, microorganisms can be found in the washings of the intestines and stomach.

Types of analyzes

A patient who is suspected of having salmonellosis needs to take three main types of tests:

• blood test (serological examination);
• bakposev, or bacteriological examination;
• coprogram.

A serological study is a blood test taken from a patient's vein. Antibodies to salmonella in human blood can be detected as early as 5-7 days after infection. The development and course of the disease can be seen by changes in antibody titers. In addition, based on the results of the analysis, the doctor determines the optimal treatment regimens.

The main serological methods by which blood tests are done for salmonellosis:

• RNHA (analysis with complex and group salmonella erythrocyte diagnosticums, when setting up a reaction in paired sera. Interval - 6-7 days);
• RKA (coagglutination reaction);
• RLA (latex agglutination reaction);
• ELISA (enzymatic immunoassay).

According to the indicators of hematocrit, blood viscosity, acid-base state and electrolyte composition, a conclusion is made about the degree of dehydration of the body, and the rehydration therapy is corrected as necessary.

How to prepare for donating blood for salmonella? A blood test is taken in the morning, on an empty stomach. The day before, the patient needs to give up physical activity and emotional upheaval. A serological test is prescribed 7-10 days after the onset of the disease, since in the first days antibodies to the pathogen have not yet formed in the blood. In terms of time, the preparation of results takes 1-2 days.

The express method for studying blood involves enzyme immunoassay, which takes less time.

In addition, a general blood test is prescribed to determine the degree of the inflammatory process.

A blood test should be taken in such cases:

• bakposev gave negative results;
• the person has been in contact with an infected person;
• in the second week from the onset of the disease, if the symptoms do not subside.

Bacteriological examination, or bakposev, provides more accurate data than serological analysis. The materials for the study are all the patient's biological fluids (feces, urine, bile, blood, pus, vomit, washings of the stomach and intestines). The collected elements are placed in a selenite or magnesium nutrient medium, which is favorable for the reproduction of Salmonella. Next, the container is sent to a special box with a temperature of 37 degrees Celsius, that is, to conditions that promote the growth and reproduction of bacteria, if it was originally in the collected material. The results of the analysis are usually prepared within 3-5 days - this is how long, on average, it takes for microorganisms to reach a specific concentration. It is also possible to use several differential diagnostic media (Ploskireva, Endo, bismuth-sulfite agar).

The standard of bakposev for salmonellosis is the isolation of a culture of pathogenic bacteria using selective enrichment media, and differential diagnostic media, followed by biochemical identification, the establishment of a serovar isolate in agglutination reactions.

As such, the analysis does not require preparation; it is taken from those admitted to the hospital with the corresponding symptoms immediately after hospitalization.

A coprogram is a general analysis of feces that shows pathogenic changes in the structure of feces, for example, the presence of undigested, blood, leukocytes, and an increased number of fibers.

A few days before the delivery, it is recommended to exclude flour products and sweets from the diet, stop taking iron-containing and laxative preparations. The material is collected fresh, in the morning after waking up and the first toilet. Preparation of the coprogram takes 2-3 days.

Testing for salmonellosis is mandatory for women who plan to become a mother. During pregnancy, the doctor leading the woman may also prescribe tests, even if visually obvious signs she has no illness. In pregnant women, feces, blood from a vein, and a swab from the anus are taken for analysis.

For children, it is important not only to pass an analysis for salmonellosis in the presence of appropriate symptoms, but also preventive examinations. If salmonellosis is suspected in a child, it is important to conduct a comprehensive diagnosis in a timely manner for a quick diagnosis. Children are assigned:

• serological examination (7-10 days after the onset of infection);
• stool culture;
• smear from the anus;
• express diagnostics (immunofluorescent method).

Ways to treat the disease

Treatment of the disease at home is possible only if the patient has mild form salmonellosis. Children, pregnant women, people with a weakened immune system, in the presence of a moderate or severe form of the disease, must be hospitalized for observation in a hospital.

The patient is shown bed rest, especially with severe manifestations of dehydration and intoxication. If the patient's condition allows, treatment begins with washing the stomach and intestines, siphon enemas, taking enterosorbents, for example, Enterosgel, Atoxil, activated charcoal.

The presence of dehydration of the 1st or 2nd degree in a patient requires the appointment of glucose-salt solutions - Regidron, Citroglucosolan, Oralit, by infusion method of administration. Droppers with solutions must be placed already before the start of the main treatment. Lost water reserves also need to be replenished with frequent fractional drinking in volumes up to 1 liter per hour in the first 2-3 hours, and then monitoring the fluid level and consuming 1-1.5 liters of fluid every 3-4 hours.

With dehydration of 3-4 degrees, isotonic polyionic solutions are administered intravenously by stream until the manifestations of dehydration shock are eliminated. Next, the patient is prescribed droppers.

At the discretion of the doctor, an additional correction of the content of potassium ions is carried out, intravenous solutions of potassium chloride or potassium citrate are administered, 1 g per day, 3-4 times.

