Salmonellosis, Campylobacteriosis, Yersiniosis, Escherichiosis, Shigellosis

Question 1

Salmonellosis (5)

Answer 1

• Resistant to the environment, may survive
• S. enteriditidis, S. typhi –> most common
• Endotoxin destroyed at 70 degrees
• Optimal growth – 35-37 degrees
• Are sensitive to most common disinfectants

Question 2

Salmonellosis

1. Source of infection
2. Route of infection
3. Pathogenesis
4. Incubation period

Answer 2

1. poultry (most common), pork, beef, wild animals, rodents, sick person or carriers
2. Route of infection: contaminated food, fecal-oral, person to person, contact with infected animals
3. Pathogenesis: depends on the endotoxin
   - Reaches the stomach –> causes gastritis –>bloodstream –> transient bacteremia –> intestines –> gastroenteritis
   - Less common –> colitis
4. contaminated food 8-36hrs, fecal-oral 5-6 days

Question 3

Salmonellosis

-clinical presentation

Answer 3

• General manifestation: fever, headache, abdominal pain
• Typhoid manifestation: fever 1-2 weeks, meteorism, enteritis, dizziness, roseolar rash 2nd week
• Sepsis manifestation: fever, chills, enlarged liver and spleen, purulent foci in different organs and body tissues

Question 4

Salmonellosis

1. Predominance in which time of the year?
2. Most common clinical syndrome
3. Diagnosis
4. Treatment

Answer 4

1. Summer
2. E, GE
3. stool culture, PCR (rare), blood culture (if suspected sepsis), CBC, pH, electrolytes, glucose, CRP
4. only in severe cases antibiotics are recommended. Systemic infections –> Ceftriaxone

Question 5

Campylobacteriosis

1. Source of infection
2. Route of infection
3. Incubation period

Answer 5

1. poultry, wild animals, cats, pigs, infected humans
2. contaminated food
3. 1-4 days, up to 7 days

Question 6

Campylobacteriosis

-clinical presentation

Answer 6

-Fever, abdominal pain, chills, bloody diarrhea, secondary local manifestations

Question 7

Campylobacteriosis

1. Predominance in which time of the year?
2. Most common clinical syndrome
3. Diagnosis
4. Treatment

Answer 7

1. Summer
2. EHC
3. Stool culture, PCR in rare cases, CBC, CRP, pH, glucose, electrolytes. Blood culture is sepsis is suspected
4. Treatment: Macrolides – Azithromycin (3d.), Doxycycline (>8 years), Ciprofloxacin (>17 years)
   - Most often associated with: Guillain Barre Syndrome

Question 8

Yersiniosis

1. Source of infection
2. Route of infection
3. Incubation period

Answer 8

1. rodents, infected humans, domestic and wild animals
2. contaminated food with animal feces
3. 1-14 days, average 5 days

Question 9

Yersiniosis

-clinical presentation

Answer 9

• Fever, abdominal pain, maculopapular rash, pseudo-appendicitis, mesadenitis
• Y. Pseudotuberculosis –> “socks and gloves”, strawberry tongue, hepatomegaly, arthralgia, enteritis, jaundice, abdominal pain, desquamation

Question 10

Yersiniosis

1. Predominance in which time of the year?
2. Most common clinical syndrome
3. Diagnosis
4. Treatment

Answer 10

1. Winter
2. EC
3. Serology, stool culture, PCR (rare cases), Blood culture, CBC, glucose, electrolytes, CRP, pH
4. antibiotics are only needed in very severe cases

Question 11

Yersiniosis

1. typical complications
2. when should serology be performed?
3. two forms

Answer 11

1. nodular erythema, join pain
2. when the patient doesn’t have diarrhea but has other typical symptoms, when the disease lasts for a long time
3. Y. enterocolitica, Y. pseudotuberculosis
   - Y. Enterocolitica –> often it has to be differentiated between appendicitis

Question 12

Escherichiosis

1. types
2. source of infection
3. route of infection

Answer 12

1. ETEC, EHEC, EPEC, EIEC, EAEC, DAEC
   - EPEC – most often causes infant’s diarrhea
   - ETEC – most often causes traveler’s diarrhea–> Infectious dose is high, IP 14-50h, via contaminated food and water, during warm months, watery diarrhea
2. EHEC – cattle, EPEC – cattle, humans, rabits, dogs…
3. fecal-oral route via contaminated food

Question 13

Escherichiosis

1. incubation period
2. most common clinical syndrome
3. diagnosis
4. treatment

Answer 13

1. 1-6 days
2. E, EC
3. stool culture, PCR (rare)
4. EHEC treatment with antibiotics is not recommended!
   - ETEC – TMP/SMX, Azithromycin (5d.), Ceftriaxone (5d.), Ciprofloxacin (>17 years)

Question 14

Escherichiosis

-clinical presentation (4)

Answer 14

• EHEC and EIEC –> enterocolitis
• The rest –> enteritis
• Fever, abdominal pain, tenesmus, vomiting
• Sepsis like form –> fever, chills, diarrhea, enlarged liver and spleen, secondary local manifestations

Question 15

Shigellosis

1. groups
2. source of infection
3. route of infection
4. Predominance in which time of the year?

Answer 15

1. 4 groups according to O antigen: S. sonnei, S. dysenteriae, S. flexneri, S. bodyii
2. humans
3. fecal oral
4. Summer

Question 16

Shigellosis

1. incubation period
2. most common clinical syndrome
3. diagnosis
4. treatment

Answer 16

1. 1-3 days
2. C
3. stool culture, serology (rare), blood culture (if sepsis is suspected)
4. Azithromycin (5d.), Ceftriaxone (2-5d.), Ciprofloxacin (>17 years old)

Question 17

Shigellosis

-clinical presentation

Answer 17

• Fever, colitis, acute abdominal pain, tenesmus

- Most important cause of bloody diarrhea