History and exam
Key diagnostic factors
common
nausea/vomiting
Commonly occurs with Salmonella infections, but does not differentiate from other bacterial or viral etiologies of gastroenteritis.
diarrhea
Typically, stools are loose, moderate-volume, and without visible blood.
However, variations in presentation have been reported, including bloody stools and high- or low-volume stool quantities. Of note, in sub-Saharan Africa and in immunocompromised patients, invasive disease typically presents without diarrhea.[27][76][77]
fever
Fevers as part of gastroenteritis are typically only 1 to 3 days in duration.
Other diagnostic factors
common
myalgias
Pain in a muscle or group of muscles may occur.
headache
May occur, especially in febrile patients.
abdominal tenderness
Diffuse, mild abdominal pain may accompany gastroenteritis.
Rarely, severe pain mimicking appendicitis has been reported.
signs of volume depletion
Dry mucous membranes, decreased skin turgor, and orthostatic vital signs suggest volume depletion due to vomiting and/or diarrhea.
hyperactive bowel sounds
Increased bowel sounds may be present on examination.
uncommon
family history of Salmonella infection
A person infected with or carrying Salmonella (e.g., chronic carriers) may spread the infection to family members.
No genetic component is known for acquiring the infection.
Risk factors
strong
food exposures
Food exposures, including the ingestion of undercooked eggs or undercooked meats (especially poultry), are key risk factors. Raw produce that is contaminated by animal waste as well as peanut products have also been implicated.[40]
Most patients cannot identify a suspected food source.
extremes of age (<12 months and >50 years)
presence of an immunosuppressive state
Patients who use immunosuppressive medications (e.g., corticosteroids); those with immunosuppressive conditions (e.g., HIV); transplant recipients; and those with rheumatologic and connective tissue conditions or malignancy at increased risk.[42]
People living with AIDS are at very high risk for invasive nontyphoidal salmonellosis (up to 100-fold higher than the risk for immunocompetent patients).[43][44][45] However, HIV is not a risk factor for enteric fever caused by Salmonella Typhi or S Paratyphi.[46]
Using antitumor necrosis factor-alpha therapies may predispose to severe disseminated disease, but not necessarily an increased incidence of Salmonella infections.[47]
low gastric acidity
Gastric acidity provides a protective barrier against infections. An acidic pH is required for the production of antimicrobial reactive nitrogen species in the stomach.[48] When this is reduced, clinical infections are more likely to occur and may be initiated by a lower inoculum of organisms. Patients who ingest antacids and those with conditions that lower gastric pH (extremes of age, pernicious anemia) are at heightened risk.[35][38][39]
exposure to symptomatic person with Salmonella
People who have Salmonella gastroenteritis and are experiencing diarrhea may spread the organism to others.
animal contact
Animals, especially reptiles and live poultry, may be carriers of Salmonella.
Handling animals that carry Salmonella is a known risk factor for the disease, especially if hands are not properly washed.[17]
Handling of pet food and treats also has been linked to Salmonella infection.
use of antibiotics
poorly controlled diabetes mellitus
chronic granulomatous disease
There is some evidence that patients with chronic granulomatous disease have a higher risk of Salmonella infection due to the lack of the oxidative burst.[53]
iron overload
malnutrition
Malnutrition has been identified as a risk factor for invasive nontyphoidal salmonellosis in sub-Saharan African children.[57]
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