After correcting the water and electrolyte balance in the body, macromolecular colloid preparations such as Hemodez or Reopoliglyukin can be prescribed to relieve the manifestations of intoxication. With severe metabolic acidosis, a 4% sodium bicarbonate solution is additionally administered intravenously.

In the gastrointestinal form of the course, indomethacin is prescribed to relieve the symptoms of intoxication, mainly for early dates lesions, 50 mg three times within 12 hours.

The appointment of antibiotics and etiotropic drugs is relevant for a generalized type of course. Fluoroquinolines (0.5 g twice a day), Levomycetin (0.5 g 4-5 times a day), Doxycycline (0.1 g daily) are used.

To normalize the digestive processes, enzyme preparations are used - Creon, Festal, Pancreatin.

It is important to adhere to the rules according to Pevzner for the entire duration of the treatment, and to comply after you manage to get rid of diarrhea, up to the complete recovery of the patient.

Infection prevention

Prevention of salmonellosis, first of all, is carried out at the national level, since this disease is highly contagious and can quickly develop into an epidemic. Veterinary and sanitary-epidemiological control, which is carried out jointly by the relevant services, is of leading importance. Supervisory authorities in the veterinary field constantly monitor and record the incidence among animals, livestock, poultry, and also supervise the quality and purity of feed and meat products. Sanitary and epidemiological authorities take into account and control cases of disease in people, monitor trends in the development and duration of the disease at a specific time in a specific area. In addition, the sanitary and epidemiological services are in charge of studying the serotype structure of the pathogen isolated from the affected, as well as found in food products.

Responsible government departments are developing methods for diagnosing and standardizing procedures for recording and reporting cases of the disease, as well as controlling the quality of food products entering the market, especially imported ones.

Salmonellosis is a contagious and rapidly spreading disease that can infect an entire livestock or poultry population in a few days. The disease is also rapidly transmitted from person to person. That is why the anti-epidemic preventive measures against the causative agent of salmonellosis are of such a detailed nature - in order to avoid the formation of an epidemic.

Concerning preventive measures among the population, there are no specific ways to protect yourself from the disease. Vaccines against salmonellosis have not been developed due to the instability of the immunity produced and the antigenic diversity of the pathogen.

Prevention is based on sanitary and veterinary measures that provide appropriate conditions for the slaughter of farm animals, storage, transportation and sale of products of animal origin, as well as cooking from them. For this purpose, deratization and disinfection measures are periodically carried out at livestock enterprises, farms and poultry farms, animals are vaccinated, feed and feed ingredients are taken for selective control.

It is also important to prevent salmonellosis in medical hospitals in order to protect the bulk of patients from infection with carriers. In this regard, disinfection measures are constantly carried out in infectious diseases hospitals, the fulfillment of all requirements for the disinfection of medical devices, utensils, and common areas is strictly monitored.

In preschool, medical and preventive institutions, as well as food industry enterprises and institutions Catering periodically held bacteriological research. In addition, all persons entering the listed establishments for the first time are required to undergo a bacteriological examination, including for salmonellosis, in order to prevent the possible spread of infection.

Can you protect yourself from salmonella? The main rules that every person must remember in order not to become infected with a pathogen and not get sick with salmonellosis are similar to the requirements for the prevention of others. infectious diseases- wash your hands more often, do not eat in unfamiliar and unreliable places, strengthen the immune system and temper the body.

In addition, when buying eggs, meat and poultry, dairy products, you need to pay special attention to where they are bought, whether sellers have documents with the results of testing products by a bacteriological laboratory. All animal products must be carefully handled to protect against possible contamination. It is unacceptable, for example, to eat raw meat or eggs, especially in the summer, when Salmonella activity is highest.

Why is salmonellosis dangerous?

by the most dangerous consequence salmonellosis is considered the occurrence of infectious-toxic shock, with the manifestation of brain symptoms, cardiovascular insufficiency, adrenal and renal insufficiency. In this case, death can occur very quickly.

When the brain swells, bradycardia, short-term hypertension, cyanosis and redness of the skin on the neck and face, and rapid muscle paresis appear. Then the growing one joins, a cerebral coma sets in.

If the patient has obvious anuria and oliguria, we can talk about the onset of acute renal failure against the background of severely low blood pressure. Further, the signs characteristic of uremia increase.

Acute cardiovascular failure is accompanied by the formation of collapse, a decrease in body temperature, the appearance of pale skin, cyanosis, and cooling of the extremities. Further, the pulse may disappear due to a sharp drop in blood pressure.

Other possible complications transferred disease:

• hypovolemic shock;
• numerous septic complications in the form of purulent inflammation of the joints, abscesses of the kidneys, liver, spleen;
• endocarditis;
• dehydration;
• urinary tract infections;
• brain abscess;
• peritonitis, pneumonia, appendicitis.

