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Gastroenteritis, Salmonella

For further information, see CMDT Part 33-17: Salmonellosis

Key Features

  • Most common form of salmonellosis is acute enterocolitis, which can be caused by both typhoidal and non-typhoidal Salmonella

  • The incubation period is 8–48 h after ingestion of contaminated food or liquid

Clinical Findings

  • Fever (often with chills), nausea and vomiting, cramping abdominal pain, and diarrhea, which may be grossly bloody, lasting 3–5 days

  • Usually self-limited, but bacteremia with localization in joints or bones may occur, especially in patients with sickle cell disease or immunocompromised persons (Table 30–3)

  • Differential diagnosis

    • Viral gastroenteritis

    • Food poisoning

    • Shigellosis

    • Amebic dysentery

    • Acute ulcerative colitis

Table 30–3.Acute bacterial diarrheas and "food poisoning" (listed in alphabetical order).
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Table 30–3. Acute bacterial diarrheas and "food poisoning" (listed in alphabetical order).
Organism Incubation Period Vomiting Diarrhea Fever Associated Foods Diagnosis Clinical Features and Treatment
Bacillus cereus (diarrheal toxin) 10–16 hours ± +++ – Toxin in meats, stews, and gravy. Clinical. Food and stool can be tested for toxin. Abdominal cramps, watery diarrhea, and nausea lasting 24–48 hours. Supportive care.
Bacillus cereus (preformed toxin) 1–8 hours +++ ± – Reheated fried rice causes vomiting or diarrhea. Clinical. Food and stool can be tested for toxin. Acute onset, severe nausea and vomiting lasting 24 hours. Supportive care.
Campylobacter jejuni 2–5 days ± +++ + Raw or undercooked poultry, unpasteurized milk, water. Stool culture on special medium. Fever, diarrhea that can be bloody, cramps. Usually self-limited in 2–10 days. Treat with azithromycin. Fluoroquinolones can be used if susceptibility is confirmed. May be associated with Guillain-Barré syndrome.
Clostridium botulinum 12–72 hours ± – – Clostridia grow in anaerobic acidic environment, eg, canned foods, fermented fish, foods held warm for extended periods. Stool, serum, and food can be tested for toxin. Stool and food can be cultured. Diplopia, dysphagia, dysphonia, respiratory embarrassment. Treatment requires clear airway, ventilation, and intravenous polyvalent antitoxin (see text). Symptoms can last for days to months.
Clostridioides difficile Usually occurs after 7–10 days of antibiotics. Can occur after a single dose or several weeks after completion of antibiotics. – +++ ++ Associated with antibacterial drugs; clindamycin and beta-lactams most commonly implicated. Fluoroquinolones associated with hypervirulent strains. Stool tested for toxin. Abrupt onset of diarrhea that may be bloody; fever. Vancomycin 125 mg orally four times per day or fidaxomicin 200 mg twice daily for 10 days.
Clostridium perfringens 8–16 hours ± +++ – Clostridia grow in rewarmed meat and poultry dishes and produce an enterotoxin. Stools can be tested for enterotoxin or cultured. Abrupt onset of profuse diarrhea, abdominal cramps, nausea; vomiting occasionally. Recovery usual without treatment in 24–48 hours. Supportive care; antibiotics not needed.
Enterohemorrhagic Escherichia coli, including Shiga-toxin–producing E coli strains (STEC) 1–8 days + +++ – Undercooked beef, especially hamburger; unpasteurized milk and juice; raw fruits and vegetables. Shiga-toxin–producing E coli can ...

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