Other Salmonella Infections in Pediatrics
Introduction
Introduction to other Salmonella infections in children Other Salmonella infections in children refer to Salmonella infections other than typhoid fever, paratyphoid A, B and C, also known as non-typhoid Salmonella infection. Its clinical manifestations are complex and diverse. In 1885, Salmon and Smith first discovered Salmonella choleraesuis, which opened the curtain for the study of Salmonella. Salmonella is a multi-intestinal pathogen of zoonotic bacteria. According to the WHO Salmonella Center published in 1983, Salmonella has 2187 serotypes. At present, there are at least 255 serotypes in China. In addition to typhoid fever and paratyphoid fever, typhoid fever, pig cholera, Salmonella enteritidis and Salmonella typhimurium are the most common. basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: digestive tract spread Complications: intestinal obstruction acute hemorrhagic necrotic enteritis
Cause
Causes of other Salmonella infections in children
Causes:
In 1885, Salmon and Smith first discovered Salmonella choleraesuis, which opened the curtain for the study of Salmonella. Salmonella is a multi-intestinal pathogen of zoonotic bacteria. According to the WHO Salmonella Center published in 1983, Salmonella has 2187 serotypes. At present, there are at least 255 serotypes in China. In addition to typhoid fever and paratyphoid fever, typhoid fever, pig cholera, Salmonella enteritidis and Salmonella typhimurium are the most common.
Salmonella is a Gram-negative bacillus, without a capsule, and most bacteria have flagella and pili, which are motivated. It is moist and cold resistant.
1. The incubation period varies, and the shortest is food poisoning, only a few hours, but most of them are 1 to 3 days.
2. Clinical classification can be divided into acute gastroenteritis type, sepsis type (typhoid type) and local infection type. There are also healthy carriers.
(1) Acute gastroenteritis or food poisoning: This type accounts for about 80%. Salmonella enteritidis and Salmonella typhimurium are the main pathogens. He is ill by eating food contaminated with such bacteria. For example, the food contains no living bacteria and only a large amount of toxins produced by it. The clinical manifestations are acute food poisoning symptoms. The incubation period is only a few hours, and the onset is urgent. The course of illness is only 1 to 2 days.
The total number of peripheral blood leukocytes is mostly between 10,000 and 20,000, and the type of sepsis is higher, more than 30,000 and visible poisoning particles. The diagnosis is based on bacterial culture.
The culture of Salmonella typhimurium must be carried out by enrichment. The specimens coated with saline cotton swabs in stool, pus, cerebrospinal fluid and environment are placed in a 37°C incubator for 18h, then inoculated. SS medium.
Blood culture is best to take 5 ~ 10ml of blood, without adding anticoagulant, directly into the glucose broth or glucose broth plus bile salt culture agent, the culture temperature is suitable for 42 ~ 43 °C.
Rapid diagnosis: using the bacterial immune expansion test.
Prevention
Other prevention of Salmonella infection in children
Typhoid fever is one of the most serious diseases of the current gastrointestinal infectious diseases. Precautions such as strict disinfection and isolation must be taken.
1. There is an epidemic concept: First, we must have an epidemic concept and maintain a high degree of vigilance.
2. Strict isolation measures: Immediately take strict isolation of suspected cases, and it is best to have in-house medical personnel to be responsible. Wear gowns, shoes, wash your hands with running water after checking 1 patient, or wash your hands with 2 peroxyacetic acid or 84 solution. Non-isolated room personnel must comply with the disinfection and isolation rules. All used items should not be taken out without being disinfected.
Complication
Other complications of Salmonella infection in children Complications, intestinal obstruction, acute hemorrhagic necrotizing enteritis
More associated with dehydration, acidosis, prone to hyponatremia, paralytic ileus, liver and spleen enlargement, severe necrotizing enterocolitis, intestinal perforation, convulsions, combined with shock, DIC, cerebral edema, meninges Inflammation, often combined with intracranial hemorrhage, pericarditis or urinary tract infection, bronchitis or bronchial pneumonia. The sequelae can occur after the intracranial lesions are cured.
