Nontyphoidal Salmonella bacteremia
- Elizabeth L Hohmann, MD
Elizabeth L Hohmann, MD
- Associate Professor of Medicine
- Harvard Medical School
Nontyphoidal salmonellae are an important bacterial cause of diarrheal disease. The epidemiology and pathophysiology of nontyphoidal strains differ from typhoidal strains . (See "Epidemiology, microbiology, clinical manifestations, and diagnosis of typhoid fever".)
Issues related to the epidemiology, clinical microbiology, clinical manifestations, and treatment of nontyphoidal Salmonella bacteremia will be reviewed here. Nontyphoidal Salmonella gastrointestinal disease and typhoid fever are discussed in detail separately. (See "Nontyphoidal Salmonella: Gastrointestinal infection and carriage" and "Treatment and prevention of typhoid fever".)
Incidence — Bacteremia and other forms of extraintestinal Salmonella infection are serious complications that may not be suspected in the setting of mild primary infection. The burden varies geographically. In a systematic review that extrapolated the global incidence of invasive nontyphoidal Salmonella infections based on 10 studies, there were an estimated 49 cases per 100,000 people worldwide in 2010 . The greatest burden was in Africa, which had an estimated incidence of 227 cases per 100,000 people. Approximately 65 percent of cases worldwide are in children younger than five years.
It is estimated that perhaps 1 percent of enteric infections with nontyphoidal Salmonella result in bacteremia, but the true rate of bacteremia is unknown, as many primary enteric infections are mild or not microbiologically diagnosed.
Risk factors — Factors affecting the incidence of bacteremia include Salmonella serotype, geographic location, time of year, and host factors. Host risk factors for nontyphoidal Salmonella bacteremia include extremes of age and chronic or immunosuppressing conditions, including malignancy, rheumatological disease, TNF blockade (eg, agents such as etanercept or infliximab), transplantation, HIV infection, and congenital immune defects [3-6]. Other predisposing comorbidities include liver disease, hemoglobinopathies (especially sickle cell disease), schistosomiasis, and chronic granulomatous disease. Alteration of the GI tract also predisposes to progression from enteric to systemic salmonellosis (eg, by suppression of gastric acid, malnutrition, recent antibiotic use, or rotavirus infection) . (See "Pathogenesis of Salmonella gastroenteritis".)
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- Risk factors
- MICROBIOLOGY AND DIAGNOSIS
- CLINICAL MANIFESTATIONS
- Extraintestinal focal infection
- Endovascular infection
- Antibiotic selection
- Duration of therapy
- - Bacteremia
- - Extraintestinal focal infections and endovascular infection
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS