How do Salmonella spp. cause disease in people? Usually, Salmonella spp. are ingested.

It is commonly accepted that at between 1 million to 1 billion bacteria are needed to cause infection although some investigators suggest some people may be infected by far fewer bacteria. Nevertheless, most data suggest food, water, or other sources of contamination contain large amounts of bacteria. Although human stomach acid can reduce and sometimes eliminate Salmonellaspp., occasionally some bacteria get through to the intestine and then attach and penetrate the cells. Toxins produced by the bacteria (enterotoxin and cytotoxin) can damage and kill the cells that line the intestines, which results in intestinal fluid loss (diarrhea). Some Salmonella can survive in cells of the immune system and can reach the bloodstream, causing blood infection (bacteremia). Other Salmonella spp. can enter the gallbladder, leaving the affected patient a chronic carrier of the organisms. Salmonella can then be shed with the bile from the gallbladder into the feces and then may infect other people. Perhaps the most famous such carrier, the first to be identified in 1907, was a cook named Mary Mallon, also known as "Typhoid Mary." She was suspected of infecting hundreds of individuals. How are Salmonella infections diagnosed? Feces of patients that have symptoms of food poisoning or typhoid fever are cultured for Salmonella. Often, the preliminary diagnosis is first suggested by recognition of an outbreak (multiple patients having symptoms of a disease all at about the same time and often from the same food or water source). Again, many organisms and toxins can cause food poisoning, so it is sometimes difficult to determine the outbreak's cause. Usually, the laboratory needs to be notified that S. spp. is suspected as the cause so they will choose the correct testing media (selective agar media such as SS agar plates) to distinguish Salmonella from other potential bacterial pathogens such as E. coli, Shigella strains, Staphylococcus food poisoning, or from toxins like botulism or pesticides. The majority of Salmonella isolates come from the feces of the infected person. Occasionally, Salmonella can be cultured from blood samples. Serovars are identified by serotyping (detecting bacterial proteins by using specific immunological tests). Definitive diagnosis usually requires that the bacteria be isolated and identified by these techniques. PCR tests also have been used to distinguish between bacterial strains. What is the treatment forSalmonella poisoning? Treatment for enteritis or food poisoning is controversial. Some doctors recommend no antibiotics since the disease is self-limited, while others suggest using antibiotics such as ciprofloxacin (Cipro, Cipro XR, Proquin XR) for 10-14 days. Some medical investigators believe antibiotics prolong the carrier state. However, patients identified as immunosuppressed (for example, patients with AIDS or undergoing cancerchemotherapy, infants under 2 months of age, or the elderly) should receive antibiotics; they may need to be hospitalized and have some of their care managed by an infectious disease consultant. In addition,pregnancy often predisposes the mother to get all types of food poisoning, includingSalmonella. Pregnant females should take care to wash and