In general, the prognosis, subject to timely initiation of treatment, is favorable.

The disease does not cause the formation specific immunity, so getting sick again is absolutely real.

During pregnancy

Pregnant women may develop similar complications - dehydration, dryness, tachycardia, seizures, toxic infectious shock, hepatic, renal and adrenal insufficiency, as well as pathologies of cardio-vascular system. The liver, spleen may increase, pains appear in the joints and in the region of the heart.

The greatest danger of infection is for the unborn child, especially in the first and third trimester. At the beginning of pregnancy, in the first months of salmonellosis, like others infectious diseases, can cause irreversible developmental disorders, fetal death, miscarriage. A pronounced state of intoxication and high fever can lead to spontaneous abortion, since it is known that a body temperature of 37.7 and above in a future mother significantly increases the risk of miscarriage for up to 12 weeks.

In the second and third trimester, salmonella provokes the development of placental insufficiency and exfoliation of the placenta against the background of a strong general intoxication of the mother's body. The child does not receive enough nutrients and oxygen, which is why he develops developmental delays. Malnutrition of the fetus can also lead to premature birth.

Dehydration of the mother, which is accompanied by acute salmonellosis, negatively affects the unborn child, he does not receive the minerals necessary for growth. Constant vomiting and diarrhea lead to the depletion of available reserves useful substances, vitamins. Because of this, for up to 22 weeks, an abortion is possible, or the birth of a premature baby with a small weight.

FAQ

What is the death temperature of salmonella

Salmonella is a group of microorganisms that is quite resistant to external influences. It is especially important to know the temperature at which microorganisms begin to die in order to understand how to properly prepare and process food.

Salmonella is not afraid of low temperatures, for example, in a freezer or refrigerator, bacteria are able to remain viable for a long time, with no possibility of reproduction. As soon as the temperature becomes positive, microorganisms begin pathogenic activity. The optimum temperature for reproduction of salmonella is from 10 to 40 degrees, the growth of a colony is possible in the range from 7 to 48 degrees. Under conditions lower than 10 degrees, the breeding rate is significantly reduced.

The time during which Salmonella dies directly depends on the temperature value. So, at 55 degrees, the pathogen is killed in an hour and a half. At 60 degrees salmonella dies after 12 minutes. If the temperature reaches values ​​above 70 degrees, death occurs in 60 seconds. According to this principle, milk is pasteurized - the product is brought to a temperature of 63 degrees, and kept at this level for half an hour. During such a period of time, all pathogenic flora dies, except for the causative agents of botulism, while milk retains its beneficial properties.

Eggs that are boiled in boiling water for 3-4 minutes can only be considered safe if the infection has not penetrated into the shell.

With meat, the situation is more complicated, minced meat and frozen meat are especially dangerous in this regard. In a frozen piece of meat or poultry, the pathogen can persist for up to a year. In the depth of a piece of meat, salmonella can withstand heat treatment by boiling, as well as baking in an oven at temperatures above 120 degrees for several hours. For example, when boiling a piece of meat weighing 500 grams, the death of the pathogen occurs after 2.5-3 hours.

Salmonellosis is a highly contagious, contagious infectious disease that first attacks the human gastrointestinal tract, and if left untreated, is transferred to other systems, tissues, organs, causing their damage. Typical symptoms of salmonellosis (nausea, vomiting, fever weakness, tachycardia) may be similar to heart failure, appendicitis, food poisoning, dysentery or typhoid fever, so if you feel a strong deterioration in well-being and the symptoms described, it is better to immediately consult a doctor. If the disease takes a mild course, it is likely that it will be possible to do without hospitalization. However, if the patient has a moderate or severe course with high fever, severe symptoms and increasing intoxication, hospitalization is mandatory.

salmonellosis- This is an infectious disease of the digestive system resulting from infection with bacteria of the genus Salmonella, accompanied by severe intoxication and dehydration, sometimes proceeding like typhoid fever, or with septicemia. The most dangerous in terms of salmonellosis are thermally poorly processed eggs, dairy and meat products. The course of salmonellosis can occur according to the gastrointestinal or generalized variant, bacterial excretion is possible without clinical manifestations. The diagnosis of salmonellosis is made when salmonella is found in the feces and vomit of the patient.

General information

salmonellosis- This is an infectious disease of the digestive system resulting from infection with bacteria of the genus Salmonella, accompanied by severe intoxication and dehydration, sometimes proceeding like typhoid fever, or with septicemia.

