Diagnosis of salmonellosis in adults

Characterized by an acute onset with increased body temperature, nausea, vomiting, diarrhea, and abdominal pain.

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Indications for consultation with other specialists

A surgeon's consultation is necessary if appendicitis, mesenteric vascular thrombosis, or intestinal obstruction are suspected.

A gynecologist consultation is prescribed if there is a suspicion of an ectopic pregnancy, ovarian apoplexy, or salpingo-oophoritis.

Consultation with a cardiologist - to rule out myocardial infarction, hypertensive crisis, and to correct therapy for concomitant coronary heart disease and hypertension.

Indications for hospitalization

Severe course of the disease, presence of complications; epidemiological indications.

Epidemiological diagnostics of salmonellosis

Eating food that was prepared and stored in violation of sanitary standards, eating raw eggs. Group outbreaks. In megacities, identifying group cases of the disease is very difficult if a product contaminated with salmonella is sold through a retail network or public catering establishments. Without confirmation of the diagnosis by laboratory tests, differential diagnostics of salmonellosis with foodborne toxic infections is very difficult.

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Specific and non-specific laboratory diagnostics of salmonellosis

Bacteriological examination of feces (once or twice), vomit, blood, urine, bile, gastric lavage, and remains of suspicious products.

Salmonella antigens can be detected in blood and urine using ELISA and RGA. For retrospective diagnostics, specific antibodies are determined (RIGA and ELISA). Paired sera taken at intervals of 5-7 days are examined. A fourfold or more increase in titers is of diagnostic value.

Differential diagnostics of salmonellosis

Differential diagnostics of salmonellosis, dysentery, cholera

Clinical signs	Salmonellosis	Dysentery	Cholera
Chair	Watery, with an unpleasant odor, often with an admixture of greenery the color of swamp mud	Scanty, fecal-free stool with an admixture of mucus and blood - "rectal spit"	Watery, rice-colored, odorless, sometimes with a raw fish odor
Defecation	Painful in the colitic variant	With tenesmus	Painless
Abdominal pain	Moderate cramping, in the epigastrium or mesogastrium	Strong, with false urges, in the lower abdomen, left iliac region	Not typical
Vomit	Multiple, precedes diarrhea	Possible with gastroenterocolitic variant	Multiple watery. appears later than diarrhea
Spasm and pain in the sigmoid colon	Possible in the colitic variant	Characteristic	Not marked
Dehydration	Moderate	Not typical	Typical, sharply expressed
Body temperature	Increased	Increased	Normal, hypothermia
Chills	Typical	Typical	Not typical

Differential diagnostics of salmonellosis, acute appendicitis, thrombosis of mesenteric vessels

Clinical signs	Salmonellosis	Acute appendicitis	Mesenteric vascular thrombosis
Anamnesis	Consumption of poor quality food, possibility of group outbreaks	No special features	IHD. atherosclerosis
Onset of the disease	Acute, with severe intoxication, clinical picture of acute gastroenteritis	Pain in the epigastrium with movement to the right iliac region	Acute, less often gradual, with abdominal pain
The nature of abdominal pain	Moderate cramping. In the epigastrium or diffuse. Disappears before the cessation of diarrhea or simultaneously with it.	Severe, constant, worse with coughing. Persists or worsens when diarrhea stops	Sharp, unbearable, constant or paroxysmal, without a specific localization
Chair	Liquid, abundant, fetid, with an admixture of greenery, multiple	Liquid feces, without pathological impurities, up to 3-4 times. more often constipation	Liquid, often mixed with blood
Cramps, dehydration, chills	During the height of the illness	None	None
Examination of the abdomen	Moderately swollen, rumbling on palpation, painful in the epigastrium or mesogastrium	Pain in the right iliac region with muscle tension. Symptoms of peritoneal irritation are positive.	Swollen, diffuse soreness
Vomit	Multiple, in the first hours	Sometimes at the beginning of the disease. 1-2 times	Often, sometimes with an admixture of blood
Leukocytosis	Moderate	Expressed, increasing	Expressed, increasing

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Example of diagnosis formulation

A02.0. Salmonellosis. Gastrointestinal form. Gastroenteric variant. Moderate course.

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