Symptoms of salmonellosis

The incubation period of salmonellosis varies from several hours (in case of massive foodborne infection) to 5-6 days (in case of contact infection or a small dose of the pathogen). Clinical symptoms, their severity, sequence of appearance and duration of the disease depend on the clinical form. There are typical (gastrointestinal, typhoid-like and septic) and atypical (absent, subclinical) forms of salmonellosis. as well as bacterial carriage.

The gastrointestinal form of salmonellosis in children is the most common. Depending on the predominant lesion of a particular section of the gastrointestinal tract, the leading ones can be gastritis, enteritis, colitis, gastroenteritis, enterocolitis, etc.

• Gastritis and gastroenteritis as a clinical syndrome of salmonellosis are observed mainly in older children and, as a rule, with foodborne infection (massive invasion). The incubation period is short, up to 1 day. The disease begins acutely, with pain in the epigastric region, repeated vomiting, an increase in body temperature to 38-40 ° C, general weakness. The tongue is thickly coated, dryish, the abdomen is moderately swollen. The disease can end within 2-3 days without the appearance of loose stools (gastritis form). In some cases, this form of salmonellosis begins acutely, with abdominal pain, repeated vomiting, but severe weakness, hypothermia, cold extremities and a drop in blood pressure by the collapse type are noted. Most often, after the symptoms of gastritis, diarrhea syndrome appears - the gastroenteric variant of the course. The stool is usually infrequent (up to 3-5 times a day), mushy or liquid, abundant, undigested, sometimes watery or foamy with a small amount of transparent mucus and greenery. Symptoms of intoxication or toxicosis with exsicosis are expressed to varying degrees.
• Enteritic salmonellosis often develops with contact infection in young children with concomitant diseases (rickets, anemia, hypotrophy, etc.). The disease begins with abdominal pain. Nausea, single vomiting are possible, stool becomes more frequent up to 5-10 times a day or more, it can be mushy or liquid, watery, abundant, undigested, with white lumps, a small admixture of transparent mucus, greenery and a sharp sour smell. The abdomen is moderately swollen, rumbling throughout the abdomen is characteristic when palpated). Body temperature rises to subfebrile values. Toxicosis with exsicosis may develop. The course of the disease is longer, diarrhea syndrome can persist for up to 2-3 weeks, accompanied by repeated, sometimes prolonged bacterial excretion.
• The colitis form of salmonellosis is isolated, rare and resembles shigellosis in clinical manifestations. As with shigellosis, the onset of the disease is acute, with an increase in temperature, the appearance of symptoms of intoxication and political syndrome: pain along the colon, liquid, scanty, fecal stool with a large amount of cloudy mucus, often green and streaks of blood. Unlike shigellosis, the manifestations of the toxic syndrome are more prolonged, the symptoms of distal colitis (tenesmus, spasm of the sigmoid colon, compliance of the anus, etc.) are absent or appear not from the first days of the disease, but on the 3-5th day, the stool, as a rule, remains fecal.
• Gastroenterocolitis and enterocolitis are the most common manifestations of salmonella infection in children of any age, accounting for more than half (53.2-67%) of all clinical variants of the disease. The disease begins acutely, the severity of the main symptoms gradually increases over 3-5 days. From the first days of the disease, frequent, abundant liquid stool appears, containing feces mixed with water, often fetid stool, with a large amount of cloudy mucus and greenery. The color and consistency of feces often resemble "swamp mud" or "frog spawn" (dark green foamy mass consisting of mucus clots). In rare cases, symptoms of distal colitis are also noted in the form of a spasmodic sigmoid colon, anal compliance, tenesmus or their equivalents (in young children - straining and redness of the face, anxiety before defecation).

Vomiting in the gastroenterocolitic form of salmonellosis is infrequent but persistent, appears periodically, not every day, is not associated with the intake of food, water and medications (“unmotivated”), and persists throughout the acute period of the disease.

When examining children, attention is drawn to a thickly coated, sometimes thickened tongue with teeth marks, a moderately distended abdomen ("full abdomen"), and in young children - hepatosplenomegaly. Children with salmonella infection are usually lethargic, sleepy, inhibited, adynamic, and their appetite is significantly reduced.

The body temperature rises from the first day of illness, reaches its maximum by the 3rd-4th day and lasts on average 5-7 days. Sometimes the febrile period lasts up to 2-3 weeks or more. Despite the seemingly adequate therapy, the symptoms of intoxication persist, the stool normalizes slowly (by the 7th-10th day and later), and prolonged bacterial excretion is often noted.

Typhoid-like salmonellosis has accounted for no more than 1-2% of all forms of salmonellosis in recent years and occurs primarily in older children. This form is characterized by pronounced bacteremia and toxic syndrome. The clinical manifestations of the disease resemble paratyphoid fever. The disease begins acutely, with a high fever (39-40 °C), headache, vomiting, loss of appetite, adynamia, and confusion. Early and fairly constant symptoms include delirium, clouding of consciousness, and meningitis. The tongue is heavily coated, thickened (often with teeth marks), and dryish ("typhoid tongue"). The abdomen is moderately distended, and rumbling and diffuse pain in the right iliac region are palpated. From the 4th to 6th day of the disease, the liver and spleen become enlarged in most patients. At the height of the disease, a mild roseolous-papular rash may appear. There may be no intestinal disorders, but most children have enteritic stools from the first days of the disease. In young children, pneumonia and otitis often join in, which complicates differential diagnosis with typhoid fever.

The duration of the febrile period is usually up to 2 weeks, normalization of body temperature occurs most often by the type of shortened lysis. In some cases, relapses of the disease occur.

Septic form of salmonellosis occurs in newborns, premature babies and infants on artificial feeding, weakened by previous diseases. This form of salmonellosis infection can develop as a result of generalization of the process in gastrointestinal forms or without previous damage to the gastrointestinal tract, as primary salmonellosis sepsis. It is often a mixed infection. The disease begins acutely, with a rise in body temperature, which remains high for 3-4 weeks with large swings during the day. Purulent foci appear in various organs with the formation of a clinical picture of purulent meningitis, pneumonia, otitis, pyelonephritis, etc. Sometimes arthritis and osteomyelitis occur. Cases of salmonellosis peritonitis, endocarditis, and lung abscess are known.

There are no specific symptoms characteristic of salmonella sepsis, but the disease is often accompanied by frequent stools with pathological impurities. The specificity of multiple foci of inflammation is confirmed by the detection of salmonella by bacteriological methods in the cerebrospinal fluid (in purulent meningitis), sputum (in pneumonia), urine (in urinary tract infection), synovial fluid (in arthritis), etc.

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