Non-typhoid salmonella (NTS)

A02.9

• Description
• Diagnostic criteria
• General and supportive measures
• Medicine treatment
• Referral

DESCRIPTION

Present as:

• gastroenteritis, or
• extra-intestinal (invasive) disease.

DIAGNOSTIC CRITERIA

Clinical

• Self-limiting mucosal intestinal disease presenting with diarrhoea and vomiting in immunocompetent patients.
• Young infants (< 3 months) and immunodeficient children (especially HIV infected children) are prone to invasive, often recurrent disease.
• Invasive disease includes bacteraemia (fever), osteomyelitis and meningitis.
• There is also an association of invasive NTS with malaria and severe anaemia.

Investigations

• Positive blood cultures, less commonly, stool, urine and bone biopsy.

GENERAL AND SUPPORTIVE MEASURES

• Correct and maintain fluid and electrolyte status.

MEDICINE TREATMENT

Note:
Relapse may occur despite adequate therapy. Antibiotic therapy in NTS gastroenteritis may prolong excretion of Salmonella.

Antibiotic therapy is not generally recommended for non-invasive disease. However, in infants < 3 months of age and severely immunocompromised children at high risk of developing invasive disease treat as for invasive disease.

Invasive disease

If < 1 month of age:

• Cefotaxime, IV/IM, 50–75 mg/kg/dose 8 hourly.

OR

If > 1 month of age:

• Ceftriaxone, IV, 50–80 mg/kg once daily.
  Duration:
  • Bacteraemia: 10–14 days.
  • Acute osteomyelitis: 4–6 weeks.
  • Meningitis: 4 weeks.

If cephalosporin resistance reported treat according to sensitivity.

REFERRAL

• Inadequate response to treatment.
• Patients with complications.