Kingdom: Bacteria Phylum: Proteobacteria Class: Gamma Proteobacteria Order: Enterobacteriales Family: Enterobacteriaceae Genus: Salmonella Species: e.g.

S. enterica

Salmonella
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Flagella stained Salmonella Typhi peritrichous flagella

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Courtesy By CDC

Gram negative rods, facultative anaerobes, facultative intracellular parasites Oxidase negative, Motile peritrichous, Lactose negative - color less colonies on Mackonkey agar H2S positive:
Hektoen Agar color full colonies Wilson and Blair bismuth sulfate media H2S producing, grow as black colonies

Acid labile Taxonomic classification problematic because of different Antigenic serotypes Pathogenic Salmonella species - Salmonella enterica
Salmonella typhi, Salmonella paratyphi Salmonella enteritidis Salmonella choleraesuis
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Virulent factors
Type I Pili H Antigen ( Flagellar Antigen)
Phase Variation, Immunogenic

K Antigen
Vi Capsular Antigen( S.Typhi) - Inhibits Compliment Mediated Killing. Poorly Immunogenic

O Antigen:
Somatic Antigen (LPS) Less Immunogenic Than H Antigen Endotoxin

Widal Test O And H Antigen (Positive Results After 13 Days) Type III Secretary System (12 Proteins):
Endocytosis, Phagosome Lysosome Fusion, Promotes Replication, Prostaglandins, cAMP

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Epidemiology
Majorly By Contaminated Food: At Outdoor Social Gatherings, Poultry Products, Including Eggs Salmonella Enteritidis & Choleraesuis: Large Infectious Dose (105 Or Higher) 50,000 Cases Were Reported In United States In 2010. Summer And Fall Oral Fecal Route Turtle Salmonella Typhi And Paratyphi: Person-to-person Spread - Food And Water Low Dose Of Infection Leukemia, Lymphoma, Sickle Cell Disease, ICP, And Reduced Gastric Acidity Chronic Pts- Gallbladder And Biliary Tract
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Dr.Aravind

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Pathogenesis Gastroenteritis
Salmonella Enteritidis & Choleraesuis

Attach to enterocytes by Type I pili

Initiates inflammatory response Prostaglandins and cAMP Dysentery

Injects Type III secretary proteins

Endocytosis release Type III proteins in endosome and replicates

Released into sub mucosa may be by apoptosis

Dr.Aravind osteomyelitis, pneumonia, and meningitis Salmonella choleraesuis can disseminate

Pathogenesis of Salmonella

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Courtesy by HHMI

Pathogenesis Enteric fever (Typhoid fever)

Salmonella Typhi and Paratyphi Biliary Tract And Gall Bladder (Chronic) Intestine

Attach To Enterocytes And M Cells With Pili

Disseminates To Mesenteric Lymph Nodes, Liver And Spleen

Release Type III Secretary System Proteins In Host Cells

Vi Antigen Inhibits Macrophage & Compliment Killing Replication

Endocytosis Release Type III Proteins In Endosome And Replicates

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Released Into Sub Mucosa And Taken By Macrophages

Clinical Conditions Gastroenteritis

24 To 48 Hours Incubation Symptoms: Nausea, Vomiting, Abdominal Cramps, Diarrhea And Dysentery. Predominant Symptom For 3 To 4 Days And Resolves In 7 Days Dissemination: Salmonella Choleraesuis In Sickel Cell Pts And ICP Osteomyelitis, Endocarditis, Arthritis
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Enteric fever or Typhoid fever

Ten to 14 days incubation Symptoms:
Step ladder increasing fever, headache, myalgia, malaise, constipation and anorexia. Rose spots on Abdomen and trunk Repeated chronic cases blood diarrhea Hepatosplenomegaly

Complications:
Infection of Peyers patches, Perforation of intestine, Thrombophlebitis (inflammation of vein wall), Cholecystitis (inflammation of GB), pneumonia, Osteomyelitis , Arthritis and CNS infections
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Diagnosis

Specimens Blood Or Feceas Lactose Negative, H2S positive, Motile Blood Cultures Are Positive In First For Typhi Culture Medium Mackonkeys Agar, Hecktoen Agar, W&B Media. Serology Widal Test.
1 Week 85% Blood Cultures Are Positive, Pts Get Rose Spots On Abdomen And Trunk 2 Week Widal Test Will Be Positive 3 Week Stool Cultures Are Positive
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Treatment & Prevention

Enteric Fever:
Fluoroquinolones, Chloramphenicol, Trimethoprim,Or Cephalosporin's
Typhoid Mary

Gastroenteritis:
Antibiotics Not Recommended For Enteritis

Prevention:
Proper Preparation Of Poultry And Eggs (Completely Cooked) Carriers Of Salmonella Typhi And Salmonella Paratyphi Should Be Identified And Treated Vaccine For Typhi Against Vi Antigen.

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