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The infectious dose is lower for people at high risk

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The infectious dose is lower for people at high risk for disease because of age,immunosuppression or underlying disease (leukemia, lymphoma, sickle cell disease), or reducedgastric acidity.
DiagnosisIsolation from stool specimens requires use of selective mediaTreatment, Prevention, and ControlAntibiotic treatment not recommended for enteritis because this may prolong the durationof diseaseInfections withSalmonellaTyphi andSalmonellaParatyphi or disseminated infectionswith other organisms should be treated with an effective antibiotic (selected by in vitrosusceptibility tests); fluoroquinolones (e.g., ciprofloxacin), chloramphenicol, trimethoprim-sulfamethoxazole, or a broad-spectrum cephalosporin may be usedMost infections can be controlled by proper preparation of poultry and eggs (completelycooked) and avoidance of contamination of other foods with uncooked poultry productsCarriers ofSalmonellaTyphi andSalmonellaParatyphi should be identified and treatedVaccination againstSalmonellaTyphi can reduce the risk of disease for travelers intoendemic areasClinical DiseasesThe following four forms ofSalmonellainfection exist: gastroenteritis, septicemia, enteric fever,and asymptomatic colonization.-GastroenteritisGastroenteritis is themost common form of salmonellosisin the United States. Symptomsgenerally appear 6 to 48 hours after the consumption of contaminated food or water, with theinitial presentation consisting ofnausea, vomiting, and nonbloody diarrhea.Fever, abdominalcramps, myalgias, and headache are also common. Colonic involvement can be demonstrated inthe acute form of the disease. Symptoms can persist from 2 to 7 days before spontaneousresolution.-SepticemiaAllSalmonellaspecies can cause bacteremia, although infections withSalmonellaTyphi,SalmonellaParatyphi, andSalmonellaCholeraesuis more commonly lead to a bacteremic phase.
-Enteric FeverSalmonellaTyphi produces a febrile illness calledtyphoid fever.A milder form of this disease,referred to asparatyphoid fever,is produced bySalmonellaParatyphi A,SalmonellaSchottmuelleri (formerlySalmonellaParatyphi B), andSalmonellaHirschfeldii(formerlySalmonellaParatyphi C). OtherSalmonellaserotypes can rarely produce a similarsyndrome. The bacteria responsible for enteric fever pass through the cells lining the intestinesand are engulfed by macrophages. They replicate after being transported to the liver, spleen, andbone marrow. Ten to 14 days after ingestion of the bacteria, patients experience graduallyincreasing fever, with nonspecific complaints of headache, myalgias, malaise, and anorexia.These symptoms persist for 1 week or longer and are followed by gastrointestinal symptoms.This cycle corresponds to an initial bacteremic phase that is followed by colonization of thegallbladder and then reinfection of the intestines. Enteric fever is a serious clinical disease andmust be suspected in febrile patients who have recently traveled to developing countries wheredisease is endemic.

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