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Sumitr Sutra Salmonellosis ป ร ะ ชุ ม วิ ช า ก า ร ค ณ ะ แ พ ท ย ศ า ส ต ร์ ม ห า วิ ท ย า ลั ย ข อ น

Mar 31, 2015

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Sumitr Sutra Salmonellosis 1 0 1 4 2 5 4 8 Slide 2 DIARRHEA Travel Immunocom promised Immunocom promised Foodborne or waterborne Foodborne or waterborne Child care Centers Child care Centers Hospitalization Antimicrobiol agents Antimicrobiol agents Slide 3 ACUTE INFLAMMATORY DIRRHEA Salmonella spp. Shigella spp. Vibrio parahemoliticus Aeromonas hydrophila Plesiomonas shigelloides Campylobacter jejuni/coli Enterohemorrhagic Escherichia coli Yersinia enterocolitica Entamoeba histolitica Strongyloides stercolalis Vibrio parahemoliticus Trichinella spiralis Cryptosporidium parvum Balantidium coli Schistosoma Bacteria Parasite Cytomegalovirus Enterovirus Virus Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 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 Slide 9 Non-typhoidal Salmonella Typhoidal Salmonella Shigella Other Bacteria No growth 7,329 228 728 147 26 8,458 84.53 2.70 8.62 1.74 6.31 ( WHO National Salmonella and Shigella center : NSSC ) NSSC . .2544 Slide 10 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:z 4, Z 23 :- S. enterica subsp. houtenae ser. Marina Salmonella ser. Typhi S. ser. Typhimurium S. ser. Enteritidis S. ser. Dublin S. IIIa 18: Z 4, Z 23 :- 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, Z 51 : Salmonella Nomenclature Slide 11 Salmonella Bacteremia Metastatic focal infection Enteric fever Gastroenteritis Asymptomatic Carrier Slide 12 PATHOGENESIS INGESTIONSalmonella INVADE M cells MULTIPLY IN MACROPHAGES AND LYMPH NODE MOST NON-TYPHOIDAL SALMONELLA SURVIVAL IN BLOOD STREAM PRODUCE ENTEROTOXIN S. Typhi S. Dublin S. Cholerasuis S. Paratyphi S. Typhi S. Typhimurium Slide 13 PATHOGENESIS INGESTION Salmonella INVADE M cells MULTIPLY IN MACROPHAGES AND LYMPH NODE MULTIPLY IN MACROPHAGES AND LYMPH NODE MOST NON-TYPHOIDAL SALMONELLA MOST NON-TYPHOIDAL SALMONELLA SURVIVAL IN BLOOD STREAM SURVIVAL IN BLOOD STREAM PRODUCE ENTEROTOXIN S. Typhi S. Dublin S. Cholerasuis S. Paratyphi S. Typhi S. Dublin S. Cholerasuis S. Paratyphi S. Typhi S. Typhimurium S. Typhi S. Typhimurium Slide 14 FACTORS PREDISPOSING TO SALMONELLOSIS & DISSEMINATION Dose and Serotype Hypochlorhydria Inflammed Bowel Alter Gut Flora Defected CMI Defected RE System Slide 15 Bacterial Isolation In Khon Kaen 2000-2002 Organisms 2000 Year 20012002 Salmonella spp. Vibrio cholerae V. paraheamolyticus Aeromonas spp. Plesiomonas spp. Shigella spp. Others Total 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) 549 380 1,051 Slide 16 Community Specimens Food Salmonella Isolation(%) 1234512345 Total 74 (18.4) 82 6 (7.3) 84 74 69 105 71 Specimens Drinking water Salmonella Isolation(%) 12 (14.3) 14 (18.9) 16 (23.2) 20 (19.0) 12 (16.7) 16 18 16 14 18 2 (12.5) 0 2 (14.3) 2 (11.1) 403 Salmonella isolated from food and drinking water in five communities in Khon Kaen, 2002. Slide 17 Specimens Food handlers Salmonella Isolation(%) Sex Males Females Age (year) < 30 31 - 40 41 - 50 51 - 60 > 60 Total 10 (11.0) 403 19 (4.7) 14 76 14 20 35 21 - Specimens Healthy population Salmonella Isolation(%) 6 4 (3.3) 2 (14.3) 4 (20.0) 3 (8.6) 1 (4.8) - 90 2.5 168 96 170 95 32 10 11 (4.7) 8 (4.8) 0 12 (7.1) 5 (5.3) 2 (6.3) 0 Salmonella isolated from food handlers and others in Khon Kaen, 2002. Slide 18 Salmonella isolated from pork and chicken from fresh markets in Khon Kaen. February June October Total Specimens Pork Salmonella Positive (%) Month Specimens Chicken Salmonella Positive (%) 32 34 