cook foods well before eating. They should contact their OB/GYN doctor if they begin to have any signs of dehydration, especially if they develop a fever above 101 F. Supportive therapy for both enteritis and enteric fevers consists mainly of preventing dehydration and electrolyte abnormalities (for example, abnormal levels of potassium and sodium ions) with fluids containing electrolytes (for example, IV fluids or oral fluids like sports drinks). Carriers of Salmonella are considered to be infected even though they may show no symptoms. Carriers can infect other people and need to be cured of the carrier state. About 85% of carriers can be cured by a combination of surgery to remove their gallbladder and antibiotic treatments. How can Salmonella infection be prevented? Cleanliness is a key to prevention. Hand washing with soap and hot water, especially after handling eggs, poultry, and raw meat is likely to reduce the chance for infections. The use of antibacterial soaps has been recommended by some investigators. By using chlorine-treated drinking water, washed produce, and by not ingesting undercooked foods such as eggs, meat, or other food, people can also reduce the chance of exposure to Salmonella. Avoiding direct contact with animal carriers of Salmonella (for example, turtles, snakes, pigs) also may prevent the disease. Public-health authorities that enforce restaurant cleanliness and employee hand washing have helped in general prevention. Human carriers ofSalmonella should never work in the foodhandling service industry and ideally should undergo gallbladder removal and antibiotic therapy for an attempt for a cure of the carrier state. Public-health authorities also ask for product recalls when products are contaminated with Salmonella or other contaminating organisms or toxins. In 2009, there was a recall for peanut-containing foods (for example, peanut butter, cookies, crackers). The Westco Fruit and Nut Co., Inc., provided peanut-based paste that was reported to contain Salmonella and was used to make many food products. Eventually, about 3,800 products were recalled. Similar recalls have occurred for pistachio nuts from a California provider in March 2009 and for tomatoes in 2008, both contaminated with Salmonella. Recent recalls for contaminated beef in July and August 2009 contained Salmonella with multiple drug resistance. The huge egg recall in September 2010 may have been prevented if the several egg-farming companies had practiced good sanitation and provided sanitary conditions for the hens to be housed. Recalls increase the safety of the population from exposure to microbial and toxic food contaminants. Although some Salmonella vaccines are available for poultry and animals, human vaccines are available only for typhoid fever. However, the CDC does not recommend that everyone get vaccinated for typhoid fever; they recommend that only those people going to developing countries where typhoid fever is endemic (for example, regions in Africa, Asia, and Latin America) should receive the vaccine. The typhoid fever vaccine is available in an oral (Ty21) and injectable form (ViCPS). People planning to request these vaccines should notify their doctors well in advance (about eight to 10 weeks) before they need the vaccine as it may not be

readily available and need to be administered about two weeks before travel. Researchers are attempting to develop other vaccines for all types of Salmonella infections. The animal vaccine is being used in Europe to make hens less likely to transmit disease to their eggs and to other hens. However, those European egg producers who use the vaccine on hens are cautioned to also maintain sanitary conditions and good housing for the poultry since the vaccine is not 100% protective. The FDA does not require U.S. egg producers to vaccinate their hens; however, the 2010 egg recall has caused the agency to reexamine this policy and the FDA may require vaccination of hens in the future. Sewage disposal The disposal of human excreta and other waterborne waste products from houses, streets, and factories. Conveyed through sewers to sewage works, sewage has to undergo a series of treatments to be acceptable for discharge into rivers or the sea, according to various local laws. Raw sewage, or sewage that has not been treated adequately, is one serious source of water pollution and a cause of eutrophication.
When Salmonellae gain entry into the gastro-intestinal tract, for example through contaminated eggbased foods such as mayonnaise or tiramis, their victims culinary enjoyment is over. The infection is violent, lasts several days and weakens patients severely. The pathogens themselves are tenacious and can be detected in faeces up to 30 days after the initial infection. Salmonellae have developed an ingenious mechanism to do this. Some of them penetrate into intestinal epithelium cells, which form the topmost layer of the intestinal tissue. Although the pathogens are killed in these cells, they nonetheless succeed in provoking inflammation that destroys the intestinal flora and nullifies their protective function. Their comrades of the same species that remained in the intestine exploit this and proliferate, and the affected person develops violent diarrhoea. A completely different function Scientists led by Wolf-Dietrich Hardt, Professor at the Institute of Microbiology (D-BIOL), have now shown for the first time which molecule is sufficient to trigger the diarrhoeal disease: the protein SopE, which Hardt has studied for a good part of the past 12 years and whose molecular function he determined during his post-doctoral research. However, the biological function of SopE is quite different to what the researchers expected at that time. The bacteria inject the protein molecule into an intestinal epithelium cell, where it triggers a cascade of signals inside the cell. SopE tampers with two specific GTPases called Cdc42 and Rac1. These molecules are responsible for, among other things, building the cells skeleton and thus for the cells structure. When SopE binds to these two factors, the cell changes its surface and Salmonellae can penetrate into the cell. Previously, the researchers had assumed that this cell invasion brought about by SopE causes the diarrhoea. Unexpected immune response However, Hardt and his research group have now shown that Cdc42 and Rac1 are also a part of the cells early warning system. This system is indispensable for a rapid, non-specific defence against disease pathogens. What the two molecules do is to activate, via a route that is still unknown, the molecule Caspase-1, which is a cornerstone of inflammatory responses in the cell and also becomes active in sunburn, for example. Caspase-1 in turn activates chemical messengers that attract phagocytes such as macrophages. These finally put an end to the Salmonellae that penetrated into the intestinal tissue. On the other hand, earlier observations suggest that theSalmonellae that remain in the intestinal lumen can benefit from the resulting inflammation. The perfidiousness of SopE is that the bacteria tamper with, of all things, a communication system which a cell cannot simply replace or switch off, because otherwise the non-specific immune response would fail to happen or the cells skeleton would be paralysed. Consequently, it is also not easy to find an active ingredient that disables Caspase-1, for example, to prevent the infection. Hardt stresses That would impair the hosts general fitness more severely than the infection bySalmonellae.