Causes

Salmonella is a genus of gram-negative, motile, facultative anaerobic, rod-shaped microorganisms. Relatively stable in the environment. They can remain viable in water for up to 5 months, in soil for up to one and a half years, in meat for up to six months, in bird carcasses for up to a year or more. About 20 days are preserved in milk, a month in kefir and four in butter. Salmonella can remain alive in cheese for up to a year, 3-9 months in egg powder and 17-24 days on egg shells. Salmonella die after 5-10 minutes at a temperature of 70 ° C. They can withstand boiling for some time if they are in the thickness of a large piece of meat. When boiled, eggs die after 4 minutes. In milk and meat products, Salmonella not only persist, but also actively multiply, without affecting the organoleptic properties of the products. Microorganisms are quite resistant to salting and smoking, and when frozen, they increase the duration of their lifespan. At present, resident (in other words, hospital) strains of Salmonella have been isolated that have a high degree of resistance to antibiotic therapy and disinfectants.

The reservoir and source of salmonellosis is livestock, poultry, and some wild animals. In animals, the disease can occur both with clinical manifestations and asymptomatically. Healthy animals do not get sick with salmonellosis, individuals with a weakened immune system are prone to this. Salmonella enters the bloodstream of such animals and colonizes organs and tissues. A person becomes infected when caring for sick animals, slaughtering them, eating infected products of animal origin. Birds with salmonellosis can contaminate furnishings and food with droppings. In some cases (certain types of pathogen), a person can be the source of infection. Animals are contagious for several months, a person can transmit the infection from a few days to three weeks, sometimes the carrier state persists for years.

Salmonellosis is transmitted by the fecal-oral mechanism, mainly by food. The main role in the epidemiology of salmonellosis is played by meat and dairy products, bird eggs. The water way of infection is realized in case of Salmonella ingress into sources of drinking water for livestock in livestock farms. The contact-household route is often of great epidemiological significance in cases of nosocomial infections. In urban conditions, the implementation of the air-dust route of infection is possible.

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.

Classification

According to the clinical picture and the degree of spread, the infectious process is divided into gastrointestinal, generalized salmonellosis and bacterial excretion. The gastrointestinal form differs in localization into options: gastritis, gastroenteritis and gastroenterocolitis.

Generalized salmonellosis can occur in the form of two variants: typhoid-like and septic. Bacterial excretion can be acute, chronic and transitory.

Salmonellosis symptoms

The incubation period for salmonellosis can range from a few hours to two days. Clinical manifestations depend on the variant of the disease. The most common form is the gastroenteric variant of salmonellosis. It is characterized by general intoxication and impaired water-salt metabolism. The disease begins acutely, with an increase in temperature and an increase in signs of intoxication (headache, muscle aches, weakness). Then, spastic pain occurs in the abdomen with predominant localization in the upper abdomen and umbilical region, nausea and frequent vomiting. Diarrhea soon joins, the stool quickly becomes watery, frothy, fetid, sometimes their greenish tint is noted. Diarrhea and vomiting have different frequency depending on the severity of the course of the disease. The abundance of excreted fluid during vomiting and defecation leads to the development of dehydration.

Physical examination reveals pallor of the skin despite fever, sometimes cyanosis, dry and coated tongue, and bloating. On palpation in the abdomen, rumbling, moderate pain is noted. When listening to the heart tachycardia, the tones are muffled. Pulse of soft filling, tendency to arterial hypotension. Quite often note a moderate oliguria. With severe dehydration, seizures may develop, mainly of the lower extremities.

In the gastroenterocolitic variant, by the second or third day, the volume of bowel movements decreases, mucus and streaks of blood can be found in the feces. Palpation of the abdomen reveals soreness and spasm of the large intestine, defecation may be accompanied by tenesmus. The gastritis variant has the mildest and shortest duration, and is relatively rare. It is also characterized by an acute onset, less pronounced intoxication, and repeated vomiting. The pain is localized mainly in the epigastric region, diarrhea does not develop. In the gastrointestinal form of salmonellosis, the severity is determined by the severity of intoxication and dehydration syndromes. The degree of intoxication usually characterizes body temperature, which can vary from low-grade fever to severe fever.

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, insomnia, 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; on days 3-5, hepatosplenomegaly is detected. Characterized by moderate arterial hypotension, relative bradycardia. Clinical picture resembles that of typhoid fever.

The septic variant of salmonellosis also often begins with a gastrointestinal clinic, followed by severe persistent remitting fever, tachycardia, chills, and intense sweating when the temperature drops. There is a hepatolienal syndrome. The disease proceeds severely, for a long time, can contribute to the development of secondary foci of purulent inflammation in the lungs, kidneys and bladder(pyelonephritis, cystitis), endocarditis, abscesses and cellulitis. Sometimes inflammation of the iris is noted.

After suffering salmonellosis, regardless of its form, some patients continue to excrete the pathogen (bacterial excretion) for up to a month. If bacterial excretion is delayed for more than three months, it is recognized as chronic. Severe complications with a high probability of death include infectious toxic shock, which is accompanied by swelling of the lungs and brain, cardiovascular, renal and adrenal insufficiency. Generalized forms are fraught with the development of purulent complications.

