salmonellosis

Salmonellosis - an infectious disease characterized by a variety of clinical manifestations - from asymptomatic carriage to severe septic flow. Most often it occurs in the form of gastrointestinal forms (gastroenteritis, gastroenterokolity). Pathogen - a large group of Salmonella. Salmonella is a gram-negative rods, motile, have flagella contain endotoxin. Long remain in the environment: water - up to 120 days, in meat and meat products - from 2 to 4 months in cheeses - up to 1 year in soil - 18 months. In some products (eggs, milk, meat products), they are able to not only be maintained, but also to reproduce without changing the taste and appearance of products. Salting and smoking have on them very little impact.

The source of the infectious agents are different animals .- large and small cattle, pigs, chickens, ducks, geese, pigeons, as well as patients and bacillicarriers Salmonella (mostly sick children, mothers, the staff of medical institutions). The carrier may continue for a long time recovering from illness. Most infected people comes through the alimentary by eating foods that contain large amounts of salmonella. Usually this occurs at irregular cooking, when contaminated foods, mainly meat (minced meat and products out of it, jelly, meat salads, cooked sausage) were under conditions conducive to reproduction and accumulation of Salmonella, and most importantly, when the products (for example, eggs, meat and egg dishes) are subjected to insufficient heat treatment. Less contaminated fish and dairy products. Dangerous dust scattered dried droppings of pigeons.

The clinical picture. The incubation period lasts from 6 hours to 3 days (usually 12 - 24 hours). Distinguish following clinical forms of salmonellosis: gastrointestinal (localized), flowing through gastriticheskomu, gastroenteriticheskomu gastroenterokoliticheskomu and options; generalized as typhoid and septic embodiment; bacteriocarrier (acute, chronic and transient).

Gastrointestinal form is the most common (90% of all cases). The disease begins acutely, the body temperature rises, there are general weakness, headache , chills, nausea , vomiting , epigastric pain, and diarrhea. When gastriticheskom variant of the disease localized pain in the epigastric region, there is vomiting , diarrhea absent. This variant is rare. When gastroenteriticheskom variant of the disease observed vomiting , frequent watery stools, pain localized in the epigastric and mesogaster. When gastroenterokoliticheskom version 2 - the third day of illness appear sigmoid pain, tenesmus, fecal - an admixture of mucus and blood. In less severe disease low-grade body temperature, stool thin, watery stools up to 5 times per day, duration of 1-3 days of diarrhea, fluid loss of no more than 3% of body weight. When the disease to moderate the temperature rises to 38- 39 ° C, duration of fever up to 4 days, re-marked emesis , stool to 10 times per day, the duration of diarrhea to 7 days. Characterized by tachycardia , drop in blood pressure. Fluid loss is 6% of body weight. In severe cases the fever above 39 ° C, the duration of its 5 days or more. Vomiting repeated for several days; chair more than 10 times a day, stool profuse, watery, fetid, there may be mixed with mucus. Diarrhea lasting more than 7 days. There enlarged liver and spleen, may be ikterichnost skin and sclera. Observed cyanosis of the skin, reducing its turgor, cramps , hoarseness, aphonia , tachycardia , a significant drop in blood pressure. Kidney changes are revealed: oliguria, albuminuria, red blood cells and the cylinders in the urine. When the loss of fluid to 7 - 10% of body weight and over the picture of hypovolemic shock.

Generalized form as typhoid variant of the disease begins acutely, sometimes with the appearance of vomiting, diarrhea, fever, intoxication, but after 1-2 days pass intestinal disorders, the body temperature remains high, growing signs of intoxication. The majority of patients at the beginning and course of the disease similar to typhoid fever. Fever can be a permanent type, but often wavy or remittent; duration of fever 1-3 weeks. Patients inhibited, apathetic, his face pale. On 6 -7 th day of the rash appears roseolous preferentially localized on the skin of the abdomen. Observed relative bradycardia , low blood pressure, cardiac muted tones. Above the light listened absent-minded dry rattles . Bloating, liver and spleen were enlarged. Recurrences are rare. There may be mild forms of the disease with fever lasting 3 - 4 days.

Septic variant of the disease more severe. Disease begins acutely, in the early days has for typhoid. In the future, the condition of patients worsens. Body temperature is characterized by large daily scope, observed repeated chills and profuse sweating. The disease responds poorly to antibiotic therapy. The secondary septic lesions can form in various organs and act symptoms to the fore. Purulent lesions often develop in the locomotor system: osteomyelitis, arthritis. Sometimes there are septic endocarditis , aortitis with the subsequent development of an aortic aneurysm. Relatively often arise holetsistoholangit, tonsillitis, meningitis . After suffering salmonellosis may form acute and chronic bacteriocarrier. Sharp bacteriocarrier assumed abjection from 15 days to 3 months after clinical recovery, chronic - more than 3 months. Transient bacteriocarrier is in those cases where in the absence of clinical signs of disease at the present time and in the previous 3 months there is a single or double abjection with negative results of serological studies in the dynamics.

Diagnosis is based on clinical and epidemiological history data (reference to the consumption of food, which could be a factor in the transmission of Salmonella). Diagnosis is confirmed by isolation of Salmonella from product use in patients, as well as vomit, faeces; in generalized form - from the blood and pus of secondary foci. Salmonellosis differentiate cholera, botulism, acute gastroenteritis bacterial and viral nature, food poisoning, acute appendicitis, myocardial infarction with abdominal syndrome.

Treatment. Patients hospitalized for clinical (severe and moderate flow) and epidemiological (eg, persons living in dormitories, food workers, child care) indications. The rest are treated at home. With gastrointestinal forms of causal therapy is not indicated (it only extends terms of recovery and purification of the body from the pathogen). It is necessary to wash out the stomach as soon as possible. When fluid losses to 3% of body weight is used via the oral rehydration solution of the following composition: sodium chloride - 3.5 g Potassium chloride - 1.5 g of sodium hydrogen carbonate - 2.5 g, -20 g of glucose in 1 liter of drinking water . In more severe dehydration used intravenous solutions. Treatment of typhoid form is the same as the treatment of typhoid fever, and septic - like other forms of sepsis.

The prognosis for septic forms of serious.

Prevention involves identifying patients with farm animals, a permanent bacteriological control of feed, veterinary checks for slaughter, hygienic requirements in the processing of products in meat processing plants, dairies. Carry out bacteriological control of animal products, such as bacteriological studies on Salmonella contamination of poultry carcasses and eggs. Careful compliance with rules for processing and preparation of poultry, especially after handling raw meat and poultry carcasses should be thoroughly washed with soap and hands, utensils, cutting boards, table tops; well boil thoroughly (roast thoroughly) meat, poultry carcasses; not eat raw eggs, preferably cook them in boiling water for 7 - 10 minutes, after having washed carefully.