Nontyphoidal Salmonella Infection

CLINICAL MANIFESTATIONS
spectrum of illness:
asymptomatic gastrointestinal tract carriage
urinary tract infection 
bacteremia
focal infections: meningitis, brain abscess, and osteomyelitis (sickle cell pt).
gastroenteritis:
 diarrhea, abdominal cramps, and fever
the distal small intestine as well as the colon.
In USA, incidence of invasive Salmonella infection is highest among infants.

ETIOLOGY
Salmonella organisms are gram-negative bacilli that belong to the family Enterobacteriaceae. 

2 Salmonella species: 
S enterica with 6 subspecies; s enterica enterica vast majority of infections in humans and warm-
blooded animals
Salmonella bongori and other S enterica subspecies from coldblooded animals.

> 2,500 Salmonella serovars; serovars human disease within O serogroups A through E. 

In 2011, the most commonly reported human isolates in the United States
were Salmonella serovars Enteritidis, Typhimurium, Newport, and Javiana; these 5 serovars
generally account for nearly half of all Salmonella infections in the US

The incubation period for NTS gastroenteritis is 6 to 48 hours

DIAGNOSTIC TESTS
 Gastroenteritis is diagnosed by stool culture; stool cultures should be obtained in all children
with unexplained persistent or severe diarrhea and or those with bloody diarrhea.
GPP

Optimum recovery of Salmonella from stool is achieved with the use of enrichment broth and
multiple selective agar plate media. Definitive identification requires confirmation by either
phenotypic methods (biochemical profiling) or mass spectrometry of cellular components and O
Nontyphoidal Salmonella Infection

serogroup determination. Serovar (serotype) determination is helpful and is usually performed at

public health laboratories.

If enteric fever is suspected, blood, bone marrow, or bile culture is diagnostic, because organisms

often are absent from stool.

The Role of Short-course Ceftriaxone Therapy in the Treatment of Severe Nontyphoidal

Salmonella Enterocolitis
Nontyphoidal salmonellae (NTS) is one of the most important pathogens of gastroenteritis in
humans. Although most nontyphoidal Salmonella infections result in self-limited gastroenteritis,
invasive infections such as bacteremia, meningitis or extraintestinal infection could also occur.
Antimicrobial therapy is not recommended for routine treatment of nontyphoidal salmonellosis
and effective antibiotic treatment is essential if NTS infection spreads beyond the intestine such
as bacteremia, meningitis or osteomyelitis.
Although some reports revealed that antimicrobial therapy may be beneficial for shortening the
clinical courses of severe NTS enterocolitis, most of them were based on clinical observations,
not based on the results of objective examinations. Thus, the use of antibiotics in the treatment of
patients with severe NTS gastroenteritis is still controversial in clinical practice.
As a third generation cephalosporin, ceftriaxone has a higher concentration than conventional
antibiotics such as ampicillin and trimethoprim-sulfamethoxazole in the intestinal mucosa and
gallbladder. Besides, ceftriaxone maintains relatively lower resistance rate in Salmonella than
those of other conventional antibiotics. So the purpose of our study is to evaluate if short-course
of ceftriaxone therapy could shorten the clinical courses of severe NTS enterocolitis in children
and the excretion of Salmonella in feces. The investigators think that the study may be helpful
for clinicians in the treatment of severe NTS enterocolitis in children, especially on the
judgments of the choices and the treatment cures of antibiotics.

3 Months to 18 Years  old