Symptom
Other symptoms of Salmonella infection in children Common symptoms Fever accompanied by abdominal pain, ... Dehydrated mucus, lethargy, snoring, watery stool, hepatosplenomegaly, convulsion, cellulitis, paralytic ileus
1. The incubation period varies, and the shortest is food poisoning, only a few hours, but most of them are 1 to 3 days.
2. Clinical classification: clinical can be divided into acute gastroenteritis type, sepsis type (typhoid type) and local infection type. There are also healthy carriers.
(1) Acute gastroenteritis or food poisoning: This type accounts for about 80%. Salmonella enteritidis and Salmonella typhimurium are the main pathogens. He is ill by eating food contaminated with such bacteria. For example, the food contains no living bacteria and only a large amount of toxins produced by it. The clinical manifestations are acute food poisoning symptoms. The incubation period is only a few hours, and the onset is urgent. The course of illness is only 1 to 2 days. If the food contains more live bacteria and less toxins, the incubation period can be as long as 2 to 3 days. The onset is slower and the course of disease can be as long as more than one week. Symptoms are vomiting, diarrhea, and older children complain of abdominal pain with high fever. Diarrhea is often stubborn and refractory. Stool 6 to 15 times a day. The nature of the feces is diversified, often with water thinning and then mucus, pus and bloody stools or bloody stools. The sick children are often accompanied by dehydration and acidosis. Hyponatremia is prone to occur due to the insufficiency of neonatal regulation of water and electrolyte metabolism. Abdominal distension is more common. When the disease is severe, paralytic ileus may occur. It may also be accompanied by liver and spleen enlargement, cough, lung vocalization, congestive rash, jaundice, severe necrotizing enterocolitis and intestinal perforation.
(2) Septic type (typhoid type): The symptoms of poisoning are heavy, the heat is high, and the heat history is long. This type accounts for about 4% to 25%. Performance is wilting, lethargy, convulsions, coma, congestive rash is more common. This type can occur alone or in combination with the gastrointestinal type, which is called a mixed type. This type is easy to combine with shock DIC and brain edema.
(3) Local infection: infants are more common.
1 meningitis: about 13%, which mostly occurs under 2 years old. The highest incidence is less than 3 months. Venomitis can also occur. The cause of meningitis in newborns may be related to birth injury. This type of meningitis often combined with intracranial hemorrhage, the mortality rate is as high as 50% or more, about 18% after the occurrence of sequelae.
2 local cellulitis: unexplained fever, crying, and then the skin soft tissue local redness, swelling, heat, pain, and finally the formation of abscess. The abscess is quickly healed after incision and drainage, and the pus can culture Salmonella.
3 umbilical inflammation: umbilical secretions cultured Salmonella typhimurium.
4 can be complicated by pericarditis or urinary tract infection.
5 pulmonary infection: some sick children are admitted to the hospital with lung infection, and later diarrhea. With coughing up to 20% to 50%, the lungs can often smell vocal, can be expressed as bronchitis or bronchial pneumonia. It mainly depends on the epidemiological history, such as patients with Salmonella infection in the family and in the same disease room; eating suspected contaminated food, and collectively ill in the short-term; foods are often uncooked livestock, meat and eggs of poultry , or other food contaminated with such food. The clinical manifestation is sudden onset of acute gastrointestinal symptoms within 1 to 2 days after eating suspicious food, initial abdominal pain, nausea, vomiting, followed by diarrhea, with chills, chills, fever up to 38 ~ 40 °C. At the beginning of the stool, it is sparse, and then it turns into a yellow watery sample with a heavy odor and a small amount of pus. It can also manifest as typhoid-like symptoms, sepsis or local suppurative infection. Laboratory tests rely mainly on pathogenic examinations to culture and isolate pathogens from vomit, feces, and suspected foods. Patients with typhoid and septicemia can be isolated from blood to pathogens. The ELISA test is used to detect Salmonella specific antigen, which has the advantages of specificity and high sensitivity.
