Salmonellosis

Description:

Salmonellosis – acute zoonotic antroponozny infectious a disease with a fecal and oral mekhanzm of transfer which activator is the sort Salmonella bacterium. At it salmonellezeporazhatsya in a digestive tract. The current a disease variously on severity, is rare – in the form of generalized forms.
Classification of clinical forms:
1. Gastrointestinal (localized) which includes gastritichesky, gastroenteric or gastroenterokolitichesky forms.
2. Generalized (typhus-like and septicopyemic options)
3. A bacteriocarrier – acute, chronic and tranzitorny.
4. Subclinical (asymptomatic) form.
Focal forms of a salmonellosis include meningitis, abscess of a liver and lungs, plevropulmonalny diseases.

Salmonellosis reasons:

The salmonella belongs to family of enterobakteriya, the sort Salmonella. These are gram-negative sticks with flagellums at the expense of what are mobile. The dispute is not formed. Are the optional intracellular parasites very steady against action of the environment. In structure of a disease-producing cell 3 types of antigens – Oh, N are a part, To.
Source of a disease are people (patients with clinical manifestations or salmonellonositel) and various hematothermal animals and birds, first of all agricultural. Wild and poultry can pollute the environment the dung containing pathogenic bacteriums that promoting spread of a disease. The infected people belonging to dekretiruyemy groups are especially dangerous. It is worth to remember that after the postponed acute salmonellosis of people there can be a bakteriovydelitel about a year more.
The transfer mechanism – fecal and oral. As major factors of transfer of infectious agents serves the foodstuff inseminated by salmonellas, is especially frequent – meat and milk. A long time of a salmonella live and even breed in salads. Water can act as a factor of transmission of infection, however has smaller value, it is possible only at very considerable pollution by its sewage which contains salmonellas.
It is established that in water the salmonella can keep the pathogenicity up to 5 months, and in the frozen meat – about a year. At storage of eggs in the refrigerator over a month the possibility of penetration of a salmonella through a shell and its reproduction sharply increases in yolks.
In treatment and prevention facilities distribution of a salmonella is rather connected  with a contact and household way of transfer – through the contaminated tools and  the equipment.
Seasonality – summer and fall is characteristic.

Pathogeny:

Features of a course of infectious process at a salmonellosis in many respects depend on many factors: properties and doses of the activator, condition of a macroorganism. So, persons with hemoglobinopathies, reduced gastric secretion, children up to 5 years are ill heavier. Diarrhea – an optional symptom of salmonellosis, as not all salmonellas but only enterotoxigenic strains, form enterotoxin.
Infection occurs through a digestive tract. Mass death of salmonellas is followed by a toxaemia. Sometimes the disease can will end at a stage of death of the activator in a stomach. If the activator overcame protective barriers (acidity of a gastric juice, antagonistic action of microflora) of a salmonella breed in a small bowel. The endotoxin emitted by salmonellas causes aggregation of thrombocytes of blood that promotes a thrombogenesis. Formation of enterotoxin involves adenylatecyclase stimulation, increase in formation of tsATF against the background of what a water exit from a gleam of cells of an intestinal epithelium increases. Clinically this mechanism is shown by diarrhea.

Salmonellosis symptoms:

The gastrointestinal form of a salmonellosis is characterized by an incubation interval from 2 hours to several days, the acute beginning of a disease, a collapse, a faint, weakness, a megalgia in a stomach. Fervescence, vomiting, nausea is observed. The disease proceeds as food toxicoinfection.
At a gastritichesky form of a salmonellosis of diarrhea can not be.
Enteritis – the most constant sign to a gastrointestinal form of a salmonellosis.
Less often the generalized option which includes typhus-like and septicopyemic option meets.
The typhus-like type of development of a salmonellosis is followed by a fever, fever, enteritis and a gastroenteritis. The injection of scleras, emergence of rash is possible.
Besides, there is the heaviest option of a current – septicopyemic which is followed by the phenomena of infectious and toxic shock. Tachycardia, hypotension, the remettiruyushchy nature of fever is observed. The secondary centers of an inflammation in lungs, a pleura, heart and a pericardiac bag, muscular tissue form.
Duration of a bakteriovydeleniye makes from several weeks to several years, and even for life.
At any form of a salmonellosis injury of kidneys is observed.
Salmonellosis complications:
- collapse
- infectious and toxic shock
- trombogemorragichesky syndrome
- toxic encephalopathy
- wet brain
- reactive arthritis.

