Salmonella (Enteric Fever)

Question 1

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

Answer 1

4 - 11-21 million/year

Salmonella Paratyphi causes around 5 million cases/year

Question 2

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?

Answer 2

• typhoidal

Question 3

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

Answer 3

1 - Salmonella Typhi

Leads to enteric fever, but more commonly referred to as typhoid fever

Question 4

Salmonella Paratyphi can lead to enteric fever, also referred to as paratyphoid fever. Is this as common or as dangerous as Salmonella Typhi?

Answer 4

• no

Less common
Less severe form of infection

Question 5

What is the incubation period of Salmonella Paratyphi?

1 - <10 days
2 - 7-15 days
3 - 6-20 days
4 - >21 days

Answer 5

1 - <10 days

Question 6

Which of the following has the highest and lowest incidence of enteric fever?

1 - Caribbean
2 - Americas
3 - Africa
4 - Asia

Answer 6

2 - Americas = highest

3 - Africa = lowest

Middle-East, South Asia, and South-East Asia may have antibiotic resistant strains

Question 7

What is the incubation period of Salmonella typhi?

1 - <10 days
2 - 7-15 days
3 - 6-20 days
4 - >21 days

Answer 7

3 - 6-20 days

Question 8

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%

Answer 8

2 - 10%

2-5% become chronic carriers, which may last many years

Question 9

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%

Answer 9

4 - 100%

Most patients do excrete the bacteria

Few will excrete bacteria for month- yrs

Question 10

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

Answer 10

2 - contaminated water and/or food
4 - contact with infected individuals

Question 11

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%

Answer 11

2 - 12-30%

Question 12

Is the onset of enteric fever rapid or insidious?

Answer 12

• insidious

Question 13

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

Answer 13

6 - pneumonia

Antacids lower gastric pH and doesnt kill bacteria effectively

Antibiotics offset gut flora

Question 14

Which of the following is NOT part of the classical triad of enteric fever?

1 - headache
2 - fever
3 - haematuria
4 - abdominal pain

Answer 14

3 - haematuria

Question 15

Abdominal pain, fever and headaches form part of the classical triad of enteric fever. Typically is constipation or diarrhoea more common?

Answer 15

• 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

Question 16

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

Answer 16

1 - epistaxis

Not common

Question 17

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

Answer 17

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

Question 18

Does enteric fever typically cause a high or low neutrophilia?

Answer 18

• 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

Question 19

In enteric fever which of the following blood results are common?

1 - thrombocytopenia
2 - lymphopenia
3 - abnormal LFTs
4 - all of the above

Answer 19

4 - all of the above

Question 20

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

Answer 20

2 - fluids, analgesia and anti-pyretics

Question 21

What is the definitive diagnosis of enteric fever?

1 - Blood culture
2 - Nucleic-Acid Amplification Test
3 - PCR
4 - ELISA

Answer 21

1 - Blood Culture

Culture: Blood, urine, rose spots, faeces, bone marrow

Blood cultures are only 50-70% sensitivity - repeat

Question 22

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

Answer 22

1 - Azithromycin

Ceftriaxone is an alternative given IV

Meropenem may be considered in resistant strains

Question 23

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

Answer 23

6 - all of the above

Question 24

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?

Answer 24

Dengue and Malaria = no bites/animal exposure
Both spread by mosquitos

Malaria = Prophylaxis/Vaccinations = some protection

Question 25

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?

Answer 25

• rural travel, suggests she may have consumed contaminated food and/or water

Question 26

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?

Answer 26

• CRP is high

If this was viral, as in malaria and dengue, this is more likely to be low

Question 27

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

Answer 27

1 - Bacterial

Accounts for 80–90% of cases

Most episodes are short-lived and self-limiting, lasting a few days

Question 28

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

Answer 28

4 - Lopermide

Senna = softener
Docusate sodium = stool softener +stimulant
Macrogol = laxative

Question 29

Is Enteric Fever a notifiable disease?

Answer 29

• yes

Question 30

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

Answer 30

3 - 1 month before travel

Question 31

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

Answer 31

3 - stool of cattle

Question 32

Shiga toxin-producing Escherichia coli (E. coli) infections (STEC) can present in a similar manner to enteric fever. Is this a notifiable disease?

Answer 32

• Yes

Report to The UK Health Security Agency

Question 33

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

Answer 33

1 - 2-4 days

Can occur in 6 hours to 10 days though

Symptoms typically last 2 weeks

Question 34

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

Answer 34

2 - severe bloody diarrhea

Does NOT happen in enteric fever

STEC does NOT cause a high fever

Question 35

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?

Answer 35

• No

Closely monitored, antibiotics can increase the risk of complications

Question 36

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

Answer 36

3 - pericarditis

The toxin secreted by STEC causes HUS