Salmonella disease (salmonellosis)

Salmonella is a type of bacteria and has a rod-shaped appearance. There are many different types of salmonellae, which can all lead to various diseases. Basically, salmonellae can be divided into the group of typhoid salmonellae and the group of enteritis salmonellae.

Not all Salmonella species cause disease in humans. Salmonella from the enteritis group usually cause diarrhea, and salmonella from the typhoid group cause typhoid and paratyphoid fever.

In most cases, antibiotic treatment is not necessary for infections with salmonella, as they almost always heal on their own. However, drug therapy should be considered for small children and babies, as well as for elderly people and people with a weakened immune system, because they have a higher risk of Salmonella infections taking a complicated course. In these risk groups, the immune system is not strong enough or stomach acid production is too low to destroy the bacteria. Reduced stomach acid production is also the reason why drugs that inhibit stomach acid promote salmonella infections.

In most cases, salmonellae enter the gastrointestinal tract through food and drinking water. From there, they can enter the blood via the lymphatic system and infect other organs of the body. People infected with salmonella excrete many bacteria through stool and urine. It is also possible for people to be infected with Salmonella and excrete high numbers of the bacteria through their stool without having any symptoms themselves. However, these people are still at risk of infecting people around them.

Salmonella infects food and drinking water, especially if hygiene measures are poor, for example if people do not wash their hands after using the toilet and then come into contact with food.

Furthermore, pets or reptiles can be the carriers of salmonella infections.

In third world countries, where hygienic conditions are sometimes very poor, salmonella infections are mostly caused by contaminated drinking water. In Europe, however, infections with salmonella are mainly caused by food. It can also happen that flies carry the bacteria from a contaminated food to another food.

Particular care should be taken with the following foods:

- In most cases, people become infected with Salmonella through meat and raw animal products, such as milk, eggs, and.

- Salmonella can also be present in seasonings or in powdered milk.

- Especially foods with a high fat content, such as sausage, cheese or chocolate, can be responsible for salmonella infections.

- In very rare cases, people have been infected via vegetables, for example tomatoes.

Basically, however, it can be said that people with a healthy immune system need not fear contracting a salmonella infection. However, sick people, older people and small children have a greater risk of contracting salmonella, which is why particular care must be taken when preparing food for these groups of people.

The incubation period, i.e. the time from infection with the bacteria to the appearance of the first symptoms, is usually between 12 and 36 hours, but in some cases it can also be between six hours and three days. The duration of the incubation period is mainly influenced by the subgroup of Salmonella and the number of bacteria.

Infection with the enteritis salmonella group (Salmonella enteritidis) mainly causes abrupt onset of gastrointestinal illness with severe vomiting and diarrhea. In addition, those affected may also develop a fever. In most cases, the symptoms subside on their own after a few days.

In contrast, typhoid and paratyphoid have a gradual, very non-specific onset. The most common early symptoms of these diseases, which usually last for several weeks, are headache, aching limbs, fever, abdominal cramps, constipation and weight loss. Body temperature rises steadily during the first month to return to normal after one month.

Salmonella infection is often characterized by several of the following symptoms:

- a yellowish-gray coating on the tongue

- a slowed pulse

- an enlarged spleen

- Roseolae, which are small red skin lesions on the abdomen that can be pushed away in most cases

- Digestive problems, which can often change from constipation to mushy liquid stools and vice versa.

However, it can also happen that people are infected by salmonella and only show very mild symptoms or even have no symptoms at all.

At the beginning, the doctor usually conducts a patient interview and a physical examination, which often allows him to make a tentative diagnosis. For a definitive diagnosis, however, additional examinations are necessary, such as the detection of germs from stool, blood or vomited food residues, as well as a blood sample for the examination of certain inflammation parameters. Bacteria can also be detected in foodstuffs in order to determine the possible cause of the infection. On the one hand, special nutrient media can be used to cultivate and detect salmonellae; on the other hand, rapid test procedures are available for the rapid detection of salmonellae infections.

Salmonella infections of any kind are notifiable diseases and must therefore be reported by the doctor to the public health department.

People infected with salmonella are very contagious, which is why especially people who work in communal facilities (schools, nursing homes) are not allowed to work if there is the slightest suspicion of a salmonella infection.

The treatment of the various diseases caused by salmonella can vary greatly.

For example, in the case of gastrointestinal diseases with diarrhoea and vomiting, the focus is on sufficient fluid therapy. The loss of water due to vomiting and diarrhea can be so enormous that the affected person becomes severely dehydrated, which can even be life-threatening. Therefore, it is important to replenish the lost water and electrolytes to the body by means of drinks and food. In case of high water loss, fluid and electrolyte substitution by means of infusions is necessary. Treatment with antibiotics is not necessary in most cases, but in the case of complicated courses of the disease or in patients who belong to risk groups, the infection should be treated with medication in any case.

In the treatment of typhoid fever, the focus is on treating the symptoms. Fluid and electrolyte substitution can also be very important here. Patients who have typhoid fever should also receive antibiotic therapy.

The majority of salmonella infections take a fairly good course and can be brought under control with appropriate treatment. Only in exceptional cases did salmonella infections take a fatal course in the past. The course of the disease should be monitored more closely, especially in young children and older people, as these individuals often have a poorer prognosis.

The most serious risks and consequences of all salmonella infections include:

- Bleeding in the gastrointestinal tract

- ulcers in the intestine, which can subsequently lead to intestinal rupture

- Inflammation of the lungs, liver, gallbladder, and heart muscle.

Hygiene is essential to protect against salmonella infections.

- For food that could be infected with salmonella, proper storage (below 10°C) and appropriate preparation are important.

- Water and food that may be contaminated with salmonella should never come into contact with other food.

- When preparing food that may be contaminated with salmonella, care should be taken to ensure that all food is cooked or fried sufficiently and never eaten raw.

- Minced meat should still be prepared on the day it is produced.

- Also, when reheating food in the microwave, be sure to check that the food is uniformly cooked through all over or has been heated above 70°C. - Food containing raw eggs (e.g. tiramisu) should be eaten as soon as possible.

- People infected with salmonella can pass it on very easily and should therefore not handle food under any circumstances.

- When travelling to countries where typhoid fever is more common, you should protect yourself from the disease with a vaccination.

- You should wash your hands thoroughly after every contact with food.

- Especially during stays abroad, the saying "peel it, cook it, boil it, or forget it" has proven to be helpful. Fruit or vegetables should be peeled or steamed before consumption and any contaminated drinking water should be boiled to remove the pathogens.