Salmonellosis - Khon Kaen University · Salmonellosis Sumitr Sutra ป ร ะ ชุม วิช...
Transcript of Salmonellosis - Khon Kaen University · Salmonellosis Sumitr Sutra ป ร ะ ชุม วิช...
Salmonellosis
Sumitr Sutra
ป ร ะ ชุ ม วิ ช า ก า ร ค ณ ะ แ พ ท ย ศ า ส ต ร ม ห า วิ ท ย า ล ัย ข อ น แ ก น วั น ที่ 1 0 – 1 4 ตุ ล า ค ม 2 5 4 8
DIARRHEATravelTravel
Immunocompromised
Immunocompromised
Foodborneor
waterborne
Foodborneor
waterborneChild care
CentersChild care
Centers
HospitalizationHospitalization
Antimicrobiolagents
Antimicrobiolagents
ACUTE INFLAMMATORY DIRRHEA
Salmonella spp.Shigella spp.Vibrio parahemoliticusAeromonas hydrophilaPlesiomonas shigelloidesCampylobacter jejuni/coliEnterohemorrhagic Escherichia coliYersinia enterocolitica
Entamoeba histoliticaStrongyloides stercolalisVibrio parahemoliticusTrichinella spiralisCryptosporidium parvumBalantidium coliSchistosoma
Bacteria ParasiteCytomegalovirusEnterovirus
Virus
DIAGNOSIS: FOOD AND WATER BORNE INFECTION
MICROBIAL CAUSES
Nausea, Vomiting or Diarrhea within 1-16 hours
• Staphylococcus aureus• Bacillus cereus• Clostridium perfringens
Diarrhea and Abdominal Cramps within 16-48 hours• Viruses• Vibrio• Enterotoxogenic E. coli
Fever, Diarrhea, Abdominal Cramps within 16-48 hours• Salmonella• Shigella• C. jejuni• Yersinia
Abdominal Cramps, Bloody diarrhea, no fever 72-120 hours• Enterohemorrhagic E. coli O157 : H7
ผลการเพาะเชื้อจากอุจจาระของผูปวยจากรายงานของ NSSC ป พ.ศ.2544
ชนิดของเชื้อ จํานวนตวัอยาง เปอรเซน็ต
Non-typhoidal Salmonella
Typhoidal Salmonella
Shigella
Other Bacteria
No growth
7,329
228
728
147
26
84.53
2.70
8.62
1.74
6.31
รวม 8,458
(คัดลอกจาก WHO National Salmonella and Shigella center : NSSC โดย อรุณ บางตระกูลนนท)
Salmonella Nomenclature
Complete Name CDC Designation
Common Clinical Usage
S. enterica subsp. enterica ser. Typhi
S. enterica subsp. enterica ser. Typhimurium
S. enterica subsp. enterica ser. Enteritidis
S. enterica subsp. enterica ser. Dublin
S. enterica subsp. arizonae ser. 18:z4, Z23:-
S. enterica subsp. houtenae ser. Marina
Salmonella ser. Typhi
S. ser. Typhimurium
S. ser. Enteritidis
S. ser. Dublin
S. IIIa 18: Z4, Z23:-
S. ser. Marina
S. typhi
S. typhimurium
S. enteritidis
S. dublin
Arizona hinshawii ser. 7a,
7b:1, 2, 5:-
S. marina or S. IV 48: g, Z51:
SalmonellaBacteremia
Metastaticfocal
infection
Enteric fever
Gastroenteritis
AsymptomaticCarrier
PATHOGENESIS
INGESTION Salmonella
INVADE M cells
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MOST NON-TYPHOIDALSALMONELLA
SURVIVAL IN BLOODSTREAM
PRODUCE ENTEROTOXIN
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. TyphiS. Typhimurium
PATHOGENESIS
INGESTIONINGESTION SalmonellaSalmonella
INVADE M cellsINVADE M cells
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MULTIPLY IN MACROPHAGESAND LYMPH NODE
MOST NON-TYPHOIDALSALMONELLA
MOST NON-TYPHOIDALSALMONELLA
SURVIVAL IN BLOODSTREAM
SURVIVAL IN BLOODSTREAM
PRODUCE ENTEROTOXINPRODUCE ENTEROTOXIN
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
S. TyphiS. TyphimuriumS. TyphiS. Typhimurium
FACTORS PREDISPOSING TO SALMONELLOSIS & DISSEMINATION
• Dose and Serotype
• Hypochlorhydria
• Inflammed Bowel
• Alter Gut Flora
• Defected CMI
• Defected RE System
Bacterial Isolation In Khon Kaen 2000-2002
Salmonella spp.
