Complications of Salmonellosis
The most dangerous complication in salmonellosis is an infectious-toxic shock, accompanied by acute edema and swelling of the brain, acute cardiovascular insufficiency, often against the background of acute adrenal insufficiency and acute renal failure.
Edema and cerebral swelling that occur against the backdrop of exsicosis are manifested by bradycardia, short-term hypertension, reddening and cyanosis of the skin of the face and neck (“shock syndrome”), rapidly developing paresis of the muscles innervated by the cranial nerves. Then the dyspnea increases, and finally, a brain coma with a loss of consciousness sets in.
Expressed oliguria and anuria is an alarming signal of possible onset of acute renal failure. These suspicions increase if urine is still not released after the restoration of blood pressure. In such cases, it is urgent to determine the concentration of nitrogenous slags in the blood. In the future, patients develop symptomatology, characteristic of uremia.
Acute cardiovascular failure is characterized by the development of collapse, a decrease in body temperature to normal or subnormal levels, the appearance of pallor and cyanosis of the skin, cold extremities, and further – the disappearance of the pulse due to a sharp drop in blood pressure. If the adrenal glands are involved in the process (hemorrhages in them due to DIC-syndrome), the collapse is very resistant to therapeutic effects.
Treatment of Salmonellosis
Hospitalization of patients is carried out only with severe or complicated course, as well as by epidemiological indications. Bed rest is prescribed for severe manifestations of toxicosis and dehydration.
If the clinical condition of the patient allows, treatment should begin with gastric lavage, siphon enemas, administration of enterosorbents (activated charcoal, etc.)
With the dehydration of I-II degree, the appointment of glucose-salt solutions of the type “Citroglucosolan”, “Glucosolan”, “Regidron”, “Oralite” is indicated, taking into account the water and salt deficiency in the patient before the start of therapy, replenished with a fractional frequent drink (up to 1-1 , 5 l / h) for 2-3 hours, and further fluid loss during treatment (should be monitored every 2-4 hours).
With dehydration of III-IV degree, isotonic polyionic crystalloid solutions are injected intravenously until the signs of dehydration shock are eliminated, and then drip.
If necessary, additional correction of the content of K + ions inwards in the form of solutions of potassium chloride or potassium citrate 1 g 3-4 times a day (the electrolytes in the blood should be monitored).
Intravenous injection of macromolecular colloidal preparations (reopoliglyukin, hemodez, etc.) for detoxification can be carried out only after correction of water-electrolyte losses. At the expressed metabolic acidosis the additional intravenous introduction of 4% of a solution of sodium bicarbonate under the control of indicators of an acid-alkaline condition can be required.
In addition, for the relief of signs of intoxication in the gastrointestinal form of salmonellosis, indomethacin may be prescribed. The drug is prescribed in the early stages of the disease at 50 mg 3 times for 12 hours.
In the gastrointestinal form, the use of antibiotics and other etiotropic drugs is not shown in most cases. They must be used in the generalized form of salmonellosis (fluoroquinolones 0.5 g 2 times a day, levomycetin 0.5 g 4-5 times a day, doxycycline 0.1 g / day, etc.). It is expedient to use complex enzyme preparations (enzyme, festal, mexazate, etc.).
The diet of patients in the acute period of the disease corresponds to table number 4 according to Pevzner, after stopping diarrhea appoint table number 13.
The leading role in the prevention of salmonellosis belongs to the combined epidemiological-epizootological surveillance carried out by the veterinary and sanitary-epidemiological services. The veterinary service maintains constant monitoring of the incidence of animals, the frequency of infection of feed and meat products, carries out microbiological monitoring of serological structure of salmonella and their biological properties. The Sanitary and Epidemiological Service monitors the incidence of people, its trends and characteristics in a certain period of time and in a given territory, monitors the serotype structure of the pathogen isolated from humans and food products, and studies the biological properties of salmonella. Of great importance are the development of reliable diagnostic methods and standardization of accounting procedures and notification of cases, as well as control over incoming food products, especially imported from other regions of the country or from abroad. The combined analysis of the morbidity of the population and the epizootic process of salmonellosis among animals and agricultural birds makes it possible to carry out timely epidemiological diagnostics, planning and organizational and methodological support of preventive and anti-epidemic measures.
The basis for the prevention of salmonellosis among people is veterinary and sanitary measures aimed at ensuring proper conditions in the slaughter of cattle and poultry, adherence to the slaughter regime of animals, technology for carcass processing, cooking and storing meat and fish dishes. Of great importance are regular selective monitoring of feed and feed ingredients, planned disinfection and deratization activities at meat processing plants, food and raw materials stores, refrigerators, vaccination of farm animals. In public catering and personal home practice, you should strictly follow the sanitary and hygienic rules for cooking, the separate processing of raw meat and cooked foods, the conditions and terms of storage of ready meals. The signal for special anti-epidemic measures is the increase in the number of isolations of Salmonella strains of the same serovar, the appearance of new or increased numbers of salmonella precipitates, rare in the territory of serovars: an increase in the proportion of strains resistant to antibiotics, the emergence of a salmonella outbreak. For the prevention of hospital-acquired infection, all the requirements of the sanitary-hygienic and anti-epidemic regimen in medical and preventive institutions should be observed. Persons entering the work for the first time into preschool institutions and medical and preventive institutions, food industry enterprises and institutions equivalent to them are subject to mandatory bacteriological examination. There are no means of specific prevention.
Activities in the Epidemic Outbreak
Hospitalization of patients is carried out according to clinical indications. Obligatory hospitalization and dispensary supervision of those who have been ill are subject only to workers of food enterprises and persons equal to them.
An extract from the hospital is performed after a clinical recovery and a single bacteriological study of the feces, conducted 2 days after the end of treatment. Workers of the food industry and persons equated with them are subjected to a 2-fold bacteriological examination after discharge after negative results. Persons who do not excrete the pathogen are allowed to work. When establishing bacteriocarriers within 3 months, these individuals as chronic carriers of salmonella are suspended from work for a period of at least one year. Children – chronic carriers of salmonella are not allowed in nurseries (children’s homes). Such children attending kindergartens and general education schools, including boarding schools, are admitted to collectives, but they are not allowed to watch on food units.
In the case of people who have been in contact with a patient with salmonellosis, separation does not apply if the patient is left at home. Workers of food and equated enterprises, children attending children’s institutions, as well as children from orphanages and boarding schools are subjected to a single bacteriological examination. In case of hospital infection with salmonellosis patients, and in case of illness of children – and mothers caring for them, they are transferred to an infectious hospital; in case of group diseases, temporary organization of a special department on the spot is possible with the involvement of an infectious disease patient. The admission of new patients to this department before the stopping of the outbreak ceases. Disinfection measures in the departments are carried out as in other acute intestinal infections, paying special attention to the disinfection of patient discharge, bedding and dishes. Systematic processing of items for care of patients, baths, cleaning equipment, etc. is carried out. In the children’s departments of disinfection, the swaddling tables are subjected after each use. The only means of emergency prophylaxis in the focus of infection in the event of long-term nosocomial outbreaks of salmonella is the therapeutic bacteriophage of the salmonella group ABCDE.