Diagnosis of salmonellosis

For diagnosis, the pathogen is isolated from vomit and feces (in generalized forms, the pathogen is detected in blood cultures). Sometimes bacteria can be isolated from the washings of the stomach and intestines, bile. To identify the pathogen, inoculation is carried out on nutrient media. Serological diagnostics is performed using RNGA, RKA, RLA, ELISA, RIA.

The degree of dehydration is determined based on the analysis of data on hematocrit, blood viscosity, acid-base state and electrolyte balance. With the development of complications of salmonellosis, it is necessary to consult a cardiologist, urologist, nephrologist and other specialists, depending on the type of complication.

Treatment of salmonellosis

Patients with a severe form of the course or those prone to the development of complications are subject to hospitalization, in other cases, treatment is carried out at home. It is desirable to initially carry out measures to wash the stomach and intestines (siphon enemas, enterosorbents). Then carry out the correction of the water-salt balance, taking measures for rehydration. Dehydration of the first and second degree is corrected by frequent fractional ingestion of saline solutions. More severe dehydration may require intravenous fluid therapy with isotonic polyionic solutions.

Detoxification therapy with colloidal solutions or 10% dextran solution is carried out only after the restoration of water and electrolyte homeostasis. Signs of severe metabolic acidosis are indications for prescribing intravenous administration sodium bicarbonate.

Antibiotic therapy is indicated for the generalized form of the disease. Prescribe drugs of the fluoroquinolone group, chloramphenicol, doxycycline. For the treatment of gastrointestinal forms of the disease, antibiotics are used only in cases of infection resistant to other therapeutic measures. With the gastrointestinal form good effect gives the appointment of enzyme preparations (pancreatin, dry bile). In the acute period of the disease, the patients were prescribed diet No. 4, after the subsidence of intestinal manifestations - No. 13.

Prevention of salmonellosis

The general prevention of salmonellosis includes measures to ensure sanitary and hygienic conditions when keeping, slaughtering livestock and poultry, processing carcasses and products of animal origin, preparing dishes from them at public catering establishments and food production. As well as measures to control the incidence of farm animals and birds. Individual prevention consists in careful culinary processing of products of animal origin, compliance with the terms of food storage.

Measures for the specific prevention of salmonellosis (vaccination) are not provided due to the antigenic heterogeneity of the pathogen and the instability of the immune system. Emergency prophylaxis in the focus of infection during nosocomial outbreaks is carried out using a therapeutic Salmonella bacteriophage.

The Office of Rospotrebnadzor in the Republic of Buryatia recalls measures to prevent salmonellosis and other intestinal infections.

To prevent salmonellosis, the following preventive measures must be observed:

Meat and meat products subject to thorough heat treatment;

For cutting raw meat and ready-to-eat products use separate boards;

Eggs used for the preparation of culinary and confectionery dishes must be clean;

Raw foods and ready-to-eat foods should be stored in the refrigerator separately and in packaging.

Observe the shelf life of products and ready meals, exclude long-term storage of food even in a refrigerator;

Do not forget about the basic rules of personal hygiene, thorough hand washing with soap and water before eating and after using the toilet.

Some facts about salmonella.

1. What is salmonellosis?

Salmonellosis is an infectious disease caused by various bacteria of the genus Salmonella, characterized by a variety of clinical manifestations: from asymptomatic carriage to severe forms. In most cases, it occurs with a predominant lesion of the digestive tract.

2. Who is the causative agent of salmonellosis?

Small mobile gram-negative rods are relatively stable in the external environment: they remain in the water of open reservoirs from 11 to 120 days, in the soil - up to 140 days, in room dust - up to 90 days; in meat and sausages - then 60 to 130 days (in frozen meat - from 6 to 13 months); in milk at room temperature - up to 10 days, in the refrigerator - up to 20 days; in butter - 52-128 days; in eggs - up to 13 months, on eggshells - from 17 to 24 days.

3. Who is the source of the disease?

The reservoir and sources of infection are many types of agricultural and wild animals (large and small cattle, pigs) and birds (chickens, ducks, geese).However, a certain value is also played by a person (a patient, a carrier) as an additional source.

4. How does the pathogen enter the human body?

In recent years, there has been a predominance of the incidence of salmonellosis associated with the spread of the pathogen Salmonella enteritidis, which is most often transmitted through poultry meat and eggs, as well as products prepared from them (half-cooked steaks, raw and soft-boiled eggs, fried eggs). Less important are fish and vegetable products.

5. What should you pay special attention to?

The causes of food contamination with Salmonella are varied. Catering establishments or your table may receive food (meat, milk, poultry, eggs, fish) already contaminated with salmonella (primary contamination). Infection of meat can occur during the life of the animal, possibly during slaughter, and when cutting carcasses by contamination of meat with intestinal contents. Poultry eggs, especially duck and goose, become infected during formation and laying, milk - during milking and processing. Salmonellosis can occur as a result of secondary contamination of food with Salmonella in case of violation of the sanitary rules for its preparation and storage.