Examine
Examination of other Salmonella infections in children
The total number of peripheral blood leukocytes is mostly between 10,000 and 20,000, and the type of sepsis is higher, more than 30,000 and visible poisoning particles. The diagnosis is based on bacterial culture.
The culture of Salmonella typhimurium must be carried out by enrichment. The specimens coated with saline cotton swabs in stool, pus, cerebrospinal fluid and environment are placed in a 37°C incubator for 18h, then inoculated. SS medium.
Blood culture is best to take 5 ~ 10ml of blood, without adding anticoagulant, directly into the glucose broth or glucose broth plus bile salt culture agent, the culture temperature is suitable for 42 ~ 43 °C.
Rapid diagnosis: using the bacterial immune expansion test.
Diagnosis
Diagnosis and identification of other Salmonella infections in children
1. Differential diagnosis of gastroenteritis
(1) Staphylococcus aureus food poisoning: the incubation period is short, about 1 to 6 hours. Nausea and vomiting are obvious, and there is no fever. The diarrhea is yellow watery, stinking, and the amount is small each time. Bacterial culture of stool and residual food may have S. aureus growth.
(2) Vibrio parahaemolyticus food poisoning: incubation period 6 ~ 12h, initial abdominal pain, fever, chills, followed by diarrhea, vomiting. The stool is yellow watery or bloody, with more mucus and pus and odor, several times a day, a large amount, and there is a serious infection after urgency, which is easy to lose water. The stool and the remaining food can produce pathogenic bacteria. Coastal areas are more common, with a history of eating seafood and pickles.
(3) Escherichia coli food poisoning: the incubation period is 2 to 20 hours. At first, there is loss of appetite, abdominal pain, nausea, diarrhea after the occurrence, and few vomiting. The ambassador is mostly yellow watery, with mucus and pus and blood, and has a foul odor, a large amount, and no more urgency. Severe cases can cause loss of water. The stool and the remaining food can produce pathogens.
(4) Proteus food poisoning: the incubation period is 4 to 12 hours, and it can be as long as 19 to 45 hours caused by Proteus morganii. At the beginning, abdominal pain, aversion to cold, fever, vomiting and diarrhea occur, and the stool is yellow water. The amount is large, and there is no urgency and heavy feeling, which can cause loss of water. Stool and residual food culture can have pathogen growth.
(5) Cholera: The incubation period is 1 to 3 hours. The typical person vomits and then vomits. The vomiting and diarrhea is rice sputum water, and the water loss is obvious. Patients caused by O1 group generally have no fever or abdominal pain; those caused by non-O1 group often have fever and abdominal pain. It can often occur that bacteremia causes extra-gastrointestinal damage. The vomiting and diarrhea can often produce pathogenic bacteria.
(6) chemical poisons and biotoxic gastroenteritis: chemical poisons such as arsenic, mercury, organic phosphorus, etc., bio-toxic substances such as gastroenteritis caused by gastroenteritis can ask the corresponding medical history, the incubation period is shorter, generally no fever. In addition to gastrointestinal symptoms, there may be damage to the liver, kidneys, and nervous system. Toxic substances and food can detect poisons.
(7) Others: The disease needs to be differentiated from viral enteritis, Campylobacter enteritis, and sputum enteritis.
2. Differential diagnosis of typhoid and sepsis
(1) Typhoid fever and paratyphoid fever: the fever is longer and the condition is heavier. There may be complications such as slow pulse, rose rash, and pharyngeal bleeding and intestinal perforation. Non-typhoid Salmonella infection is rare or absent. Blood fat response and blood, stool, bone marrow culture and other results can be identified.
(2) sepsis: the primary lesion can often be found, blood leukocytes and neutrophils are increased, and blood culture can isolate pathogenic bacteria.
3. Differential diagnosis of localized purulent infection
Compared with other bacterial-induced local suppurative infections, the clinical manifestations are similar and difficult to identify. The only reliable method is to cultivate pathogens in the pus of local lesions.
