Salmonella

Salmonella is a bacteria that can cause illness to people. First discovered by

an American scientist named Dr. Daniel E. Salmon in 1885, salmonellae are
gram-negative motile, non-sporulating, straight-rod bacteria that can cause
an upset stomach, diarrhea, fever, and pain and abdominal cramps. Illness
from these bacteria is called salmonellosis.

 What is Salmonella Infection (Salmonellosis)?

 Pathophysiology
 Classification
 Causes
 Statistics and Incidences
 Clinical Manifestations
 Assessment and Diagnostic Findings
 Medical Management
o Pharmacological Management
 Nursing Management
o Nursing Assessment
o Nursing Diagnosis
o Nursing Care Planning and Goals
o Nursing Interventions
o Evaluation
o Documentation Guidelines
 Summary
 References

What is Salmonella Infection (Salmonellosis)?

Salmonellosis, the illness caused by Salmonella, primarily results in a mild
to severe diarrheal illness, known as acute gastroenteritis.

 Salmonellae are gram-negative motile, nonsporulating, straight-rod

bacteria.
 The genus Salmonella is named after Daniel E. Salmon, an American
veterinarian who first isolated Salmonella choleraesuis from pigs
with hog cholera in 1884.
 The two species of Salmonella are Salmonella
enterica and Salmonella bongori.
 They pose a great threat to the food industry because they are able
to adapt to environmental conditions that differ significantly from
those in which they normally grow.
  When Salmonella infections become invasive, they can affect the
bloodstream, bone, joint, brain, or nervous system, or other internal
organs.

Pathophysiology
The genus Salmonella is a member of the family Enterobacteriaceae.

 The Salmonella infection cycle starts after the ingestion of microbes.

 Through the stomach, the bacteria reach the small intestine.
 Infection with salmonellae is characterized by attachment of the
bacteria by fimbriae or pili to cells lining the intestinal lumen.
 Salmonellae selectively attach to specialized epithelial cells (M cells)
of the Peyer patches.
 The bacteria are then internalized by receptor-mediated endocytosis
and transported within phagosomes to the lamina propria, where
they are released.
 Once there, salmonellae induce an influx of macrophages (typhoidal
strains) or neutrophils (nontyphoidal strains).
 Through the induction of cytokine release and via mononuclear cell
migration, S typhi organisms spread through the reticuloendothelial
system, mainly to the liver, spleen, and bone marrow.
 Within 14 days, the bacteria appear in the bloodstream, facilitating
secondary metastatic foci (eg, splenic abscess, endocarditis).
 As a rule, infection with nontyphoidal salmonellae generally
precipitates a localized response, while S typhi and other especially
virulent strains invade deeper tissues via lymphatics and capillaries
and elicit a major immune response.

Classification
Salmonella bacteria are classified as either “typhoidal” or “nontyphoidal,”
based on their serotype.

 Typhoidal. Typhoidal Salmonella refers to the specific Salmonella

serotypes which cause typhoid fever or paratyphoid fever, including
Typhi, Paratyphi A, Paratyphi B, and Paratyphi C.
 Nontyphoidal. Nontyphoidal Salmonella refers to all other
Salmonella serotypes
Causes
Salmonellosis is caused by all nontyphoid serotypes of the Salmonella genus
except for S typhi and Salmonella paratyphi A, B, and C.

An infected chicken can produce eggs

that are contaminated with salmonella before the shells are even formed.
Image via: food processing
 Contaminated food or water. Salmonella is usually transmitted to
humans by eating foods contaminated with small amounts of animal
feces; when preparing raw meat or poultry, food handlers can
transfer Salmonella on their hands to other foods if they do not
wash their hands between food preparation steps.
 Contact with infected animals. Salmonella live in the intestinal
tracts of humans and other animals, including poultry and other
birds, amphibians, and reptiles; Salmonella may be found in the
feces of some animals, and people can become infected if they do
not wash their hands after contact with animals or animal feces.

Statistics and Incidences

CDC estimates that approximately 1.35 million illnesses and 420 deaths
occur due to non-typhoidal Salmonella annually in the United States.

