Salmonella (Enteric Fever) Flashcards
Salmonella can be divided into Salmonella bongori and Salmonella enterica. Within Salmonella enterica there is a subspecies called enterica. Within this is there is typhoidal or non-typhoidal Salmonella. What is the estimated incidence of typhoid fever (enteric fever)?
1 - 1000 - 10,000/year
2 - 100,00 - 500,000/year
3 - 1-2 million/year
4 - 11-21 million/year
4 - 11-21 million/year
Salmonella Paratyphi causes around 5 million cases/year
Salmonella can be divided into Salmonella bongori and Salmonella enterica. Within Salmonella enterica there is a subspecies called enterica. Within this is there is typhoidal or non-typhoidal Salmonella. Which of these is most commonly infects humans?
- typhoidal
Salmonella typhoid is the most common cause of human related infection, but which of the following is most common causing enteric fever?
1 - Salmonella Typhi
2 - Salmonella Paratyphi
3 - Salmonella Peticious
4 - Salmonella Histimato
1 - Salmonella Typhi
Leads to enteric fever, but more commonly referred to as typhoid fever
Salmonella Paratyphi can lead to enteric fever, also referred to as paratyphoid fever. Is this as common or as dangerous as Salmonella Typhi?
- no
Less common
Less severe form of infection
What is the incubation period of Salmonella Paratyphi?
1 - <10 days
2 - 7-15 days
3 - 6-20 days
4 - >21 days
1 - <10 days
Which of the following has the highest and lowest incidence of enteric fever?
1 - Caribbean
2 - Americas
3 - Africa
4 - Asia
2 - Americas = highest
3 - Africa = lowest
Middle-East, South Asia, and South-East Asia may have antibiotic resistant strains
What is the incubation period of Salmonella typhi?
1 - <10 days
2 - 7-15 days
3 - 6-20 days
4 - >21 days
3 - 6-20 days
What % of untreated patients with Salmonella typhi will excrete bacteria for at least 3 months after the onset of acute symptoms
1 - 1%
2 - 10%
3 - 50%
4 - 100%
2 - 10%
2-5% become chronic carriers, which may last many years
What % of untreated patients with Salmonella Paratyphi will excrete bacteria for 5-6 weeks months after the onset of acute symptoms
1 - 5%
2 - 10%
3 - 50%
4 - 100%
4 - 100%
Most patients do excrete the bacteria
Few will excrete bacteria for month- yrs
How is Salmonella typhi and Paratyphi typically contracted? (select 2)
1 - sexual contact
2 - contaminated water and/or food
3 - air droplets
4 - contact with infected individuals
2 - contaminated water and/or food
4 - contact with infected individuals
Typhoid fever can last for 3 to 4 weeks, but what are the death rates from this?
1 - 1-2%
2 - 12-30%
3 - 25-35%
4 - 55-75%
2 - 12-30%
Is the onset of enteric fever rapid or insidious?
- insidious
Which of the following is NOT a risk factor for developing enteric fever?
1 - international travel in developing countries with poor sanitation.
2 - contact with animals, birds, reptiles, etc
3 - Immunodeficiency
4 - GIT disorders
5 - antacids
6 - pneumonia
7 - IBD
8 - recent antibiotics use
6 - pneumonia
Antacids lower gastric pH and doesnt kill bacteria effectively
Antibiotics offset gut flora
Which of the following is NOT part of the classical triad of enteric fever?
1 - headache
2 - fever
3 - haematuria
4 - abdominal pain
3 - haematuria
Abdominal pain, fever and headaches form part of the classical triad of enteric fever. Typically is constipation or diarrhoea more common?
- diarrhoea may be the first symptom, BUT constipation occurs in up to 40% of patients with 20-40% experiencing pain
Often starts as diarrhoea and then turns into constipation
Abdominal pain, fever and headaches form part of the classical triad of enteric fever. Which of the following non-specific symptoms is NOT normally present?
1 - epistaxis
2 - lethargy
3 - cough
4 - anorexia
5 - confusion/delirium
6 - dizziness
7 - myalgia
1 - epistaxis
Not common
Which of the following dermatological signs can present in enteric fever?
1 - erythema multiforme
2 - erythema migrans
3 - maculopapular rash rose/salmon spots
4 - all of the above
3 - maculopapular rash rose/salmon spots
These are bacteria leaking out of capillaries
macule = flat, reddened area of skin
papule = raised area of skin in a rash
So a rash with flat and raised parts
Does enteric fever typically cause a high or low neutrophilia?
- low
Intracellular = low neutrophils
Pathogens MUST enter cells to replicate
Extracellular = high neutrophils
Pathogens do NOT need to enter cells to replicate
If pathogen is inside the cell the neutrophils cannot target it, and therefore neutrophils are low
In enteric fever which of the following blood results are common?
1 - thrombocytopenia
2 - lymphopenia
3 - abnormal LFTs
4 - all of the above
4 - all of the above
If a patient is asymptomatic but has a confirmed diagnosis of Salmonella typhoid or non-typhoid, what should they be treated with?
