Salmonella infections in Canadian Children Flashcards
Non-typhoid salmonella is transmitted how? (2)
contaminated food/water OR contact with carrier animals (esp reptiles)
major sx of NTS infections?
diarrhea
why should you be careful about giving antibiotiocs for NTS?
- does NOT decrease severity/duration of diarrhea
- may increase the incidence of NTS carriage
- only use with suspected or proven bacteremia or invasive infection!
presentation of tyhpoid/paratyhpoid fever? timeline?
fever and abdo
with bacteremia within 60 days of travel
when do blood culture for returning travel and pt unwell, give what?
ceftriaxone
when can you transition to PO antibiotics? and what?
azithro after blood cultures cleared and child improved
which cause typhoid fever?
S Typhi
S Paratyphi
S Typhimurium
S. Typhi
S. paratyphi
foods that can transmit NTS
eggs (which can be contaminated even when intact, from NTS in the oviduct of the hen), dairy products, ground beef, or produce
NTS incubation period?
usually 12-48 h (up to 7 days)
3 major RFs for disseminated NTS disease?
<3 months of age
asplenia
immunocomp
primary host for typhoid/paratyhoid fever?
humans
tyhpoid fever trasnmited how?
contaminated food/water or person-to-person sprad
TF/PTF incubation period?
3-60 days (usually 7-14 days0
give 3 signs/sx of TF/PFT
fever, abdo pain, hepatopmegaly, splenomeglay, macular rash on abdo, multiorgan failure, bactermiea, GI bleed
what type of salmonella is seen in osteomyelitis, SA in sickle cell pts?
NON typhoid
main dx test for NTS? when would you do blood cx?
stool cx; if fever and positive stool cx OR if positive stool cx and <3 mos
in order to catch TF/PTF important to do blood culture in kid with fever returning from resource poor country within how many months?
2 months
restricvtions on people with NTS?
should no be food handler if infectious! will continue to be carrier for months after no symptoms but still send to daycare when asympomatic (while having diarrhea depends on jurisdiction)
2 non-pharm things to do if pt has NTS?
- ask about expsorues
- advise remove reptile from home
- alert public health
why is azitrho step-down for TF/PTF?
less resistance than cipro
duration of tx for TF/PTF?
controversial. 7 days for azitrho. 10-14 for ceftriaxone.
major reason for relpase of TF/PTF
due to residual disease in the reticuloendothelial system rather than antibiotic resistance
how long do you expect fever to last in TF/PTF?
Fever typically persists 6 to 8 days from the start of antibiotics [4]. Fever is not a contraindication to switch to oral antibiotics or to hospital discharge, providing the child is otherwise well.
for TF/PTF when can pt return to work/child care?
n general, food handlers, health care workers and diapered children must have two or three negative stool tests 24 h apart over a variable number of days following completion of antibiotics before returning to work or to child care. Urine cultures may be required if patients have been in an area endemic for schistosomiasis
ways to prevent Non-typhoid salmonella?
- safe food handling
- good hand washing after touching animals (esp poultry, reptile, frogs)
- advise preschool aged kids not touch these animals
- vaccinate poultry
ways to prvent TF/PTF?
- careful food/drink selection when traveling to resource poor countries
- good hand hygiene
- typhoid vaccine for all kids >2 yrs traveling to areas known to have tyhpoid
which tyhpoid vaccine is only one with some protection against S parathyphi?
oral live= vivotif
best course of action if pt has + stool culture for salmonella AND traveled to endemic country in past 2 months? (3)
- blood cx
- advise handwashing
- start ceftriaxone if unwell/age <3 mos/immunocomp
under what circumstance would you send stool cx and start antibx (and admit) if + salmonella stool cx but no travel?
- fever
- unwell
- immunocomp
- <3 mos (also check CSF)
when would you not send blood cultures for + stool salmonella?
-no fever, well, >3 mos of age
what if blood cx neg for salmonella but stool cx pos and NO evidence of dissemianted infection?
if unwell: repeat cx, continue antibx; consider consulting ID….if well, stop antibx, unless stool group S typhi/parathyphi and kid is <3 mos, immunocomp
what if blood cx neg for salmonella with pos stool cx and there IS evidence of dissmeinated infection?
call ID:)
blood cx + for salmonella–> do what? (4)
- examine for disseminated disease
- start ceftraixone
- admit to hospital unless totally well and parents reliable
- repeat cx q 24-48 h
if blood cx + for salmonella and well and blood cx clear in under 48 h?
discharge on antibx based on suspceptibilities. can still send home if fever. if suspcetiabilities not back, can do additional azitro x 5-7 days
5 clinical manifestations of slamonella infection
- no sx
- acute gastro
- GI bleed
- intestinal perf
- *bacteremia
- *meningitis
- *encephatlopathy
- *endocarditis
- *osteomyeltiis
- *septic athritis
risk for being chronic carrier
gallstones
