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Nontyphoidal Salmonella: Gastrointestinal infection and carriage

Elizabeth L Hohmann, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Salmonellae are motile gram-negative bacilli that infect or colonize a wide range of mammalian hosts. They cause a number of characteristic clinical infections in humans, including:


Enteric fever (systemic illness with fever and abdominal symptoms)

Bacteremia and endovascular infection

Focal metastatic infections such as osteomyelitis or abscess

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Literature review current through: Nov 2017. | This topic last updated: Feb 18, 2016.
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  1. Brooks JT, Matyas BT, Fontana J, et al. An outbreak of Salmonella serotype Typhimurium infections with an unusually long incubation period. Foodborne Pathog Dis 2012; 9:245.
  2. Abe K, Saito N, Kasuga F, Yamamoto S. Prolonged incubation period of salmonellosis associated with low bacterial doses. J Food Prot 2004; 67:2735.
  3. Mintz ED, Cartter ML, Hadler JL, et al. Dose-response effects in an outbreak of Salmonella enteritidis. Epidemiol Infect 1994; 112:13.
  4. Liu LJ, Yang YJ, Kuo PH, et al. Diagnostic value of bacterial stool cultures and viral antigen tests based on clinical manifestations of acute gastroenteritis in pediatric patients. Eur J Clin Microbiol Infect Dis 2005; 24:559.
  5. SAPHRA I, WINTER JW. Clinical manifestations of salmonellosis in man; an evaluation of 7779 human infections identified at the New York Salmonella Center. N Engl J Med 1957; 256:1128.
  6. From the Centers for Disease Control. Outbreak of Salmonella enteritidis infection associated with consumption of raw shell eggs. JAMA 1992; 267:3263.
  7. Helms M, Simonsen J, Molbak K. Quinolone resistance is associated with increased risk of invasive illness or death during infection with Salmonella serotype Typhimurium. J Infect Dis 2004; 190:1652.
  8. Patrick ME, Adcock PM, Gomez TM, et al. Salmonella enteritidis infections, United States, 1985-1999. Emerg Infect Dis 2004; 10:1.
  9. Krueger AL, Greene SA, Barzilay EJ, et al. Clinical outcomes of nalidixic acid, ceftriaxone, and multidrug-resistant nontyphoidal salmonella infections compared with pansusceptible infections in FoodNet sites, 2006-2008. Foodborne Pathog Dis 2014; 11:335.
  10. Cohen JI, Bartlett JA, Corey GR. Extra-intestinal manifestations of salmonella infections. Medicine (Baltimore) 1987; 66:349.
  11. SAPHRA I, WASSERMANN M. Salmonella cholerae suis: a clinical and epidemiological evaluation of 329 infections identified between 1940 and 1954 in the New York Salmonella Center. Am J Med Sci 1954; 228:525.
  12. Wang JH, Liu YC, Yen MY, et al. Mycotic aneurysm due to non-typhi salmonella: report of 16 cases. Clin Infect Dis 1996; 23:743.
  13. Cherubin CE, Neu HC, Imperato PJ, et al. Septicemia with non-typhoid salmonella. Medicine (Baltimore) 1974; 53:365.
  14. Rice PA, Craven C, Wells JG. Salmonella heidelberg enteritis and bacteremia. An epidemic on two pediatric wards. Am J Med 1976; 60:509.
  15. Varma JK, Molbak K, Barrett TJ, et al. Antimicrobial-resistant nontyphoidal Salmonella is associated with excess bloodstream infections and hospitalizations. J Infect Dis 2005; 191:554.
  16. Perry MD, Corden SA, Howe RA. Evaluation of the Luminex xTAG Gastrointestinal Pathogen Panel and the Savyon Diagnostics Gastrointestinal Infection Panel for the detection of enteric pathogens in clinical samples. J Med Microbiol 2014; 63:1419.
