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basics
Dr.T.V.Rao MD
Dr.T.V.Rao MD
Salmonella
Causes Infections in Humans and vertebrates, Enteric Fever ( Typhoid fever ) Gastroenteritis Septicemias, Carrier state.
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Salmonella
A Very complex group Contains more > 2,000 spp Typed on the basis of Serotyping, and species typing Divided into two groups 1 Enteric fever group 2 Food poisoning group Septicemias.
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Morphology of Salmonella
Gram negative bacilli 1-3 / 0.5 microns, Motile by peritrichous flagella
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Cultural Characters
Aerobic / Facultatively anaerobic Grows on simple media Nutrient agar, Temp 15 41c / 37 c Colonies appear as large 2 -3 mm, circular, low convex, On MacConkey medium appear Colorless ( NLF ) Selective Medium - Wilson Blair Bismuth sulphide medium. Produce Jet black colonies H2 S produced by Salmonella typhi
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Enrichment Medium
Liquid Medium
Selenite F medium Tetrathionate broth Above medium are used for isolation of Salmonella from contaminated specimens Particularly stool specimens..
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Biochemical Characters
Glucose ,Mannitol ,Maltose produce A/G Salmonella typhi do not produce gas Lactose/Salicin/sucrose not fermented. Indole Methyl Red + VP Citrate + Urea H2S produced by Salmonella typhi Paratyphi A do not produce H2S Dr.T.V.Rao MD
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2 Flagellar or H Antigens are strongly immunogenic and induces antibody formation rapidly and in high titers following infection or immunization. The flagellar antigen is of a dual nature, occurring in one of the two phases.
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Classification of Salmonella Classified on the basis of Kauffmann-White Scheme Structure of 0 and H antigens are taken into consideration, More than 2000 species characterized.
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Antigenic Variation in Salmonella May be phenotypic / Genotypic H to O = loss of Flagella May be phase variation from I to II V to W variation S to R variation
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Pathogenicity
Salmonella are definite parasites to humans. Eg S.typhi. S.paratyphi A, B ,C Other groups Salmonella The important clinical syndromes 1. Enteric fever, Septicemias, gastroenteritis.
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Enteric Fever Typhoid Typhoid caused by S.typhi Paratyphoid Caused by Paratyphi A,B,C Typhoid --- Like Typhus 7, Infective dose ID50 / 10
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Immunity in Typhoid
Typhoid bacilli are Intracellular pathogens Cell mediated immunity is crucial
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Clinical manifestation
Head ache, malise,anorexia ,coated tongue Abdominal discomfort, Constipation / Diarrhea Step ladder type fever, Relative bradycardia, A soft palpable spleen Hepatomegaly Dr.T.V.Rao Rose spots appear MD
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Rashes in Typhoid
May present with rash, rose spots 2 -4 mm in diameter raised discrete irregular blanching pink maculae's found in front of chest Appear in crops of up to a dozen at a time Fade after 3 4 days
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Other complications
Causes relapses in particular to patients treated with chloramphenicol. S.paratyphi produce septicemias.
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Epidemiology
Developed countries - Controlled. Water supply/ Sanitation /Economically poor. S.typhi and S.paratyphi are prevalent in India Previously Typhi are more common Paratyphoid A on raise. Age 5 20 years, Sanitation
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Epidemiology
Sanitation has great role Source an active patient or a Carrier shed the Bacilli. Who are carriers. Convalescent carrier 3 weeks to 3 months Temporary carrier 3 months to 1 year Chronic carrier > 1 year, Women attain more carrier stage
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Epidemiology (Contd)
Bacilli persist in the Gall bladder and kidney Food handlers spread the infection Cooks great role S.typhi and S.paratyphi in humans S.para B in Animals, Typhoid spread through Water, Milk, Food HIV patients potentially susceptible for Typhoid disease.
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Typhoid Mary
A famous example is Typhoid Mary Mallon, who was a food handler responsible for infecting at least 78 people, killing 5. These highly infectious carriers pose a great risk to public health.