Vibrio cholerae
V. paraheamolyticus
Aeromonas spp.
Plesiomonas spp.
Shigella spp.
Others
345 (62.8)
50 (9.1)
73 (13.3)
29 (5.3)
15 (2.7)
29 (5.3)
8 (1.5)
112 (29.5)
35 (9.2)
204 (53.6)
12 (3.2)
1 (0.3)
7 (1.8)
9 (2.4)
336 (32.0)
235 (22.4)
188 (17.8)
120 (11.4)
94 (8.9)
29 (2.8)
49 (4.7)
Organisms2000
Year
2001 2002
Total 549 380 1,051
Salmonella isolated from food and drinking waterin five communities in Khon Kaen, 2002.
CommunitySpecimens
FoodSalmonellaIsolation(%) Specimens
Drinking waterSalmonellaIsolation(%)
1
2
3
4
5
84
74
69
105
71
12 (14.3)
14 (18.9)
16 (23.2)
20 (19.0)
12 (16.7)
16
18
16
14
18
2 (12.5)
0
0
2 (14.3)
2 (11.1)
Total 74 (18.4) 82 6 (7.3)403
Salmonella isolated from food handlers and others in Khon Kaen, 2002.
Specimens
Food handlers
SalmonellaIsolation(%) Specimens
Healthy population
SalmonellaIsolation(%)
SexMalesFemales
Age (year)< 3031 - 4041 - 5051 - 60> 60
1476
14203521
-
64 (3.3)
2 (14.3)4 (20.0)3 (8.6)1 (4.8)
-
11 (4.7)8 (4.8)
012 (7.1)5 (5.3)2 (6.3)
0
2.5168
96170
953210
Total 10 (11.0) 403 19 (4.7)90
Salmonella isolated from pork and chicken from fresh markets in Khon Kaen.
Specimens
Pork
SalmonellaPositive (%)
Specimens
Chicken
SalmonellaPositive (%)
Month
February
June
October
32
34
25
29 (90.6)
34 (100)
24 (96.0)
28
30
26
28 (100)
28 (93.3)
25 (96.2)
Total 91 87 (95.6) 84 81 (96.4)
Salmonella serovars isolated from pork and chicken (fresh market)
Port Chicken
Serovar Strains(%) Serovar Strains(%)
31 (27.2)21 (18.4)9 (7.9)9 (7.9)7 (6.1)6 (5.2)4 (3.5)3 (2.7)3 (2.7)3 (2.7)
10 (15.7)
S. VirchowS. EnteritidisS. PanamaS. HadarA. AnatumS. BlockleyS. AgonaS. AlbanyS. SaintpaulS. TyphimuriumOthers
S. AnatumS. RissenS. PanamaS. AlbanyS. AmsterdamS. DerbyS. Subspecies 19, 12: 1 V:-S. WorthingtonS. Subspecies 14, 15, 12:I:-S. SaintpaulOthers
57 (47.1)30 (25.1)17 (14.1)2 (1.6)2 (1.6)2 (1.6)2 (1.6) 2 (1.6)2 (1.6)2 (1.6)3 (2.5)
Total 121 Total 114
Port ChickenSerovar(serogroup) Strains(%)
Serovar(serogroup) Strains(%)
Salmonella serovars and serogroups isolated in 2002 from pork and chicken from Khon Kaen supermarkets
S. Anatum (E)S. Rissen (C)S. Panama (D)S. Weltevreden (E)S. Worthington (G)S. Derby (B)S. Stanley (B)S. Virchow (C)S. Cerro (K)S. Albany (C)S. Scwarzengrum (B)S. Typhimurium (B)
43 (32.6)34 (25.8)10 (7.6)5 (3.8)5 (3.8)4 (3.0)4 (3.0)3 (2.5)3 (2.5)2 (1.5)2 (1.5)2 (1.5)
12 (15.8)12 (15.8)12 (15.8)5 (6.6)4 (5.3)4 (5.3)3 (3.9)2 (2.6)2 (2.6)2 (2.6)2 (2.6)
S. Rissen (C)S. Virchow (C)S. Anatum (E)S. Panama (D)S. Stanley (B)H. Hadar (C)S. Havana (G)S. Enteritidis (D)S. Scwarzengrun (B)S. Blockley (C)S. Senftenberg (G)
Salmonella isolated from pork and chicken and internal organs from the Khon kaen abattoir 2002
