Salmonella (non-typhoidal)

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A 15-year-old boy with a history of sickle cell disease presents to his primary care physician for evaluation of bone pain in the right leg, fevers, and difficulty walking. The physician suspects osteomyelitis. Which of the following is the most likely causative pathogen?  

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Diarrhea

Salmonella p. , 142

Fever

Salmonella spp. p. 147

Salmonella typhi p. , 142

Gastroenteritis

Salmonella spp. p. 142

Immune response

Salmonella / Shigella spp. p. 142

Peyer patches p. 369, 381, 392

Salmonella / Shigella invasion p. 142

Salmonella spp.

animal transmission p. 147

bloody diarrhea p. 176

encapsulated bacteria p. 125

food poisoning p. 175

Gram-negative algorithm p. 139

immunodeficient patients p. 116

intracellular organism p. 125

osteomyelitis p. 177

penicillins for p. 185

reactive arthritis p. 475

Shigella spp. vs p. 142

splenic dysfunction p. 96

taxonomy p. 122

TMP-SMX for p. 191

type III secretion system p. 127

Salmonella typhi p. , 142

Shigella spp.

vs Salmonella spp. p. 142

Vaccines p. 109

Salmonella typhi p. , 142

Virulence factors

Salmonella/Shigella p. , 142

Vomiting

Salmonella spp. p. 147

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Content Reviewers

Salmonella is a bacterium belonging to the family Enterobacteriaceae.

There are two main species: Salmonella bongori and Salmonella enterica, and the latter has six subspecies.

One of the subspecies is enterica, which has over 2500 serotypes that can be divided into two main groups based on the clinical symptoms they cause- so typhoidal or non-typhoidal Salmonella.

The non-typhoidal group, can infect humans and animals and cause a variety of disease states.

But, the most common serotype, Salmonella enteritidis, causes intestinal inflammation, called gastroenteritis, or commonly called “food poisoning”.

OK, but generally, Salmonella are encapsulated gram-negative, rod bacteria – meaning, they have a polysaccharide layer outside the cell envelope and look like little red or pink sticks on a gram stain.

They’re facultative intracellular pathogens, meaning they can live both outside or inside of its host’s cells.

And have flagella, making them motile, but don’t form spores.

They’re also facultative anaerobes, so they can undergo respiratory and fermentative metabolism; and they can ferment glucose but not lactose; are oxidase negative, and produce hydrogen sulfide gas.

And while a variety of media can be used to selectively identify Salmonella, among them is Triple Sugar Iron agar which produces a black precipitate when hydrogen sulfide is produced.

Now, once Salmonella is ingested and reaches the distal ileum of the small intestine, it tends to target the epithelial layer of the mucosal lining where it uses surface appendages to adhere to microfold cells, or M-cells.

And these M-cells eat, or phagocytose, the bacteria from the intestinal lumen and spit it out into the underlying Peyer’s patches - a type of mucosal immune tissue that extends into the submucosa.

When encountering non-typhoidal Salmonella, the immune system responds strongly by releasing proinflammatory cytokines that recruit additional immune cells, particularly neutrophils.

This causes inflammation of the small intestines and the colon, called enterocolitis.

Summary

Salmonella is a rod-shaped, gram-negative bacteria of the Enterobacteriaceae family, which is known to cause salmonellosis infection. Non-typhoidal Salmonella (NTS) infections are the most common type of salmonellosis and are caused by several different strains of the bacteria like S. Enteritidis, and S. Newport. NTS infections are foodborne diseases and primarily spread through contaminated food and water. They cause symptoms of food poisoning like fever, diarrhea, abdominal cramps, vomiting, and headache. These symptoms can be severe and may lead to dehydration, sepsis, or even death.

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