What Is Salmonella Septicemia?

Common Bacterial Infection Potentially Deadly in People with HIV

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Electron micrograph of a Salmonella typhimurium bacterium. Photo Credit: National Institute of Allergies and Infectious Diseases (NIAID)

Classification

Salmonella septicemia is a condition wherein the presence of Salmonella bacteria in the blood triggers a potentially life-threatening, whole-body inflammatory response. Recurrent Salmonella septicemia is classified as an AIDS-defining condition by the U.S. Centers for Disease Control and Prevention (CDC).

With the advent of combination antiretroviral therapy (ART), Salmonella septicemia is considered rare among people living with HIV in the developed world, with one study showing only 22 cases out of 9,000 patients monitored over a nine-year period.

By contrast, invasive non-typhoidal Salmonella has emerged as a major public health problem in developing countries, particularly sub-Saharan Africa.

Causal Agent

Salmonella consist of a large family of bacterium which occur normally or pathogenically in the intestines of humans and other animals. Over 2,500 strains of Salmonella have been identified.

What differentiates salmonellosis (popularly referred to as Salmonella poisoning) from Salmonella septicemia is that salmonellosis is isolated to the gastrointestinal tract. When Salmonella endotoxins spread from the intestines into the bloodstream and then to other body sites, the bacteria can trigger a severe immune response which, if left untreated, can be fatal.

Modes of Transmission

Salmonella transmission usually occurs through fecal-oral route. Animals can become infected through contaminated feed, water, or close contact with an infected host.

The bacteria can then be passed to humans through tainted meat or animal products that have not thoroughly cooked (145°-160°F). 

Salmonella can also be transmitted through tainted fruits and vegetables, from animals/pets to human, and from human to human.

Even after treatment, humans can remain infectious for months after recovery.

Proper hygiene (including food hygiene) is recommended, particularly for those with CD4 counts under 200 cells/μL.

Symptoms of Salmonella Septicemia

In addition to the diarrhea, vomiting and abdominal cramping commonly associated with salmonellosis, symptoms can include high fevers, chills, swelling, flushed skin, increased heart rate, confusion, hyperventilation, and high blood pressure.

Diagnosis of Salmonella Septicemia

Salmonella septicemia is confirmed with a blood test, supplemented by a stool culture.

Treatment of Salmonella Septicemia

For HIV-positive patients with severe Salmonella septicemia, a broad-spectrum antibiotic would be administered intravenously, immediately upon diagnosis. Cipro (ciprofloxacin), a fluoroquinolone-class antibiotic, is generally recommended. In the event of fluoroquinolone resistance, cephalosporins are also known to be effective.

Treatment duration can last anywhere from seven to 10 days, depending on severity. Intravenous fluids would be administered to address any fluid deficits.

Maintenance therapy should continue for six to eight months after completion of treatment. With the implementation of ART, the risk of recurrence is significantly reduced..  

Pronunciation: sal-muh-NEL-uh sep-tuh-SEE-mee-uh

Also Known As:

  • Salmonella sepsis
  • Non-typhoidal Salmonella septicemia
  • Non-typhoid Salmonella septicemia
  • Non-Typhi Salmonella septicemia
  • NTS Salmonella septicemia
  • Invasive non-typhoidal Salmonella septicemia
  • Invasive non-typhoid Salmonella septicemia
  • Invasive non-Typhi Salmonella septicemia
  • iNTS Salmonella septicemia

Alternate Spellings: Salmonella septicaemia

Sources:

U.S. Centers for Disease Control and Prevention (CDC). "Appendix A - AIDS Defining Conditions." Atlanta, Georgia; last reviewed November 20,2008.

Burckhardt, B.; Sendi, P.; Pluger, D.; et al. "Rare AIDS-Defining Diseases in Swiss HIV Cohort Study." European Journal of Clinical Microbiology and Infectious Diseases. July 1999, 18(6):399-402.

Morpeth, S.; Ramadhani, H.; and Crump, J. "Invasive Non-Typhi Salmonella Disease in Africa." Clinical Infectious Disease. August 15, 2009, 49 (4): 606-611.

Dhanoa, A. and Fatt, Q. "Non-typhoidal Salmonella bacteraemia: Epidemiology, clinical characteristics and its' association with severe immunosuppression." Annals of Clinical Microbiology and Antimicrobials. March 18, 2009; 8(15):e1-15.

Celum, C.; Chaisson,R.; and Rutherford, G. "Incidence of salmonellosis is patients with AIDS." Journal of Infectious Diseases. December 1987; 156(6);998-1002.

Hung, C.; Hung, M.; and Hseuh, P. "Risk of Recurrent Nontyphoid Salmonella Bacteremia in HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy and an Increasing Trend of Fluoroquinolone Resistance." Clinical Infectious Disease. July 19, 2007, 45 (5): e60-e67.

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