1 - amoxicillin
2 - fluids, analgesia and anti-pyretics
3 - vancomycin
4 - ceftriaxone
2 - fluids, analgesia and anti-pyretics
What is the definitive diagnosis of enteric fever?
1 - Blood culture
2 - Nucleic-Acid Amplification Test
3 - PCR
4 - ELISA
1 - Blood Culture
Culture: Blood, urine, rose spots, faeces, bone marrow
Blood cultures are only 50-70% sensitivity - repeat
If a patient has severe symptoms and a confirmed diagnosis of Salmonella typhoid or non-typhoid, what should they be treated with?
1 - azithromycin
2 - fluids, analgesia and anti-pyretics
3 - vancomycin
4 - ceftriaxone
1 - Azithromycin
Ceftriaxone is an alternative given IV
Meropenem may be considered in resistant strains
If left untreated, which of the following are potential complications between 3-4 weeks?
1 - intestinal perforation / haemorrhage
2 - cholecystitis
3 - abscess formation
4 - DIC
5 - pericarditis
6 - all of the above
6 - all of the above
21-year old unemployed female graduate was admitted with fevers, nausea, headaches and change in bowel habit. She Arrived back from India 8 days previously after a 3 month trip. Her initial symptoms after 2 weeks were have been intermittent since, but have worsened since returning. She had no treatment whilst abroad. Look at the image and which of the details in the image would rule out Dengue and Malaria, or make them less likely?
Dengue and Malaria = no bites/animal exposure
Both spread by mosquitos
Malaria = Prophylaxis/Vaccinations = some protection
21-year old unemployed female graduate was admitted with fevers, nausea, headaches and change in bowel habit. She Arrived back from India 8 days previously after a 3 month trip. Her initial symptoms after 2 weeks were have been intermittent since, but have worsened since returning. She had no treatment whilst abroad. Look at the image and which of the details in the image would make you consider Enteric Fever?
- rural travel, suggests she may have consumed contaminated food and/or water
21-year old unemployed female graduate was admitted with fevers, nausea, headaches and change in bowel habit. She Arrived back from India 8 days previously after a 3 month trip. Her initial symptoms after 2 weeks were have been intermittent since, but have worsened since returning. She had no treatment whilst abroad. Which of the following blood results would make you think of enteric fever?
- CRP is high
If this was viral, as in malaria and dengue, this is more likely to be low
Travellers diarrhoea is defined as > 3 unformed stools in a 24-hour period with at least one additional symptom, such as abdominal pain or cramps, nausea, vomiting, fever, or blood in the stools. What is the most common cause of this?
1 - Bacterial
2 - Viruses
3 - Parasites
1 - Bacterial
Accounts for 80–90% of cases
Most episodes are short-lived and self-limiting, lasting a few days
Travellers diarrhoea is typically self limiting, and patients are advised to hydrate and take in salt. What medication can be given to help if needed?
1 - Senna
2 - Docusate sodium
3 - Macrogol
4 - Lopermide
4 - Lopermide
Senna = softener
Docusate sodium = stool softener +stimulant
Macrogol = laxative
Is Enteric Fever a notifiable disease?
- yes
A typhoid vaccine can be given to people if they know they are travelling to endemic countries, such as the Americas, Middle-East, South Asia, and South-East Asia. How soon before travelling should the vaccine be given?
1 - day of travel
2 - 1 week before travel
3 - 1 month before travel
4 - 3 months before travel
3 - 1 month before travel
Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) can present in a similar manner to enteric fever. How is STEC typically transmitted?
1 - sexual contact
2 - contaminated water
3 - stool of cattle
4 - blood born
3 - stool of cattle
Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) can present in a similar manner to enteric fever. Is this a notifiable disease?
- Yes
Report to The UK Health Security Agency
Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) can present in a similar manner to enteric fever. What is the incubation period of STEC?
1 - 2-4 days
2 - <11 days
3 - 1-21 days
4 - >21 days
1 - 2-4 days
Can occur in 6 hours to 10 days though
Symptoms typically last 2 weeks
What is the most severe complication of Shiga toxin-producing Escherichia coli (E. coli) infections (STEC). When comparing STEC with enteric fever, all of the following symptoms can present in both, but which only presents in STEC?
1 - non bloody diarrhea
2 - severe bloody diarrhea
3 - abdominal cramps
4 - fever
2 - severe bloody diarrhea
Does NOT happen in enteric fever
STEC does NOT cause a high fever
Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) can present in a similar manner to enteric fever. Should these patients be treated with antibiotics?
- No
Closely monitored, antibiotics can increase the risk of complications
One of the most severe complication of Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) is Haemolytic Uraemic Syndrome (HUS). All of the following present in HUS, EXCEPT which one?
1 - renal failure
2 - thrombocytopenia
3 - pericarditis
4 - haemolytic anaemia
3 - pericarditis
The toxin secreted by STEC causes HUS
