salmonellosis

Salmonellosis - an acute infectious disease caused by salmonella; It is characterized by a variety of clinical manifestations, from asymptomatic carriage to severe septic forms. Most often it occurs with a primary lesion of the digestive system (gastroenteritis, colitis).

Etiology, pathogenesis. Pathogen - a large group of Salmonella, currently has about 2,000 serotypes. Relatively common in people meet about 90 serotypes, 10 of them causes g 85-91% of human Salmonella infections. Salmonella is a gram-negative bacilli, have flagella, mobile, grow well on nutrient media; long-term (several months) are stored in the external environment, the products, and in some of them (milk, meat products) are able to reproduce without changing the appearance and taste of the products. Gated infection is preferably the mucosa of the small intestine, wherein the Salmonella are capable of intracellular parasitism in macrophages and reticulocytes. In generalized form of salmonella get into the blood, and in septic recorded in various organs where secondary purulent lesions are formed. Eye-catching salmonella endotoxin causes multiple organ damage. In severe forms of dehydration may develop, as well as toxic shock.

Symptoms within. The incubation period of from 6 hours to 3 days (usually 12-24 hours). The most common form of gastrointestinal (before it attributed to foodborne diseases) begins acutely, with the increase in body temperature to 38-40 ° C, fever and symptoms of intoxication. There are also a pain in the epigastric region, nausea, vomiting, and a few hours later - diarrhea. Stool thin, watery, fetid, up to 10-15 times a day. Tenesmus, false desires, as well as blood in the stool is not marked. With abundant and frequent stools repeated vomiting syndrome may develop dehydration: thirst, oliguria, cyanosis of the lips, sunken eyes, wrinkled skin, convulsions, decreased blood pressure. The fever lasts 2-5 days. In mild form of the disease is limited to low grade fever, vomiting, and a small single chair indulgence: all phenomena take place in 1-2 days.

Tifopodobnaya form of their manifestation is not very different from typhoid fever, the diagnosis to be confirmed after the blood culture isolation of Salmonella. The most difficult runs a septic form of salmonella. She begins acutely, accompanied by a pronounced toxicity, the wrong type of fever, with large daily scope, chills, and then repeated, lasts for weeks. The disease responds poorly to antibiotic therapy. Secondary purulent lesions often develop in the locomotor system (osteomyelitis, arthritis, spondylitis). Sometimes there Salmonella septic endocarditis, aorta with subsequent development of aortic aneurysm, purulent meningitis, rarely occur liver abscesses, purulent strumitis, infected ovarian cyst. Colitis form of salmonellosis is similar to acute dysentery. There may be tenesmus, false desires, blood in the stool, catarrhal-hemorrhagic Proctosigmoiditis (according sigmoidoscopy), and others. For the diagnosis, in addition to the clinical manifestations are important epidemiological preconditions (the group nature of diseases, the relationship with a particular product). For laboratory confirmation of the diagnosis has the greatest value abjection (explore the remnants of food, vomit, feces, blood in generalized forms pus in septic forms of the disease).

Treatment. When gastrointestinal form as early as possible is washed with 2.3 liters of water stomach or 2% sodium bicarbonate solution. Washing is carried out using a stomach tube to the discharge of clean washing water. In milder forms of limited gastric lavage, diet and drinking salt solutions. Typically, a solution of the following composition: sodium chloride - 3.5 g Potassium chloride - 1.5 g of sodium hydrogen carbonate - 2.5 g glucose - 20 g per 1 liter of drinking water. The amount of liquid should correspond to its loss (no more than 3% of body weight).

With an average severity of gastrointestinal form of salmonellosis, the absence of vomiting and pronounced hemodynamic liquid can also be administered orally. With an increase in dehydration rehydration is carried out in the same manner as in cholera.

With the development of infectious-toxic shock, in addition to polyionic solutions, introduced gemodez, polyglukin, reopoligljukin at 400-1000 ml, administered 60 to 90 mg of prednisone or hydrocortisone 125-250 mg / bolus and, in 4 to 6 hours moving to a drip ( up to 120-300 mg per day prednizopona). At the same time introduced deoxycorticosterone acetate 5-10 mg / m every 12 hours. Tifopodobnaya forms are treated the same as typhoid. When septic forms combine long appointment ampicillin (4-6 g / day) with surgical treatment of purulent lesions.

Forecast. In most cases, recovery occurs. In some patients, chronic forms bacteriocarrier for all clinical variants.

Prevention. Veterinary-sanitary supervision of the slaughter cattle, control of preparation and storage of meat and fish dishes. Convalescents are issued after full clinical recovery and holding a double bacteriological study of feces.