  17. Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev 2012; 11:CD001167.
  18. Wiström J, Jertborn M, Ekwall E, et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med 1992; 117:202.
  19. Mattila L, Peltola H, Siitonen A, et al. Short-term treatment of traveler's diarrhea with norfloxacin: a double-blind, placebo-controlled study during two seasons. Clin Infect Dis 1993; 17:779.
  20. Dryden MS, Gabb RJ, Wright SK. Empirical treatment of severe acute community-acquired gastroenteritis with ciprofloxacin. Clin Infect Dis 1996; 22:1019.
  21. Goodman LJ, Trenholme GM, Kaplan RL, et al. Empiric antimicrobial therapy of domestically acquired acute diarrhea in urban adults. Arch Intern Med 1990; 150:541.
  22. Geme JW 3rd, Hodes HL, Marcy SM, et al. Consensus: management of Salmonella infection in the first year of life. Pediatr Infect Dis J 1988; 7:615.
  23. Gökalp AS, Toksoy HB, Türkay S, et al. Intravenous immunoglobulin in the treatment of Salmonella typhimurium infections in preterm neonates. Clin Pediatr (Phila) 1994; 33:349.
  24. American Academy of Pediatrics. Salmonella infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.695.
  25. Benenson S, Raveh D, Schlesinger Y, et al. The risk of vascular infection in adult patients with nontyphi Salmonella bacteremia. Am J Med 2001; 110:60.
  26. Cohen PS, O'Brien TF, Schoenbaum SC, Medeiros AA. The risk of endothelial infection in adults with salmonella bacteremia. Ann Intern Med 1978; 89:931.
  27. Gordon MA. Salmonella infections in immunocompromised adults. J Infect 2008; 56:413.
  28. Gordon MA, Banda HT, Gondwe M, et al. Non-typhoidal salmonella bacteraemia among HIV-infected Malawian adults: high mortality and frequent recrudescence. AIDS 2002; 16:1633.
  29. Hung CC, Hsieh SM, Hsiao CF, et al. Risk of recurrent non-typhoid Salmonella bacteraemia after early discontinuation of ciprofloxacin as secondary prophylaxis in AIDS patients in the era of highly active antiretroviral therapy. AIDS 2001; 15:645.
  30. Chou YJ, Lin HW, Yang CJ, et al. Risk of recurrent nontyphoid Salmonella bacteremia in human immunodeficiency virus-infected patients with short-term secondary prophylaxis in the era of combination antiretroviral therapy. J Microbiol Immunol Infect 2016; 49:760.
  31. Kassis I, Dagan R, Chipman M, et al. The use of prophylactic furazolidone to control a nosocomial epidemic of multiply resistant Salmonella typhimurium in pediatric wards. Pediatr Infect Dis J 1990; 9:551.
  32. Dyson C, Ribeiro CD, Westmoreland D. Large scale use of ciprofloxacin in the control of a Salmonella outbreak in a hospital for the mentally handicapped. J Hosp Infect 1995; 29:287.
  33. Grady R. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J 2003; 22:1128.
  34. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguideline s/adult_oi.pdf (Accessed on November 04, 2015).
  35. Buchwald DS, Blaser MJ. A review of human salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella. Rev Infect Dis 1984; 6:345.
  36. Sirinavin S, Thavornnunth J, Sakchainanont B, et al. Norfloxacin and azithromycin for treatment of nontyphoidal salmonella carriers. Clin Infect Dis 2003; 37:685.
  37. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics 1980; 65:1125.
  38. Marzel A, Desai PT, Goren A, et al. Persistent Infections by Nontyphoidal Salmonella in Humans: Epidemiology and Genetics. Clin Infect Dis 2016; 62:879.
