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.
Overview
Salmonella consist of a large family of bacteria 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 (often called Salmonella poisoning) from Salmonella septicemia is that salmonellosis is isolated to the gastrointestinal tract.
In contrast, with Salmonella septicemia, bacterial endotoxins spread from the intestines into the bloodstream and then to other body sites, the pathogen can trigger a severe immune response. If left untreated, this can be fatal.
Modes of Transmission
Salmonella transmission usually occurs through the 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 been thoroughly cooked.
Salmonella can also be transmitted through tainted fruits and vegetables, from animals/pets to humans, and from human to human (rare).
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.
Salmonella Septicemia Symptoms
In addition to the diarrhea, vomiting, and abdominal cramping commonly associated with salmonellosis, symptoms of Salmonella septicemia can include:
High feversChillsAbdominal swellingFlushed skinIncreased heart rateConfusionHyperventilation
Diagnosis
Salmonella septicemia is confirmed with a blood test and/or stool tests.
Treatment
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.
