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Salmonella

Gram negative bacteria

Motile except S gallinarum pullorum

MAC NLF colonies

Selective medium

Wilson & Blair bismuth sulphite

Jet black colonies due to H2S

S paratyphi A green colonies ( no H2S)

Enrichment media Selenite F & tetrathionate broth

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 Diseases

Enteric fever Exclusively or primarily human parasite

S typhi (Typhoid fever)

S paratyphi A, B, C (Paratyphoid fever)

Food Essentially animal parasite also infect human

poisoning S typhimurium

S enteritidis

Septicemia S choleraesuis

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 Pathogenesis

Source Carriers Cases Poultry, diary

Transmission Ingestion of contaminated water or food

High infectious dose (108 CFU)

IP 7-14 days

Virulence factors

Invasiveness

Intracellular survival & multiplication

Endotoxin

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 Infection pattern of Salmonella
Salmonella are ingested in
contaminated food or water

Organisms reach the Enteritis

terminal ileum
Organisms invade the gut wall
& cause ulcertion, perforation
& hemorrhage

Organisms spread to intestinal

lymphatics & are phagocytosed by
macrophages

Organisms disseminate to
Enteric fever or
bones, kidneys, lungs,liver,
brain & blood
typhoid fever

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 Clinical Syndromes of Salmonella

Salmonellosis = Generic term for disease

Enteric fever (prototype is typhoid fever and less severe

paratyphoid fever)

Septicemia (particularly S. choleraesuis, S. typhi, and S.

paratyphi)

Asymptomatic carriage (gall bladder is the reservoir for

Salmonella typhi)

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 Clinical features
Nausea & vomiting

Fever (Step ladder)

Bradycardia

Toxemia

Soft palpable spleen

Hepatomegaly ?

Rose spots on skin (2nd - 3rd week)

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 Lab diagnosis of Enteric fever

Specimens Blood, Bone marrow, urine, stool, pus, csf

1st week Blood culture BHI broth

2nd week Antibody detection Widal test

(serum)

3rd week Urine culture

4th week Stool culture Use selective & enrichment

medium

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 Lab Diagnosis of Enteric fever

Specimens Blood, urine, stool,

Culture
MAC NLF colonies

W&B Jet black colonies (Stool culture)

TSI agar K-/ A +(H2S)

AST Report & Interpretations

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 Serology - Widal Test
Tube agglutination test To detect antibodies in patient
serum
Test is performed after 2 wks To diagnose Enteric / typhoid fever

Antigens used TO O antigen of S typhi

TH H antigen of S typhi

AH H antigen of paratyphi A

BH H antigen of paratyphi B
CH H antigen of paratyphi C

O is group specific Enteric fever

H is species Typhoid or paratyphoid

specific
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 Widal test - interpretation
Test is carried by double dilution of serum

1/20 1/40 1/80 1/160 1/320 1/640

Anamnestic response with TAB vaccine

Demonstration of rise in titre

Cases treated early may show poor antibody response

TO 1: 320

TH 1: 160
Titre suggestive of Typhoid fever
AH 1: 20

BH 1: 20
CH 1: 20
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Carriers

Food handlers & Cooks

Repeated stool cultures

Widal test no value in endemic countries

Vi agglutinins indicates carrier status

Sewer swab technique tracing carriers in cities

Vaccines
TAB Typhoral Typhim
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