6. What are the symptoms (signs) of salmonellosis in humans?

The incubation period for the food route of infection ranges from 6 hours to 3 days (usually 12-24 hours). With the contact-household route of transmission of infection, incubation is extended to 7 days. Usually the disease begins acutely, the body temperature rises (in severe forms up to 39 ° C and above), general weakness, headache, chills, nausea, vomiting, pain in the epigastric and umbilical regions appear, later stool disorder joins. They are most pronounced by the end of the first, on the second and third days from the onset of the disease.

In case of manifestation of clinical symptoms of intestinal infection (loose stools, vomiting) do not self-medicate, but seek immediate medical attention medical care. Seeking medical help in a timely manner will not only improve effective treatment, but also protect family members and others from infection.

Pay attention that in case of improper provision of public catering services or harm to the life and health of the consumer due to improper provision of the service, the consumer has the right to demand full compensation for losses caused to him due to shortcomings in the service provided, as well as compensation for moral damage caused.

Consumers have the right to present these requirements in a claim against the catering service provider.

It should be borne in mind that if the service provider refuses to satisfy the requirements, the consumer has the right to contact the Office of Rospotrebnadzor in the Republic of Buryatia.

The procedure for receiving applications from citizens.

Appeals of citizens are sent through:

Self-transmission by the applicant of written requests to the address of the location of the Office of Rospotrebnadzor in the Republic of Buryatia during business hours.

670013, Republic of Buryatia, Ulan-Ude, Klyuchevskaya st., 45 "B"

Appeals in the form of an electronic document are sent through a single portal of Rospotrebnadzor for filing the acceptance of citizens' appeals:Send an appeal

During the personal reception of citizens in the Office of Rospotrebnadzor in the Republic of Buryatia and its territorial bodies;

Through Public Reception Offices of the Office of Rospotrebnadzor in the Republic of Buryatia.

When using the materials of the Office of Rospotrebnadzor for the Republic of Buryatia, a reference to the Office is required.

Salmonellosis is a group of acute infectious diseases of a zooantraponous nature, caused by numerous bacteria of the genus Salmonella and characterized by a predominant lesion of the gastrointestinal tract, leading to dehydration, intoxication and the addition of a polymorphic clinic in the future.

The causative agent of salmonellosis

The causative agent was first discovered at the beginning of the 19th century in the organs of a deceased person and the meat that he had consumed the day before. In the future, all diseases with similar symptoms began to be combined under the name "salmonellosis".

There are about 100 species of salmonellosis pathogens that are pathogenic to humans, but the most common are Salmonella typhimurium, S.enteritidis, S.panama, S.infantis, S.newpart, S.agona, S.derby, S.london, S.paratyphi A /B, S.schotmuelleri.

The course and danger of the disease is due to the following pathogenicity factors:

1. Flagella (H-antigen) are located on the periphery of the pathogen, they cause movement
2. Capsule (K-antigen) explains protection against phagocytes
3. Inferiority of phagocytosis predisposes to the development of sepsis
4. Features of invasion (introduction) make the penetration of the pathogen almost unhindered into deep tissues
5. Adhesion (fastening) due to fibrils, pectins, LP-saccharide complex
6. The presence of exotoxins (waste products excreted during life):
- thermolabile exotoxin = enterotoxin, carries out its mechanism of action by activating the cascade of the enzyme system (adenylate cyclase), cAMP is activated - this causes the release of Na and Cl from the intestinal cells, and after them, along the concentration gradient, water enters the intestinal lumen, and this is how diarrhea is formed with further dehydration,
- thermostable exotoxin mediates its action through guanylate cyclase, this entails the phenomenon of rapid vascular permeability,
- cytotoxin causes damage to epithelial cells
7. Endotoxin - a biologically active substance released after destructive phagocytosis. In this case, endotoxin is a lipopolysaccharide complex and it plays a major role in the formation of intoxication:
- causes delayed hypersensitivity and immediate type
- reduces the degranulation of neutrophils and the release of biologically active substances
- activates the synthesis of prostaglandin and thromboxane - this triggers platelet aggregation in small capillaries, inflammation develops, DIC (disseminated intravascular coagulation). Prostaglandins in addition, like enterotoxin, stimulate the secretion of Na and Cl, and also cause smooth muscle contraction and intestinal motility.

Salmonella are relatively resistant to various environmental factors:

At room temperature, it can be stored on household items for up to 3 months;
In dry feces of animals up to 4 years;
In water up to 5 months, in meat and dairy products up to 6 months, in eggshells up to 24 days;
High temperatures are practically not harmful, because salmonella almost instantly die only at 100 ° C, at 70 ° for 30 minutes. Resistance to high temperatures increases when the pathogen is found in meat products (400 g of meat with a thickness of 19 cm must be boiled for 2.5 hours, only after that the meat can be considered safe). Salting and smoking have practically no effect on salmonella.
The pathogen is resistant to low temperatures, up to -80°C;
UV resistance;
When treated with disinfectants, it dies within 20 minutes.