Strains (%)
Salmonella
Serovars
Meat
Internal organ
Total 31 (77.5)
S. Derby, S. Virchow, S BlockleyS. Enteritidis, S. PanamaS. Agona, S. Virchow,S. Rissen, S.Entritidis
40
Specimens
Chicken
20
20
14 (70)
17 (85)
Strains (%)
Salmonella
Serovars
S. Rissen,S. AnatumS. DerbyS. AnatumS. Anatum
S. Senftenberg
Specimens
Pork
20
20
20
17 (85)
14 (70)
11 (55)
Meat
Liver
Internal organ
Total 42 (70)60
Salmonella isolation of diarrheal cases from hospitals in Khon Kaen and Region 6 2002.
Regional 6 Khon Kaen
Serovar Serogroup Strains (%) Serovar Serogroup Strains (%)
(27.9)(14.4)(10.7)(7.4)(6.7)(3.9)(2.3)(2.1)(2.1)(1.8)(20.2)
(16.5)(9.0)(8.2)(7.5)(6.7)(6.7)(5.2)(4.5)(3.7)(3.7)(2.7)
120624632291710998
87
22121110997655
37
ECCDDCBEBE
C1E1D1E1BBD1BC1C1
S. AnatumS. RissenS. VirchowS. EnteritidisS. PanamaS. HadarS. DerbyS. AmsterdumS. SaintpaulS. Welteredenl31 Other serovars
S. RissenS. WeltevredenS. EnteritidisS. AnatumS. DerbyS. StanleyS. PanamaS. 14, 12, IS. BraenderupS. Virchow23 Other serovars
Total 429 Total 133
Carrier
Children Salmonellosis Cure
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
8-24 %
2 - 45 %
Case Fatality
3 - 10 %
Cycle of Salmonellosis
Intrafamily
• Carrier• Prior diarrhea
Supplement foods
• Orange• Iron• Under cooked meat
Day care
Pets
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection
• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality
3 - 10 %
8-24 %2 - 45 %
Carrier
Cycle of Salmonellosis
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality3 - 10 %
8-24 %2 - 45 %
•Gall stone
•Immunocompromised
•Serotype
PermanentConvalescent
•Antibiotic
CarrierIntrafamily
• Carrier• Prior diarrhea
Supplement foods• Orange• Iron• Under cooked meat
Day care
Pets
Cycle of Salmonellosis
Host• Infant• Immuno compromised
Stereotypes• S. Typhimurium• S. Choleraesuis• S. Enteritidis
• Immunocompromised• Age < 3 Mo.
Cycle of Salmonellosis
Salmonellosis CureChildren
Extraintestinal
BacteremiaFocal Infection• Meningitis• Osteoarthritis• Pneumonia• Cholangitis
Case Fatality3 - 10 %
8-24 %2 - 45 %
• Antibiotic• Gall stone
• Immuno compromised • Serotype
PermanentConvalescent
Carrier
Intrafamily• Carrier• Prior diarrhea
Supplement foods• Orange• Iron• Under cooked meat
Day care
Pets
TREATMENT
Gastroenteritis Infant : ??Children : NoImmunocompromised : ?
Bacteremia Ceftriaxone, cefotaxime
14 Days
Focal Infection4 - 6 Weeks
4 Weeks
OsteomyelitisMeningitis
Chronic carrier FluoroquinoloneCholecystectomy
การปองกันระดับครอบครัว
ระดับชุมชน
• ลางมือ• อาหารเสริมในทารก• เขียงปรุงอาหาร
• ระบบสุขาภิบาลตลาด• โรงฆาสัตว• โรงเลี้ยงสัตว• อาหารสัตว / ยา