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CPS Statements 2018-2020 > Salmonella Infections > Flashcards

Salmonella Infections Flashcards

1
Q

What Salmonella strains cause typhoid fever

A

S. Typhi, S. Paratyphi

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2
Q

How is NTS spread?

A

Animal contact
Contaminated food - poultry, eggs, dairy, ground beef, produce, sprout seeds, tomatoes
Contaminated water

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3
Q

What is the incubation period for NTS

A

12-48h - maximum 7 days

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4
Q

How does NTS present

A

Nausea, vomiting non-bloody diarrhea +/- fever

6-8% have bacteraemia

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5
Q

Who is at risk for disseminated NTS? And how does it present?

A

<3mo old, immunocompromised, asplenic

  • Bacteremia: 6-8%
  • Meningitis, brain abscess in <12mo
  • Endocarditis, arthritis (rare)
  • OM, SA - patients with SCD
  • Renal abscess (rare)
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6
Q

How do you diagnosis NTS

A

Stool culture +

Blood cultures IF febrile or immunocompromised or <3mo (consider up to 6mo IF stool positive)

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7
Q

How is afebrile, uncomplicated NTS treated

A

No antibiotics
May need exclusion from daycare while symptomatic
Counsel family to take any reptiles out of the home, or at least keep them out of the kitchen/bathtub
Advise careful hand washing

PH is notified of all infections

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8
Q

How is febrile, complicated NTS managed initially

A

Send BCx

  • CSF if <3mo
  • Admit to hospital
  • IV ceftriaxone (or azithromycin if fever only concern)

If BCx negative and patient continues to look unwell- consider:

  • repeat BCx
  • continue antibiotics
  • ID consult

If BCx negative and patient well - d/c antibiotics

If BCx positive - continue abx until BCx clears, and then step down to azithromycin 10mg/kg/d x 5-7d

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9
Q

How is typhoid fever spread?

A

Water or food contaminated with feces from a carrier

Direct person-to-person spread

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10
Q

What is the incubation period for typhoid fever?

A

7-14 days

Range 3-60d

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11
Q

How does typhoid fever present?

A

Bacteraemia —> sepsis, MOF

Present with fever, abdominal manifestations (diarrhea then constipation and abdo pain), eventually HSM develops

Rose spots (abdo macular rash) - 30%

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12
Q

What are the complications of typhoid fever?

A

GIB - 10% of hospitalized patients
Encephalopathy
Myocarditis, endocarditis (rare)
Can lead to urinary stones

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13
Q

When should typhoid fever be suspected?

A

Children with onset of unexplained fever within 2mo of returning from resource poor country

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14
Q

How is typhoid fever diagnosed?

A
  • Stool culture + in 30%

- BCx (may need multiple)

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15
Q

How is typhoid fever treated?

A

Send BCx

  • Admit to hospital
  • IV ceftriaxone (or azithromycin if fever only concern)

If BCx negative and patient continues to look unwell- consider:

  • repeat BCx
  • continue antibiotics
  • ID consult

If BCx negative and patient well - d/c antibiotics

If BCx positive - continue abx until BCx clears, and then step down to azithromycin 10mg/kg/d x 7d

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16
Q

What are other step down agents for typhoid fever?

A 
Quinolone: 3-7d
Cefixime: 7-14 d
Ceftriaxone: 10-14d
Amoxicillin: 14d
Sentra: 14d
17
Q

How often due relapses in typhoid fever occur?

A

17% relapse within 4wk

18
Q

Do patients with typhoid fever need to be afebrile to go home?

A

NO! Fever can continue for 6-8d after antibiotics started

As long as blood culture negative and patient well - can go home

19
Q

Does NTS or typhoid fever need follow up stool cultures?

A

NTS - no

Typhoid fever: 2-3 negative, 24 hour apart before returning to work or child care

20
Q

What is needed if a patient was in an area also endemic for schistosomiasis?

A

Urine culture

  • Salmonella-schistosoma - promotes long-term survival of S. Typhi/paratyphi with intermittent bacteriuria
21
Q

How can typhoid fever be prevented?

A
  1. Careful food and beverage selection
  2. Good hand hygiene
  3. Typhoid vaccine if >24mo
22
Q

What vaccine option are there? What is their efficacy?

A
  1. Vivotif (oral, live) - for >5yo, need booster in 7y
  2. Typherix or Typhim Vi (IM, inactivated), for >2y, booster in 3y
  3. ViVaxim (IM inactivated, +hepatitis A) - for >16yo, typhoid booster in 3y

All are ~50% efficacious

23
Q

What medical conditions increase risk for typhoid fever?

A
  1. Achlorhydria
  2. Asplenia
  3. SCD
  4. Immunocompromised
24
Q

What locations require the typhoid vaccine? (8)

A
  1. Afghanistan
  2. Bangladesh
  3. Bhutan
  4. India
  5. Nepal
  6. Maldives
  7. Pakistan
  8. Sri Lanka
25
Q

Which children need a minimum of 10 days antibiotics in hospital?

A

Disseminated disease
Blood cultures take >48h to clear
Child is still unwell after cultures cleared

CPS Statements 2018-2020 (16 decks)

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