Susceptibility is ubiquitous, without gender, age and territorial restrictions. But the greatest risk of morbidity among children is within a year from the moment of birth, due to the imperfection of immunity. Salmonellosis occurs throughout the year, but sporadic outbreaks occur more frequently during the summer months.

Causes of Salmonella Infection

Source - domestic and farm animals (cattle, pigs), poultry (chickens, geese, ducks), cats, birds, fish, sick people and bacteria carriers. Ways of transmission - alimentary (through eggs, dairy and meat products) and contact and contact-household. Very often, when using eggs for food, they do not pay attention to changes in the protein and yolk (it can be either hemorrhage, or cloudiness, or a musty smell) - these are often infected salmonella eggs, the use of which inevitably leads to infection. Therefore, as soon as you notice this while cooking, immediately dispose of this contaminated product and everything that came into contact with it, and fill the dishes in which you found it with chlorine solution, also treat your hands with this solution (just soap is not enough!) .

Incubation period consider from the moment the pathogen enters the macroorganism to the onset of the first clinical symptoms, the duration of this period is widely variable and can last from 6 hours to 8 days, but in most cases it is observed after 12-24 hours from the moment the infected product is consumed.

Entering the gastrointestinal tract, Salmonella reach the small intestine, attach to the mucosa with the help of adhesion factors (No. 5 in the list of pathogenicity factors, presented above).

Period of clinical manifestations indicates the beginning of the action of exotoxin, which is released when it penetrates deep tissues, and there the action of phagocytosis begins (that is, the pathogen is consumed by the cells of the immune system) and when salmonella is destroyed, endotoxins are released, these biologically active substances cause specific symptoms.

But part of the pathogen, due to resistance to phagocytosis, is spread by the lymphogenous and hematogenous way (through the lymph and blood), causing all kinds of symptoms not only from the stomach and intestines. Depending on what is most compromised in the body, then one or another clinical form occurs (gastrointestinal, typhoid, septic, meningeal, erased, subclinical, carriage) - in various forms, their own symptoms prevail.

Yes, at gastrointestinal form the main fulcrum for endo- and exotoxin is the adenylate cyclase and guanylate cyclase systems, therefore, the violation of water-salt metabolism comes to the fore due to the resulting diarrhea, in which the stool is watery, frothy, fetid, with greenery in the form of "swamp mud", with a frequency 7-10 times a day, for 10 days. The disease is characterized by an acute onset and, against the background of diarrheal syndrome, weakness, lethargy, moderate pain in the abdomen (especially in the epigastric and navel areas) are noted. There is also pain in the abdomen on palpation, its rumbling and swelling. Depending on the severity of dehydration, the following symptoms may join:

From the side of the cardiovascular system (tachycardia, lowering blood pressure, muffled heart tones);
from the side of the central nervous system (headache and dizziness, and in young children there may be convulsive readiness).

The peculiarity of salmonellosis (not only this particular form) is that what younger age the more severe the disease.

At typhoid-like form, instead of recovery on the 7-10th day, there are features characteristic of typhoid fever:

• wave fever,
• hepatosplenomegaly (enlargement of the liver and spleen, which is determined by palpation),
• a small roseolous rash appears on the body on the 7th day (similarly, as with typhoid fever).

Clinical manifestations last for a long time (3-4 weeks) and are characterized by a gradual fading of symptoms.

septic form occurs with IDS (immunodeficiency) and / or in newborns. It is characterized by the spread of the pathogen by the lymphogenous and hematogenous route to various organs and tissues, with the formation of purulent foci in them in the form of osteomyelitis, arthritis, cholecystitis, etc. This form also begins, i.e. with symptoms of gastroenteritis (diarrhea, abdominal pain - everything that was in the gastrointestinal tract form), but subsequently an exanthema joins in the form of petechiae (specks), but in severe cases in the form of large hemorrhages and pyoderma.

Already from the first days there is a lesion of the central nervous system and the cardiovascular system. This form is longer downstream with frequent deaths.

At meningeal form salmonellosis proceeds like a septic form, but, unlike it, the only septic focus is the central nervous system. This is more often observed in children of different age groups due to the high permeability of the BBB (blood-brain barrier), in this case, cerebral symptoms join the gastrointestinal symptoms:

• frequent seizures due to increased seizure activity;
• vomiting that does not bring relief;
• in babies, before the closure of a large fontanel (up to 2 years), its bulging and pulsation can be observed;
• meningeal symptoms occur (stiff neck, symptom of Kering and Brudzinsky).

Erased form of salmonellosis characterized by mild diarrheal syndrome up to 1-2 times a day for 2 days.

subclinical form And carriage can only be detected by laboratory methods.

Features of the course in children of the first year of life: a very severe gastrointestinal form with a predominance of symptoms of enterocolitis in the form of a severe diarogenic syndrome. In 90% of cases, a septic form is formed and proceeds as a mixed infection. Features of nosocomial salmonellosis: these strains (species) are antibiotic resistant, with a severe course and death.

