Salmonellosis in children

Salmonellosis is an acute infectious disease of humans and animals caused by numerous salmonella serovars and occurring in children most often in gastrointestinal (A02) and, less often, typhoid-like and septic forms (A01).

Diseases caused by salmonella in humans are divided into typhoid fever and paratyphoid fever A, B, C - anthroponotic infections with clearly defined clinical and epidemiological features and "proper" salmonellosis, the causative agents of which are pathogenic for both humans and animals. The term "salmonellosis" is used only to designate the second group of diseases.

ICD-10 code

• A02.0 Salmonella enteritis.
• A02.1 Salmonella septicemia.
• A02.2 Localized salmonella infection.
• A02.8 Other specified salmonella infection.
• A02.9 Salmonella infection, unspecified.

Epidemiology of salmonellosis

Salmonellosis is widespread throughout the world and throughout our country. In terms of morbidity among intestinal infections of established etiology, salmonellosis ranks second after shigellosis. Mostly preschool children are affected (65%). The leading pathogen is Salmonella enteritidis.

The main source of infection is domestic animals: cows, sheep, pigs, dogs, cats, birds, etc. The disease in animals can be pronounced or latent, but asymptomatic carriage of salmonella is more common. Human infection can occur both through direct contact with a sick animal and through consumption of animal products (milk, meat, cottage cheese, sour cream, eggs, etc.).

Older children are infected primarily through food, meat, dairy and other animal products, as well as through vegetables and fruits (cabbage salads, cucumbers, tomatoes, carrot juices, fruits, etc.), which can become infected during storage, transportation and sale. Outbreaks of salmonellosis associated with foodborne infection occur mainly in children's institutions where food preparation and storage rules are violated.

The contact-household route of infection is observed mainly in young children, especially in newborns, premature babies and those weakened by other diseases. Infection often occurs in hospitals through care items, staff hands, towels, dust, changing tables, potties.

Children in their first two years of life are most susceptible to salmonellosis. At this age, the incidence is 5-10 times higher than in other age groups. Salmonellosis is registered throughout the year with the maximum increase in incidence in summer and autumn. The incidence is not the same in different areas and changes from year to year.

[ 1 ], [ 2 ], [ 3 ]

Causes of salmonellosis

According to the structure of the O-antigen, salmonella are divided into groups A, B, C, D, E, etc., and according to the flagellar H-antigen - into serovars. There are about 2000 serovars. More than 700 serovars have been isolated from humans. More than 500 have been registered in our country. Among them, salmonella of groups B, C, D, E dominate - Salmonella enteritidis, S. typhimurium, S. derby, S. panama, S. anatum, S. choleraesuis.

[ 4 ], [ 5 ], [ 6 ]

Pathogenesis of salmonellosis

The development of the infectious process largely depends on the mechanism of infection (food, contact, etc.), the size of the infectious dose and the degree of pathogenicity of the pathogen, the immune defense of the macroorganism, age, etc. In some cases, intestinal infection proceeds rapidly, with the development of endotoxin shock. pronounced toxicosis with exsicosis or a generalized infectious process (septic forms) and with significant bacteremia (typhoid-like forms), while in others, latent, subclinical forms or bacterial carriage occur. Regardless of the form of the disease, the main pathological process develops in the gastrointestinal tract and mainly in the small intestine.

What causes salmonellosis?

Symptoms of salmonellosis

The incubation period of salmonellosis varies from several hours (in case of massive foodborne infection) to 5-6 days (in case of contact infection or a small dose of the pathogen). Clinical symptoms, their severity, sequence of appearance and duration of the disease depend on the clinical form. There are typical (gastrointestinal, typhoid-like and septic) and atypical (absent, subclinical) forms of salmonellosis. as well as bacterial carriage.

The gastrointestinal form of salmonellosis in children is the most common. Depending on the predominant lesion of a particular section of the gastrointestinal tract, the leading ones can be gastritis, enteritis, colitis, gastroenteritis, enterocolitis, etc.

Symptoms of salmonellosis

Diagnosis of salmonellosis

Typical forms of salmonellosis begin acutely with increasing severity of the general condition; fever is relatively long, characterized by infrequent but prolonged "unmotivated" vomiting, pain and rumbling in the right iliac region, thickly coated tongue, flatulence ("full belly"), enteritic or enterocolitis stool of the "swamp mud" type with an unpleasant, foul odor. In moderate and severe forms, hepatosplenomegaly occurs, especially in young children, CNS changes in the form of lethargy, confusion, drowsiness, in the peripheral blood - pronounced leukocytosis, neutrophilia with a shift to the left (band-nuclear shift), increased ESR.

Diagnosis of salmonellosis

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]

Treatment of salmonellosis

For mild and moderate forms of salmonellosis with exsicosis, the following are indicated:

• oral rehydration with glucose-salt solutions: rehydron, glucosolan, etc.;
• enterosorbents: filtrum-STI;
• enzyme preparations taking into account the topic of the gastrointestinal tract lesion: abomin, festal, pancreatin (micrazyme, creon), panzinorm, etc.

For young children, it is advisable to prescribe the following from the first days of illness:

• bacterial preparations (Acipol, Bifistim, Bifidumbacterin 10-20 doses/day, Lactobacterin, Linex, Enterol, etc.);
• prebiotics (lactofiltrum);
• or include bifidokefir (bifidok) in your diet, 200-400 ml/day, in small portions.

Treatment of salmonellosis

Prevention of salmonellosis

Measures to prevent salmonellosis in children are aimed primarily at the source of infection and are carried out by medical and veterinary services.

The measures include improving the health of domestic animals, preventing the spread of salmonellosis among them. compliance with the sanitary regime at meat processing plants, poultry farms and dairy enterprises. In order to exclude contamination of raw materials during the slaughter of animals and birds, cutting up carcasses, storage, transportation and sale. The sale and consumption of raw duck and goose eggs is prohibited due to their high contamination with salmonella.

How to prevent salmonellosis?