Factors which lead to symptomatic disease from

Salmonella in humans

The potential for symptomatic salmonellosis in humans depends on a variety

of factors, of which the most important is the infectious dose of organism, the
pathogenesis of the organism to humans and the level of host defense. The
minimum infective dose (the minimum number of bacteria that should be
ingested in order to cause infection), according to research done with the
participation of many volunteers, is about 10 6 or more. That means that the
number of bacteria to be introduced the body is large enough to cause
infection. Furthermore, the serotype of Salmonella is essential for the ability
to cause symptomatic disease. For example, S. pullorum, that affects mainly
poultry, have little virulence when host is man and the infective dose is about
one billion cells (dose to cause infection). In contrast, S. typhimurium and S.
enteritidis infection is caused by ingestion of a smaller number of
microorganisms.

The sensitivity of the individual and the overall state of the defense
mechanisms are crucial for the onset of symptomatic infection. Three well-
designed non-specific factors of host defense is the acidity of the stomach,
the gastrointestinal motility and the presence of normal microbial flora. In
stomach, a pH level less than or equal to 2 leads to spontaneous eradication
of Salmonella, while a pH range between 2 and 3 is favorable for the gradual
eradication of the bacterium. Disorders associated with impaired gastric acid
secretion, such as achlorhydria, surgical resection of the stomach, vagotomy,
taking drugs such as antacids, H2 receptor antagonists of histamine and
proton pump inhibitors lead to the elimination of bactericidal action of the
gastric environment. Age is an important factor affecting the sensitivity of
people to infection by Salmonella. The reduced production of hydrochloric
acid from newborns and achlorhydria which is common in people over 60
years, make these age-groups most vulnerable to the bacteria. The rapid
emptying of gastric contents into the small intestine results in less time spent
by microbes in the stomach and a higher probability of survival of pathogenic
microorganisms that are beyond the bactericidal effect of gastric environment.
The reduction of acidity in the stomach and decreased gastrointestinal motility
in subjects treated for diabetes mellitus is a further complicating factor for this
vulnerable population group. The use of broad spectrum antibiotics and
surgery in the abdomen leads to upheavals in the population of normal
gastrointestinal flora and finally results in the conversion of asymptomatic to
symptomatic disease stretchers from Salmonella due to the rearrangement of
the rivalry between the microorganisms.
Regarding the specific immune response, according to surveys, the role of
macrophages in elimination of Salmonella is determining. Thus, patients with
a deficiency in the activity of macrophages, such as AIDS patients and
granulomatous diseases are more prone to develop symptomatic
salmonellosis. Furthermore, patients with severely impaired activity of
macrophages, such as in sickle cell anemia, other hemoglobinopathies,
malaria, bartonellosis, histoplasmosis, and in cases of malignancies, are also
prone to symptomatic form of the disease from Salmonella. The role of T
lymphocytes in the mechanisms of pathogenesis of salmonellosis is less
understood.