Salmonella infections in Canadian Children

Question 1

Non-typhoid salmonella is transmitted how? (2)

Answer 1

contaminated food/water OR contact with carrier animals (esp reptiles)

Question 2

major sx of NTS infections?

Answer 2

diarrhea

Question 3

why should you be careful about giving antibiotiocs for NTS?

Answer 3

• does NOT decrease severity/duration of diarrhea
• may increase the incidence of NTS carriage
• only use with suspected or proven bacteremia or invasive infection!

Question 4

presentation of tyhpoid/paratyhpoid fever? timeline?

Answer 4

fever and abdo

with bacteremia within 60 days of travel

Question 5

when do blood culture for returning travel and pt unwell, give what?

Answer 5

ceftriaxone

Question 6

when can you transition to PO antibiotics? and what?

Answer 6

azithro after blood cultures cleared and child improved

Question 7

which cause typhoid fever?
S Typhi
S Paratyphi
S Typhimurium

Answer 7

S. Typhi

S. paratyphi

Question 8

foods that can transmit NTS

Answer 8

eggs (which can be contaminated even when intact, from NTS in the oviduct of the hen), dairy products, ground beef, or produce

Question 9

NTS incubation period?

Answer 9

usually 12-48 h (up to 7 days)

Question 10

3 major RFs for disseminated NTS disease?

Answer 10

<3 months of age
asplenia
immunocomp

Question 11

primary host for typhoid/paratyhoid fever?

Answer 11

humans

Question 12

tyhpoid fever trasnmited how?

Answer 12

contaminated food/water or person-to-person sprad

Question 13

TF/PTF incubation period?

Answer 13

3-60 days (usually 7-14 days0

Question 14

give 3 signs/sx of TF/PFT

Answer 14

fever, abdo pain, hepatopmegaly, splenomeglay, macular rash on abdo, multiorgan failure, bactermiea, GI bleed

Question 15

what type of salmonella is seen in osteomyelitis, SA in sickle cell pts?

Answer 15

NON typhoid

Question 16

main dx test for NTS? when would you do blood cx?

Answer 16

stool cx; if fever and positive stool cx OR if positive stool cx and <3 mos

Question 17

in order to catch TF/PTF important to do blood culture in kid with fever returning from resource poor country within how many months?

Answer 17

2 months

Question 18

restricvtions on people with NTS?

Answer 18

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)

Question 19

2 non-pharm things to do if pt has NTS?

Answer 19

• ask about expsorues
• advise remove reptile from home
• alert public health

Question 20

why is azitrho step-down for TF/PTF?

Answer 20

less resistance than cipro

Question 21

duration of tx for TF/PTF?

Answer 21

controversial. 7 days for azitrho. 10-14 for ceftriaxone.

Question 22

major reason for relpase of TF/PTF

Answer 22

due to residual disease in the reticuloendothelial system rather than antibiotic resistance

Question 23

how long do you expect fever to last in TF/PTF?

Answer 23

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.

Question 24

for TF/PTF when can pt return to work/child care?

Answer 24

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

Question 25

ways to prevent Non-typhoid salmonella?

Answer 25

• safe food handling
• good hand washing after touching animals (esp poultry, reptile, frogs)
• advise preschool aged kids not touch these animals
• vaccinate poultry

Question 26

ways to prvent TF/PTF?

Answer 26

• 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

Question 27

which tyhpoid vaccine is only one with some protection against S parathyphi?

Answer 27

oral live= vivotif

Question 28

best course of action if pt has + stool culture for salmonella AND traveled to endemic country in past 2 months? (3)

Answer 28

• blood cx
• advise handwashing
• start ceftriaxone if unwell/age <3 mos/immunocomp

Question 29

under what circumstance would you send stool cx and start antibx (and admit) if + salmonella stool cx but no travel?

Answer 29

• fever
• unwell
• immunocomp
• <3 mos (also check CSF)

Question 30

when would you not send blood cultures for + stool salmonella?

Answer 30

-no fever, well, >3 mos of age

Question 31

what if blood cx neg for salmonella but stool cx pos and NO evidence of dissemianted infection?

Answer 31

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

Question 32

what if blood cx neg for salmonella with pos stool cx and there IS evidence of dissmeinated infection?

Answer 32

call ID:)

Question 33

blood cx + for salmonella–> do what? (4)

Answer 33

• examine for disseminated disease
• start ceftraixone
• admit to hospital unless totally well and parents reliable
• repeat cx q 24-48 h

Question 34

if blood cx + for salmonella and well and blood cx clear in under 48 h?

Answer 34

discharge on antibx based on suspceptibilities. can still send home if fever. if suspcetiabilities not back, can do additional azitro x 5-7 days

Question 35

5 clinical manifestations of slamonella infection

Answer 35

• no sx
• acute gastro
• GI bleed
• intestinal perf
• *bacteremia
• *meningitis
• *encephatlopathy
• *endocarditis
• *osteomyeltiis
• *septic athritis

Question 36

risk for being chronic carrier

Answer 36

gallstones