25 29 (90.6) 34 (100) 24 (96.0) 28 30 26 28 (100) 28 (93.3) 25 (96.2) 9187 (95.6)8481 (96.4) Slide 19 Salmonella serovars isolated from pork and chicken (fresh market) PortChicken S. Anatum S. Rissen S. Panama S. Albany S. Amsterdam S. Derby S. Subspecies 19, 12: 1 V:- S. Worthington S. Subspecies 14, 15, 12:I:- S. Saintpaul Others Total 57 (47.1) 30 (25.1) 17 (14.1) 2 (1.6) 3 (2.5) 121 Total 114 Serovar Strains(%) S. Virchow S. Enteritidis S. Panama S. Hadar A. Anatum S. Blockley S. Agona S. Albany S. Saintpaul S. Typhimurium Others 31 (27.2) 21 (18.4) 9 (7.9) 7 (6.1) 6 (5.2) 4 (3.5) 3 (2.7) 10 (15.7) Serovar Strains(%) Slide 20 PortChicken 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) 4 (3.0) 3 (2.5) 2 (1.5) Serovar (serogroup) Strains(%) 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) 12 (15.8) 5 (6.6) 4 (5.3) 3 (3.9) 2 (2.6) Serovar (serogroup) Strains(%) Salmonella serovars and serogroups isolated in 2002 from pork and chicken from Khon Kaen supermarkets Slide 21 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 Blockley S. Enteritidis, S. Panama S. Agona, S. Virchow, S. Rissen, S.Entritidis 40 Specimens Chicken 20 14 (70) 17 (85) Strains (%) Salmonella Serovars S. Rissen, S. Anatum S. Derby S. Anatum S. Senftenberg Specimens Pork 20 17 (85) 14 (70) 11 (55) Meat Liver Internal organ Total 42 (70) 60 Slide 22 Regional 6 Khon Kaen SerovarSerogroupStrains (%) S. Anatum S. Rissen S. Virchow S. Enteritidis S. Panama S. Hadar S. Derby S. Amsterdum S. Saintpaul S. Welteredenl 31 Other serovars ECCDDCBEBEECCDDCBEBE 120 62 46 32 29 17 10 9 8 87 (27.9) (14.4) (10.7) (7.4) (6.7) (3.9) (2.3) (2.1) (1.8) (20.2) SerovarSerogroupStrains (%) S. Rissen S. Weltevreden S. Enteritidis S. Anatum S. Derby S. Stanley S. Panama S. 14, 12, I S. Braenderup S. Virchow 23 Other serovars C1 E1 D1 E1 B D1 B C1 22 12 11 10 9 7 6 5 37 (16.5) (9.0) (8.2) (7.5) (6.7) (5.2) (4.5) (3.7) (2.7) Total429Total133 Salmonella isolation of diarrheal cases from hospitals in Khon Kaen and Region 6 2002. Slide 23 SalmonellosisCureChildren Carrier Extraintestinal BacteremiaFocal Infection Meningitis Osteoarthritis Pneumonia Cholangitis Case Fatality 3 - 10 % 8-24 % 2 - 45 % Cycle of Salmonellosis Slide 24 Intrafamily Carrier Prior diarrhea Supplement foods Orange Iron Under cooked meat Day care Pets SalmonellosisCure Children Extraintestinal BacteremiaFocal Infection Meningitis Osteoarthritis Pneumonia Cholangitis Case Fatality 3 - 10 % 8-24 % 2 - 45 % Carrier Cycle of Salmonellosis Slide 25 SalmonellosisCureChildren Extraintestinal BacteremiaFocal Infection Meningitis Osteoarthritis Pneumonia Cholangitis Case Fatality 3 - 10 % 8-24 % 2 - 45 % Gall stone Immuno compromised Serotype Permanent Convalescent Antibiotic Cycle of Salmonellosis Carrier Intrafamily Carrier Prior diarrhea Supplement foods Orange Iron Under cooked meat Day care Pets Slide 26 Host Infant Immuno compromised Stereotypes S. Typhimurium S. Choleraesuis S. Enteritidis Immunocompromised Age < 3 Mo. Cycle of Salmonellosis SalmonellosisCure Children Extraintestinal Bacteremia Focal Infection Meningitis Osteoarthritis Pneumonia Cholangitis Case Fatality 3 - 10 % 8-24 % 2 - 45 % Antibiotic Gall stone Immuno compromised Serotype Permanent Convalescent Carrier Intrafamily Carrier Prior diarrhea Supplement foods Orange Iron Under cooked meat Day care Pets Slide 27 TREATMENT Gastroenteritis Infant : ?? Children : No Immunocompromised : ? Bacteremia Ceftriaxone, cefotaxime 14 Days Focal Infection 4 - 6 Weeks 4 Weeks Osteomyelitis Meningitis Chronic carrier Fluoroquinolone Cholecystectomy Slide 28 /

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