After the disease, post-infection immunity is formed, but it is type-specific and lasts no more than a year.

Diagnosis of salmonellosis

1. Epidemiological criteria are aimed at establishing the source of infection and identifying contact persons.
2. Clinical characteristics are aimed at detecting and differentiating the leading symptoms (intoxication, diarrhea, hepatosplenomegaly, the presence or absence of generalized forms)
3. Laboratory data:
- KLA: increased Lts, Nf with a shift of the formula to the left, ESR
- The bacteriological method is aimed at detecting a pathogen from biological media (feces, blood, urine, affected organs) and suspicious products. The final results come to the 5th day.

Serological method: ELISA (enzymatic immunoassay), RGA and RNGA (reaction indirect hemagglutination) - these methods are aimed at detecting antibody titer. The results are ready by about 7 days.

The final diagnosis is competent only when the pathogen is detected.

Treatment of salmonellosis

Together with drug treatment, bed rest is necessary. The following will be the treatment in accordance with the national standard, but this is only a schematic representation, an individual approach is carried out in life, taking into account the age indicators / degree of exsicosis / toxicosis and the degree of dehydration.

1. Etotropic therapy is aimed at destroying the pathogen and the drugs of choice are: enterix, chlorquinoldol, ciprofloxacin, salmonella bacteriophage, sanguiritin.

2. Pathogenetic therapy:
- Rehydration therapy is aimed at restoring water-salt metabolism, using rehydron and trison.
- Detoxification therapy is aimed at eliminating dehydration and the amount of fluid administered depends directly on the degree of dehydration. In this case, glucose and reopoliglyukin are used.
- Eubiotics and biological products: bactisuptil, linex, acipol, bifidum-lactobacterin.
- Sorbents: Smekta (to remove salmonella waste products).
- Enzyme therapy: mezim forte, oraza.
- Antidiarrheals: calcium gluconate, indomethacin.
- Antispasmodics (painkillers): no-shpa or its analogues.

Outpatient treatment of patients with suspected salmonellosis is usually not carried out. Patients are referred for hospitalization in a hospital to provide them with specialized medical care.

Employees of food enterprises and persons equated to them are subject to mandatory hospitalization and dispensary observation of those who have been ill.

Nutrition for salmonella

Diet and table number 4; Foods that irritate the stomach and intestines, dairy products and refractory fats are excluded from the diet. It is impossible to prescribe starvation diets, it is fraught with aggravation of the immunodeficiency state, and also prevents the slowdown of reporative processes in the digestive tract. From food exclude products that enhance peristalsis, fermentation processes, containing a large amount of coarse fiber: black bread and crackers from it, whole milk, yogurt, fermented baked milk, cream, whole milk cereals, legumes, beets, cucumbers, sauerkraut, radish , radishes, citrus fruits, pears, plums, grapes, meat and fish broths, fatty meats / fish / poultry, as well as everything spicy and alcoholic.

Rehabilitation and prevention

The following methods can be attributed to non-specific prophylaxis: the duration of stay in the hospital with a localized form is 14 days, with a generalized form - up to 30 days. After the end of treatment, a bacterial study is performed 2 days later, twice and, with negative results patients are allowed to work. Food industry workers are subjected to clinical examination for up to 3 months with a single monthly examination of feces - if the results are positive, they are not allowed to work for 15 days and are placed in another job, and in parallel, a 5-fold examination of feces and a single bile is carried out if bacterial excretion lasts more than 3 months - they are transferred to another job within 1 year with a parallel examination of feces 1 time in half a year, and after this year, a five-fold examination of feces and a single examination of bile with an interval of 1-2 days are performed, with again a positive result- they are suspended from work, and if it is negative, they are deregistered and the workplace is returned.

Along with these measures, they are strengthening veterinary and sanitary supervision in the areas of livestock keeping, technologies for processing / storing / preparing carcasses. They also monitor the sanitary and epidemiological supervision at food enterprises for the control of technology and quality of preparation.

For preventive purposes, it is necessary to boil meat and eggs well, to observe personal hygiene.

Specific prophylaxis: not developed, because it is based on the principle of vaccination, which is created by neutralizing virulent strains - this is impossible in this case, because there are more than 2.5 thousand of these virulent strains.

Complications of salmonellosis

Numerous and varied:

• Vascular collapse with the formation of acute cardiac and renal failure;
• Septic complications with the development of purulent foci in various bodies and tissues and the formation as a result of this: arthritis, osteomyelitis, endocarditis, abscesses of the brain, spleen, liver and kidneys, meningitis, peritonitis, appendicitis, pneumonia, urinary tract infections, infectious toxic shock.
• The most dangerous complication for others is carriage, which is formed due to incomplete phagocytosis.

The disease is deadly.

Therapist Shabanova I.E.