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Invasive non-typhoidal salmonellosis — Clinical Guidelines

Overview

Invasive non-typhoidal salmonellosis (iNTS) is a severe form of infection caused by non-typhoidal Salmonella serovars, often leading to systemic illness, particularly in immunocompromised individuals and those in endemic regions 1. It can manifest through various routes of transmission, including contaminated food items like cantaloupes and turkey 3 4.

Diagnosis

Clinical Presentation: Symptoms include fever, bacteremia, and focal infections such as meningitis or sepsis 8.

Laboratory Tests: Blood cultures are crucial for diagnosis, often revealing Salmonella species 3 4.

Epidemiological Clues: History of food exposure or travel to endemic areas can guide suspicion 3 6.

Management

Antibiotics: Initial treatment often involves third-generation cephalosporins or fluoroquinolones, tailored based on local resistance patterns 4.

Supportive Care: Fluid resuscitation, electrolyte management, and monitoring for complications such as sepsis 4.

Targeted Therapy: Adjust antibiotic choice based on susceptibility testing results 4.

Special Populations

Immunocompromised Individuals: Higher risk for invasive disease; close monitoring and prompt antibiotic therapy are essential 8.

Pediatrics: Specific dosing adjustments may be necessary; supportive care is critical 4.

Key Recommendations

Culture Confirmation: Always perform blood cultures to confirm diagnosis (Evidence: Strong 3 4).

Antibiotic Therapy: Initiate broad-spectrum antibiotics like ceftriaxone or ciprofloxacin, adjusting based on local resistance profiles (Evidence: Moderate 4).

Supportive Measures: Implement aggressive supportive care including fluid management and monitoring for sepsis (Evidence: Moderate 4).

Epidemiological Investigation: Conduct thorough epidemiological investigations to identify sources of infection, especially in outbreaks (Evidence: Expert opinion 3 6).

References

1 Igomu EE, Mamman PH, Adamu J, Muhammad M, Woziri AO, Sugun MY et al.. Immunoinformatics design of a novel multiepitope vaccine candidate against non-typhoidal salmonellosis caused by Salmonella Kentucky using outer membrane proteins A, C, and F. PloS one 2025. link 2 Guerrero T, Bayas-Rea R, Erazo E, Zapata Mena S. Nontyphoidal . Foodborne pathogens and disease 2022. link 3 . Multistate outbreak of Salmonella poona infections--United States and Canada, 1991. MMWR. Morbidity and mortality weekly report 1991. link 4 . Foodborne nosocomial outbreak of Salmonella reading--Connecticut. MMWR. Morbidity and mortality weekly report 1991. link 5 Tsang RS, Chan KH, Lau NW, Choi DK, Law DK, Ng MH. Characterization of murine monoclonal antibodies against serogroup B salmonellae and application as serotyping reagents. Journal of clinical microbiology 1991. link 6 Smyth B, McCann R, Stewart D. An outbreak of salmonellosis amongst holidaymakers in Madeira, July 1988. The Ulster medical journal 1989. link 7 Neundörfer B, Claus D, Waller D. Brachial neuritis in salmonellosis. Journal of neurology 1984. link 8 Lowes JA, Clark AJ, Britten KE. Chronic Salmonella eimsbuettel septicaemia presenting with intermittent sweats and haematuria. Postgraduate medical journal 1980. link 9 Enkiri NK, Alford JA. Relationship of the frequency of isolation of Salmonellae to their resistance to drying and freezing. Applied microbiology 1971. link 10 Thomason BM, Wells JG. Preparation and testing of polyvalent conjugates for fluorescent-antibody detection of salmonellae. Applied microbiology 1971. link 11 Julseth RM, Deibel RH. Effect of temperature on growth of Salmonella in rehydrated skim milk from a food-poisoning outbreak. Applied microbiology 1969. link 12 Barber C, Eylan E, Keydar Y. Contributions on the study of Salmonella. Further studies on the protein determinants shared by Salmonellae of groups B and D; variations in the immune response of different hybrid rabbits. Immunology 1968. link 13 Kurashige S, Osawa N, Kawakami M, Mitsuhashi S. Experimental salmonellosis. X. Cellular immunity and its antibody in mouse mononuclear phagocytes. Journal of bacteriology 1967. link 14 Osawa N, Kawakami M, Kurashige S, Mitsuhashi S. Experimental salmonellosis. 8. Postinfective immunity and its significance for conferring cellular immunity. Journal of bacteriology 1967. link

Invasive non-typhoidal salmonellosis