Medical illustration of non-typhoid salmonella. From: CDC.gov

Thanks to Dr. Ponec for a great morning report on non-typhoid salmonella causing severe sepsis and diarrhea. Learning points:

Assessing diarrhea:

• Duration: acute (<14d) vs. persistent (14-30d) vs. chronic (>30d)
• If acute, judge severity (number per day, hypovolemia, elderly/immunocompromised, duration)
• Acute diarrhea work-up:
  • Inflammatory? Stool WBC have sens 70%, spec 50%. Calprotectin sens and spec >90%. If positive, consider campylobacter, non-typhoidal salmonella, ETEC, shigella, vibrio
  • Timing? 2-6hr = preformed toxin (s. aureus, b. cereus), 8-16hr = c. perfringens, >16hr = e. coli, viral
  • Bloody? If yes, then consider EHEC, Shigella, Campylobacter, and Salmonella.
  • Stool culture
  • Stool OxP if recent travel or from developing country
• Chronic diarrhea work-up:
  • Watery? Secretory vs. osmotic (check stool osm gap). If osmotic, consider laxative use or carbohydraate malabsorption (low stool pH). If secretory, consider chronic infection (e.g., giardia, c.difficile, campylobacter, cyclospora), microscopic colitis, or neuroendocrine (e.g., VIPoma, gastrinoma, carcinoid syndrome).
  • Fatty? Stool quantitive fat to r/o malabsorptive process
  • Inflammatory? Stool WBC/calprotectin, culture
  • Blood? Consider IBD, malignancy

Non-typhoid salmonella:

• Symptoms generally within 6-72 hours of ingestion
• 1-5% of patients w/ GI infection will have bacteremia
• Extra-intestinal sites of infection include urinary tract, bone, meninges, sites of atherosclerotic plaque
• Treatment with ciprofloxacin or cephalosporin