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Blood Culture
1 st week Positive in 90 % 2 nd week Positive in 75 % 3 rd week Positive in 60 % > 3 weeks positive in 25 % Draw 5 10 cc of Blood by venipuncture. ADD to 50 -100 ml of Bile broth. Incubate at 37 c /Subculture in MacConkey At regular intervals
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Clot culture
Clot cultures are more productive in yielding better results in isolation. A blood after clotting, the clot is lysed with Streptokinase ,but expensive to perform in developing Dr.T.V.Rao MD countries.
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Biochemical Characters
Non Lactose fermenter, Motile Indole MR + VP - Citrate + Ferment Glu/Mal/Man Do not ferment Lactose/Sucrose
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Serology
WIDAL Test Tube agglutination test. Detects O and H antibodies Diagnosis of Typhoid and Paratyphoid Testing for H agglutinins in Dryers tubes, a narrow tube floccules at the bottom Testing for O agglutinins in Felix tubes, Chalky Incubated at 37 c overnight
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Widal Test
In 1896 Widal A professor of pathology and internal medicine at the University of Paris (191129), he developed a procedure for diagnosing typhoid fever based on the fact that antibodies in the blood of an infected individual cause the bacteria to bind together into clumps (the Widal reaction).
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Widal test
S.typhi O and H tubes Paratyphi A/B H agglutinins only Common antigens O in all Factor sharing 12 Significance I st week negative. Titers raise in 2nd week Raise of titers diagnostic
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Widal Test
Single test not diagnostic. Paired samples tests Diagnostic. O > 1 in 80 H > 1in 160 H agglutinins appear first False positives in Unapparent infection, Immunization Previously infected
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Widal test
Anamnestic response previous infection and responding to unrelated infection Other Diagnostic tests CIE and ELISA Detection of Circulating antigens Co agglutination test.
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Prophylaxis
TAB vaccine S.typhi 1,000 millions S Paratyphi A,B 750 millions. Injected subcutaneously 0.5 ml at 4 6 weeks. Live Oral Vaccine Typhoral Mutant S.typhi strain Ty 2 1a Lacking enzyme UDP galctose 4 epimerase 10 to9 Viable bacilli Given orally 1 3 5 days
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Vaccines
An Inject able vaccine Typhium Vi Contains purified Vi polysaccharide antigen from S.typhi strain Ty2 A single dose, subcutaneous route Given to children > 5 years Immunity lasts for 2- 3 years. Follow a booster
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Treatment
Chloramphenicol 1948 /1970 resistance. Other Important drugs Ampicillin Amoxicillin, Furazolidine Cotromoxazole Chloramphenical resistance /Mexico Kerala
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Other Drugs
Fluroquinolones Ciprofloxacillin, Pefloxacillin Ofloxacillin Ceftazidime Ceftriaxone / Cefotoxaime
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Salmonella Gastroenteritis
Zoonotic disease S.enteritidis S.typhimurium S.halder S. agana S.indiana Contaminated poultry, Meat Milk, Milk products. Enters the shells of the Intact eggs Chicken feed, and Fecal droppings.
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Nontyphoidal Salmonella
General Incubation: 6 hrs-10 days; Duration: 2-7 days Infective Dose = usually millions to billions of cells Transmission occurs via contaminated food and water Reservoir: a) multiple animal reservoirs b) mainly from poultry and eggs (80% cases from eggs) c) fresh produce and exotic pets are also a source of contamination (> 90% of reptile stool contain salmonella bacterium); small turtles ban. General Symptoms: diarrhea with fever, abdominal cramps, nausea 65 and sometimes vomiting Dr.T.V.Rao MD
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develop septicemia; 5-10% of septicemia patients develop localized infections Endocarditis: Salmonella often infect vascular sites; preexisting heart valve disease risk factor Arteritis: Elderly patients with a history of back/chest + prolonged fever or abdominal pain proceeding gastroenteritis are particularly at risk. - Both are rare, but can cause complications that may lead to death
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Salmonella Gastroenteritis
Can occur as cross infection 24 hours Manifest with Diarrhea, omitting Abdominal pain mucous and blood in stools Last for 2 4 days Some times may lead to septicemias
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Salmonella septicemias
S.cholera suis Deep abscess, Endocarditis Isolation from Blood and Pus. Chloramphenicol highly effective
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