Salmonella

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- Always repeat blood cultures to ensure clearance of bacteremia.

- Recurrent bacteremia requires further investigation for occult focus of infection and/or underlying immunosuppression.

Previously healthy children:

- Typically related to gastroenteritis

• Rule out potential exposure to pets

- Vast majority recover uneventfully with antibiotic therapy.

- In young infants (< 1 year), may progress to meningitis.

Adults:

- Respiratory symptoms and hepatosplenomegaly common with invasive disease.

- Risk factors for invasive disease include malignancy, HIV, diabetes, prior antibiotic therapy and immunosuppressive drugs, including chronic corticosteroids.

- Bacteremia may indicate underlying immunodeficiency, especially for relapsing/recurrent infections. Always consider and test for HIV infection.

- Bacteremia may progress to other body sites, including the urinary tract, lung/pleura, endovascular/heart, bone, muscle, or central nervous system

• Salmonella urinary tract infection may represent retrograde infection or chronic infection.

• Endovascular infection can occur in up to 20% of adults > 50 years old with bacteremia, hence the rationale for more aggressive therapy of Salmonella gastroenteritis in this age group. Endovascular infection typically presents with fever (subacute/low grade) and back/abdominal pain.

Bacteremia related to gastroenteritis (no extra-intestinal infection)

Bacteremia with extraintestinal infection

- High potential for relapse; chronic suppressive therapy with TMP/SMX or quinolone typically required.

- ID consult recommended.