  39. Carlstedt G, Dahl P, Niklasson PM, et al. Norfloxacin treatment of salmonellosis does not shorten the carrier stage. Scand J Infect Dis 1990; 22:553.
  40. Neill MA, Opal SM, Heelan J, et al. Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers. Ann Intern Med 1991; 114:195.
  41. Corrado ML, DuPont HL, Cooperstock M, et al. Evaluation of new anti-infective drugs for the treatment of chronic carriage of Salmonella. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992; 15 Suppl 1:S259.
  42. Musher DM, Rubenstein AD. Permanent carriers of nontyphosa salmonellae. Arch Intern Med 1973; 132:869.
  43. Nagaraja V, Eslick GD. Systematic review with meta-analysis: the relationship between chronic Salmonella typhi carrier status and gall-bladder cancer. Aliment Pharmacol Ther 2014; 39:745.
  44. Nelson MR, Shanson DC, Hawkins DA, Gazzard BG. Salmonella, Campylobacter and Shigella in HIV-seropositive patients. AIDS 1992; 6:1495.
  45. Roberts C, Wilkins EG. Salmonella screening of pregnant women. J Hosp Infect 1987; 10:67.
  46. Citernesi A, Spinelli G, Piazzesi G, et al. [Screening for Salmonella in pregnancy]. Minerva Ginecol 1994; 46:681.
  47. Gyang A, Saunders M. Salmonella Mississippi: a rare cause of second trimester miscarriage. Arch Gynecol Obstet 2008; 277:437.
  48. Scialli AR, Rarick TL. Salmonella sepsis and second-trimester pregnancy loss. Obstet Gynecol 1992; 79:820.
  49. Coughlin LB, McGuigan J, Haddad NG, Mannion P. Salmonella sepsis and miscarriage. Clin Microbiol Infect 2003; 9:866.
  50. Rai B, Utekar T, Ray R. Preterm delivery and neonatal meningitis due to transplacental acquisition of non-typhoidal Salmonella serovar montevideo. BMJ Case Rep 2014; 2014.
  51. van der Klooster JM, Roelofs HJ. Management of Salmonella infections during pregnancy and puerperium. Neth J Med 1997; 51:83.
  52. Sirinavin S, Chiemchanya S, Vorachit M. Systemic nontyphoidal Salmonella infection in normal infants in Thailand. Pediatr Infect Dis J 2001; 20:581.
  53. Molyneux EM, Mankhambo LA, Phiri A, et al. The outcome of non-typhoidal salmonella meningitis in Malawian children, 1997-2006. Ann Trop Paediatr 2009; 29:13.
  54. Umasankar S, Mridha EU, Hannan MM, et al. An outbreak of Salmonella enteritidis in a maternity and neonatal intensive care unit. J Hosp Infect 1996; 34:117.
  55. Mahajan R, Mathur M, Kumar A, et al. Nosocomial outbreak of Salmonella typhimurium infection in a nursery intensive care unit (NICU) and paediatric ward. J Commun Dis 1995; 27:10.
  56. Benenson AS. Control of Communicable Diseases Manual, 16th ed, American Public Health Association, Washington, DC 1995.
  57. Mandal B. Typhoid fever and other Salmonellae. Curr Opin Infect Dis 1988; 1:84.
  58. Dryden MS, Keyworth N, Gabb R, Stein K. Asymptomatic foodhandlers as the source of nosocomial salmonellosis. J Hosp Infect 1994; 28:195.
  59. Khuri-Bulos NA, Abu Khalaf M, Shehabi A, Shami K. Foodhandler-associated Salmonella outbreak in a university hospital despite routine surveillance cultures of kitchen employees. Infect Control Hosp Epidemiol 1994; 15:311.
  60. Standaert SM, Hutcheson RH, Schaffner W. Nosocomial transmission of Salmonella gastroenteritis to laundry workers in a nursing home. Infect Control Hosp Epidemiol 1994; 15:22.
  61. Weikel CS, Guerrant RL. Nosocomial salmonellosis. Infect Control 1985; 6:218.
  62. Tauxe RV, Hassan LF, Findeisen KO, et al. Salmonellosis in nurses: lack of transmission to patients. J Infect Dis 1988; 157:370.