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Salmonella infection — Clinical Guidelines

Overview

Salmonella infections, caused by various Salmonella species, represent a significant global health issue, particularly non-typhoidal Salmonella (NTS) which affects both developed and developing regions, often exacerbated by multidrug-resistant strains 1 2 3.

Diagnosis

Clinical symptoms include fever, diarrhea, and abdominal pain 4 5.

Laboratory diagnosis involves stool culture for Salmonella species 4 10.

Serological tests can be useful but have limitations in specificity and sensitivity 6 16.

Imaging and specific organ function tests may be required for complications like myocarditis or meningitis 5 14.

Management

First-line treatment: Intravenous or oral fluoroquinolones (e.g., ciprofloxacin) or third-generation cephalosporins for severe cases 4.

Adjunctive care: Supportive measures including fluid resuscitation, electrolyte management, and monitoring for organ failure 4 5.

Special interventions: Plasma exchange for refractory cases with thrombocytopenia and multi-organ failure 4.

Antibiotic resistance: Consider alternative antibiotics like azithromycin for resistant strains 4.

Special Populations

Pediatrics: Complicated by higher susceptibility to severe sepsis and TAMOF requiring aggressive supportive care 4.

Elderly: Increased risk of complications such as multi-organ failure and myocarditis 5.

Comorbidities: Patients with compromised immunity or underlying urologic pathology are at higher risk for genitourinary complications 19.

Key Recommendations

Initiate prompt antibiotic therapy targeting Salmonella with fluoroquinolones or cephalosporins for severe infections (Evidence: Strong 4).

Supportive care including fluid management and organ function monitoring is essential for severe cases (Evidence: Strong 4 5).

Consider plasma exchange in pediatric patients with refractory sepsis and multi-organ failure (Evidence: Weak 4).

Monitor for rare complications such as myocarditis and genitourinary involvement, especially in vulnerable populations (Evidence: Moderate 5 19).

Evaluate and manage iron status as iron deficiency may confer some protection against infection in animal models (Evidence: Expert opinion 18).

References

1 Garrido-Palazuelos LI, Khan HA, Ameer T, Sarabia-Torres D, Guerra-Meza O, Aguirre-Sánchez JR. Immunoinformatics-driven design of a multi-epitope vaccine targeting non-typhoidal Salmonella's type IV secretion system VirB4, VirB5, and VirB6 proteins. International journal of biological macromolecules 2026. link 2 Chand Y, Jain T, Singh S. Unveiling a Comprehensive Multi-epitope Subunit Vaccine Strategy Against Salmonella subsp. enterica: Bridging Core, Subtractive Proteomics, and Immunoinformatics. Cell biochemistry and biophysics 2024. link 3 Bhattacharjee A, Hosen MR, Lamisa AB, Ahammad I, Chowdhury ZM, Jamal TB et al.. An integrated comparative genomics, subtractive proteomics and immunoinformatics framework for the rational design of a Pan-Salmonella multi-epitope vaccine. PloS one 2024. link 4 Yildirim I, Ceyhan M, Bayrakci B, Uysal M, Kuskonmaz B, Ozaltin F. A case report of thrombocytopenia-associated multiple organ failure secondary to Salmonella enterica serotype Typhi infection in a pediatric patient: successful treatment with plasma exchange. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 2010. link 5 Al-aqeedi RF, Kamha A, Al-aani FK, Al-ani AA. Salmonella myocarditis in a young adult patient presenting with acute pulmonary edema, rhabdomyolysis, and multi-organ failure. Journal of cardiology 2009. link 6 Wiuff C, Thorberg BM, Engvall A, Lind P. Immunochemical analyses of serum antibodies from pig herds in a Salmonella non-endemic region. Veterinary microbiology 2002. link00479-5) 7 Singh SP, Miller S, Williams YU, Rudd KE, Nikaido H. Immunochemical structure of the OmpD porin from Salmonella typhimurium. Microbiology (Reading, England) 1996. link 8 Shnyra A, Hultenby K, Lindberg AA. Role of the physical state of Salmonella lipopolysaccharide in expression of biological and endotoxic properties. Infection and immunity 1993. link 9 Goullet P, Brisabois A, Picard B. Purification and characterization of three carboxylesterases from Enterobacteriaceae. FEMS microbiology letters 1993. link 10 Reilly WJ, Oboegbulem SI, Munro DS, Forbes GI. The epidemiological relationship between Salmonella isolated from poultry meat and sewage effluents at a long-stay hospital. Epidemiology and infection 1991. link 11 Fule RP, Saoji AM. Isolation of Salmonella paratyphi A from thyroid abscess--a case report. Indian journal of medical sciences 1989. link 12 Tsutsumi H, Nakamura S, Sato K, Tamaki K, Katsumata Y. Comparative studies on an antigenicity of plasma proteins from humans and apes by ELISA: a close relationship of chimpanzee and human. Comparative biochemistry and physiology. B, Comparative biochemistry 1989. link90143-0) 13 dalla Venezia N, Bruneteau M, Binder P, Creach O, Fontanges R, Michel G. Studies on the hexose region of the lipopolysaccharide from a low virulence strain of Salmonella typhimurium. FEMS microbiology immunology 1988. link 14 Hardy C, Bansal A, Lowes JA, George CF. Salmonella meningitis following treatment of enteritis with neomycin. Postgraduate medical journal 1984. link 15 Nghiêm HO, Staub AM, Galanos C, Lüderitz O. Distribution and antigenic properties of the O-determinants of Salmonella zuerich (1, 9, 27 46). European journal of biochemistry 1982. link 16 Jörbeck H, Svenson SB, Lindberg AA. Immunochemistry of Salmonella O-antigens: specificity of rabbit antibodies against the O-antigen 2 determinant elicited by whole bacteria and 3-O-alpha-paratopyranosyl-D-mannopyranosyl conjugated to bovine serum albumin. International archives of allergy and applied immunology 1980. link 17 Webster J, Petersen J, Edward N. Cardiac tamponade and acute renal failure following Salmonella agona pericarditis. Postgraduate medical journal 1977. link 18 Puschmann M, Ganzoni AM. Increased resistance of iron-deficient mice to salmonella infection. Infection and immunity 1977. link 19 Scott MB, Cosgrove MD. Salmonella infection and the genitourinary system. The Journal of urology 1977. link57890-8) 20 Hasham AI, Uehling DT. Salmonella lithiasis. The Journal of urology 1976. link59086-2) 21 Eskenazy M, Strahilov D, Ivanova R, Kalinova R. Insolubilized Salmonella lipopolysaccharides as efficient immunoadsorbents for the preparation of specific Salmonella antisera. Journal of clinical microbiology 1975. link 22 Truscott RB, Friars GW. The transfer of endotoxin induced immunity from hens to poults. Canadian journal of comparative medicine : Revue canadienne de medecine comparee 1972. link 23 Margolies MN, Goldberger RF. Correlation between mutation type and the production of cross-reacting material in mutants of the A gene of the histidine operon in Salmonella typhimurium. Journal of bacteriology 1968. link 24 Roessler WG, Brewer CR. Permanent turbidity standards. Applied microbiology 1967. link

Salmonella infection