 FoodNet reports that the annual incidence of Salmonella infection in

the United States was 15.2 illnesses per 100,000 individuals.
 Compared to 2010-2012, the incidence of non-typhoidal Salmonella
infection showed a 9% decrease in 2013.
 Salmonella infection is more common in the summer months (June,
July, and August) than winter.
 Children under 5 years old are the most likely to get a Salmonella
infection
  Children who are 5 years old and younger, adults over 65 years old,
and people with weakened immune systems are the most likely to
have severe infections.
 Salmonella accounted for the most hospitalizations (64%) in
outbreaks with a confirmed cause. 
 The mortality rate associated with S enteritidis infection outbreaks
in the United States from 1985-1991 was 0.4%.
 Case-fatality rates were 70 times higher in nursing homes and
hospitals.

Clinical Manifestations
Most people with a Salmonella infection experience:

Within 12-72 hours after ingesting salmonella, abdominal

pain/cramping accompanied by diarrhea can occur. Image via: Health
 Diarrhea. Diarrhea may last for several days and lead to potentially
severe dehydration, especially in infants and children under 2 years
old and in adults over 65 years old.
 Fever. In many patients, fever is accompanied by prostration and
an apathetic-lethargic state (the so-called tuphos of the ancient
Greeks). 
 Stomach cramps. Abdominal tenderness (approximately 50%),
mild hepatosplenomegaly (approximately 50%), and coated tongue
are common in individuals with typhoid fever.

Assessment and Diagnostic Findings

Salmonella infection is diagnosed when a laboratory test detects Salmonella
bacteria in a person’s poop (stool), body tissue, or fluids.

 Blood culture. Modern blood culture systems are 80-100%

accurate in detecting bacteremia; as the disease duration increases,
the sensitivity of blood cultures decreases, while the sensitivity of
stool isolation increases.
  Stool exam. Freshly passed stool is the preferred specimen for
isolation of nontyphoidal Salmonella species; since stool carriage of
S typhi may be prolonged, the interpretation of positive results
merits caution, and the diagnosis should be established only when
accompanied by clinical findings that are typical of infection.
 Bone marrow aspiration. Bone marrow aspirate and culture is
superior to blood culture, since the bacterial concentration in bone
marrow is 10 times that of peripheral blood.

Medical Management
Salmonella gastroenteritis is usually a self-limiting disease.

Drinking plenty of fluids to

avoid dehydration.Image via: Freepik
 Fluid and electrolytes. Fluid and electrolyte replacement may be
indicated in severe cases. patients should drink extra fluids as long
as diarrhea lasts. 
 Consultations. Consultation with an infectious disease specialist
should sought in cases of bacteremia, endovascular infections, CNS
infections, and whenever typhoid fever is a strong possibility, as
well as when antimicrobial resistance is suspected or documented.

Pharmacological Management
The goals of pharmacotherapy are to eradicate infection, to reduce
morbidity, and to prevent complications.

 Antibiotic. Empiric antimicrobial therapy must be comprehensive

and should cover all likely pathogens in the context of the clinical
setting.

Nursing Management
Nursing care of a patient with salmonella infection include the following:

Nursing Assessment
Assessment of a patient with salmonella include:

 History. Salmonella infections typically produce 1 of 3 distinct

syndromes: nontyphoidal enterocolitis, nontyphoidal focal disease,
or typhoid (enteric) fever.
 Physical exam. The physical findings of nontyphoidal
gastroenteritis are generally limited to non-bloody loose stool or
watery diarrhea; patients with typhoid fever may develop pink,
blanchable, slightly raised macules (rose spots) on the chest and
abdomen. 

Nursing Diagnosis
Based on the assessment data, the major nursing diagnosis are:

 Diarrhea related to bacterial infection.

 Deficient Knowledge related to new disorder and treatment and
unfamiliarity with information resources.
 Risk for Fluid Volume Deficit related to diarrhea.
 Imbalanced Nutrition: Less Than Body Requirements related
to nausea and vomiting. 