Diagnosis:

At suspicion of salmonellosis of the patient makes the tests confirming the diagnosis.
From obligatory laboratory analyses appoint biochemical analysis of blood - renal and hepatic tests, level of amylase, glucose, electrolytes, a koagulogramma.
Specific researches: identification of the activator by a bacteriological method of inoculation of medium of Ploskirev.
Also with the diagnostic purpose statement of reaction of an interfacia, carrying out serological tests – RA and reaction of an indirect gemagllyutination (RNGA), reaction of an immunofluorescence is applied (REEF).

Example of the formulation of the diagnosis: Salmonellosis, Sal. Enteriditis, gastrointestinal form, gastroenterokolitichesky option, moderate severity. Dehydration of 1 Art., toxicosis of 1 Art., ITSh of 1 St.
Justification of the diagnosis. The diagnosis is made on the basis of the acute beginning of a disease, fervescence to 38-39 C, other symptoms of intoxication, emergence of pain with localization in epigastriums, paraumbilical, left ileal area, repeated vomiting, a repeated liquid, fetid chair of green color, with slime impurity. Objectively: morbidity in a stomach at a palpation, moderately spazmirovanny sigma, allocations from a calla and washing waters of a stomach Sal. Enteriditis given the epidemiological anamnesis with the use of thermally raw products.

Treatment of the Salmonellosis:

In the acute period of a disease of the patient the dietary table No. 4 on Pevznera is recommended, and after the termination of diarrhea pass to a table No. 13.
At the heavy course of salmonellosis, and also at development of complications patients with a salmonellosis are subject to hospitalization in infectious department. The expressed phenomena of toxicosis and dehydration are direct indications for a bed rest.
First of all, it is necessary to hold the events promoting removal of the remained bacteria from a digestive tract namely – carrying out siphon enemas, gastric lavages, use of enterosorbents.
Dehydration of an organism demands correction of water-salt balance. At dehydration 1-2 degrees appoint glyukozo-saline solutions, for example, of "Oralit", Tsitroglyukosolan, Regidron, Glyukosolan inside taking into account the deficit of water and salts at the patient prior to therapy filled by fractional frequent drink (to 1 - 1,5 l/hour) during 2-3 h, and further losses of liquid in the course of treatment (it is necessary to control each 2-4 h).
At more expressed dehydration corresponding 3-4 degrees of dehydration, intravenous infusions of crystalloid isotonic polyionic solutions are shown. Their introduction is continued before full stopping of signs of dehydrational shock. It is necessary to control the level of potassium ions in blood, and if necessary to appoint potassium drugs - potassium оротат or potassium chloride on 1 g to the 4th once a day.
After correction of water and electrolytic disturbances it is necessary to begin introduction of colloids – Neogemodez, Haemodesum, Reopoliglyukin.
At the expressed metabolic acidosis it is necessary to enter in addition sodium bicarbonate in the form of 4% of solution. At the same time it is necessary kontrolirovatpokazatel of acid-base balance.  As anti-inflammatory drug, and also apply indometacin in the scheme on 50 mg to 3 times a day to elimination of signs of a toxaemia and intoxication.  
Antibacterial therapy is reasonable only at generalized formazkh of a salmonellosis (ampicillin, Biseptolum or parenteral administration of levomycetinum of succinate). In addition to treatment appoint complex fermental drugs – festal, панзинорм, enzistat.
The septicopyemic option demands the strengthened purpose of antibacterial therapy. At an endocarditis ampicillin, Biseptolum is shown. At meningitis of a salmonellezny etiology – cephalosporins of the 3rd generation.