Diarrhoea is the lesser evil Animals in which Caspase-1 did not function would quickly perish in the wild. This was shown in experiments on mice that lacked Caspase-1. Salmonellae and other disease pathogens infect the internal organs of these animals more severely. Thus the host is in a dilemma: although Caspase-1 allowsSalmonellae to cause diarrhoea allow them to colonise the hosts intestinal lumen more easily without this protein, an animal or human being would be highly vulnerable to a large number of disease pathogens. Consequently diarrhoea is the lesser of the two evils. Ironically, not all strains of Salmonella possess SopE. Only certain strains that have incorporated the genetic code for SopE into their own genome from a bacteria-specific virus, a bacteriophage, and can express it, can produce this substance. However, SopE is only one of 12 candidate chemical messengers that Salmonellae use to crack their hosts cell. Thats why Hardts researchers are now also studying how the other virulence factors operate

Overview Typhoid, also called enteric fever, is a bacteria infection caused by salmonella typhi bacteria. According to the National Institutes of Health, about 400 cases of typhoid fever are diagnosed each year in the United States and most cases are found in international travelers and recent immigrants. Typhoid infects body tissues and organs. Transmission Salmonella typhi is spread through contaminated food, drinks and water, according to the Penn State Milton S. Hershey Medical Center College of Medicine. Salmonella is found in the feces and urine of infected people who, if they fail to wash their hands, can infect food and drinks during food preparation. Suspected typhoid carriers should not be allowed to prepare food. Typhoid fever In vitro diagnostic assay for detection of acute typhoid fever. www.idl.se
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Effects of Typhoid on the Body Salmonella typhi enters the body through consumption of contaminated food. The bacterium passes the intestines and enters the bloodstream, where it travels to the gall bladder, liver, spleen and other body parts. As salmonella continues to spread, small and large intestines become inflamed, leading to symptoms such as high fever, chills, headache, malaise, rose spots, vomiting, severe diarrhea, delirium and confusion. Treatment According to the National Institutes of Health, typhoid should be treated with antibiotics such as ciprofloxacin, chlorampenicol, ampicillin and Bactrim, but a strain of antibiotic-resistant salmonella typhi has developed in recent years. Patients who are on antibiotics should finish the full course of treatment so as to prevent antibiotic-resistant salmonella typhi. Patients experiencing severe dehydration are given fluids and electrolytes intravenously. Prevention/Solution Transmission of typhoid can be prevented through frequent hand washing and proper sanitation. Travelers visiting countries with poor sanitation should drink bottled or boiled water and avoid buying raw fruits and vegetables from street vendors. Two vaccines are available to prevent typhoid. Complications According to the National Institutes of Health, untreated typhoid can cause intestinal perforation and bleeding. Holes can develop on the walls of the intestines leading to the leakage of intestinal contents in the abdominal cavity. Infections in the brain and lungs might also occur.

Read more: http://www.livestrong.com/article/179233-how-the-body-works-when-you-have-typhoidfever/#ixzz1PjcwGKT4