Nursing Care Planning and Goals

The major nursing care planning goals for a patient with salmonella include
the following:

 Client will have a negative stool culture.

 Client will pass soft, formed stool no more than 3 x a day.
 Client will verbalize understanding of causes of salmonellosis, mode
of transmission, and management of symptoms.
 Client is normovolemic as evidenced by systolic BP 90 mm Hg or
greater, absence of orthostasis, HR 60 to 100 beats per
minute, urine output greater than 30 ml per hour, and normal skin
turgor.
 Client will have an increased nutritional intake and absence of
nausea and vomiting.
Nursing Interventions
Nursing interventions for a patient with samonellosis are:

 Relieve diarrhea. Teach the client about the importance of hand

washing after each bowel movement and before preparing food for
others; encourage increase fluid intake of 1.5 to 2.5 liters/24 hour
plus 200 ml for each loose stool in adults unless contraindicated;
encourage the client to eat foods rich in potassium; and administer
antidiarrheal medications as prescribed.
 Educate patient and folks. Assess client’s knowledge of
salmonellosis, its mode of transmission, and its treatment; educate
the client and the family about the causes of and treatments for
salmonellosis; educate the client about the importance of hand
washing after toileting and perianal hygiene and before preparing
food for others; and educate the client about food preparation and
storage methods to reduce contamination by microorganisms.
 Prevent fluid volume deficit. Assess the client’s skin turgor and
mucous membranes for signs of dehydration; monitor BP for
orthostatic changes (changes seen when changing from a supine to
a standing position); instruct the client to monitor weight daily and
consistently with the same scale, preferably at the same time of the
day, and wearing the same amount of clothing; and administer
antiemetic medications as ordered.
 Improve nutritional intake. Measure client weight; monitor and
record the number of vomiting, amount and frequency; monitor the
client’s food intake; provide a diverse diet according to his needs;
and provide parenteral fluids, as ordered.

Evaluation
Goals are met for a patient with salmonella as evidenced by:

 Client has a negative stool culture.

 Client passed soft, formed stool no more than 3 x a day.
 Client verbalized understanding of causes of salmonellosis, mode of
transmission, and management of symptoms.
 Client was normovolemic as evidenced by systolic BP 90 mm Hg or
greater, absence of orthostasis, HR 60 to 100 beats per minute,
urine output greater than 30 ml per hour, and normal skin turgor.
 Client has an increased nutritional intake and absence of nausea and
vomiting.
Documentation Guidelines
Documentation in a patient with salmonellosis include:

 Individual findings, including factors affecting, interactions, nature

of social exchanges, specifics of individual behavior.
 Cultural and religious beliefs, and expectations.
 Plan of care.
 Teaching plan.
 Responses to interventions, teaching, and actions performed.
 Attainment or progress toward the desired outcome.

Summary
Here are some of the most important points about salmonella infection:

 Salmonellosis, the illness caused by Salmonella, primarily results in

a mild to severe diarrheal illness, known as acute gastroenteritis.
 They pose a great threat to the food industry because they are able
to adapt to environmental conditions that differ significantly from
those in which they normally grow.
 Salmonella bacteria are classified as either “typhoidal” or
“nontyphoidal,” based on their serotype.
 Salmonella is usually transmitted to humans by eating foods
contaminated with small amounts of animal feces.
 Salmonella may be found in the feces of some animals, and people
can become infected if they do not wash their hands after contact
with animals or animal feces.
 CDC estimates that approximately 1.35 million illnesses and 420
deaths occur due to non-typhoidal Salmonella annually in the United
States.
 Most people with a Salmonella infection experience diarrhea, fever,
and stomach cramps.
 Salmonella infection is diagnosed when a laboratory test detects
Salmonella bacteria in a person’s poop (stool), body tissue, or fluids.
 Fluid and electrolyte replacement may be indicated in severe cases.
patients should drink extra fluids as long as diarrhea lasts. 
 The goals of pharmacotherapy are to eradicate infection, to reduce
morbidity, and to prevent complications.