Long-Term Sequelae of Salmonellosis
TASA ID: 733
As we eat in places other than our kitchen, poor sanitation and contamination of food sources become a significant problem. Although the FDA has established a series of guidelines for food safety, CDC incidence reports of Salmonella are on the rise. Some of the acute clinical symptoms related to these types of bacterial infection appear to be self-limiting, but the reality is that life-long problems persist. Of interest to the lawyer and patient is to ensure that these significant risk factors are considered when the damages to the person are assessed.
Salmonellosis can occur due to the ingestion of contaminated eggs, egg products, poultry, raw milk, etc. Although one may ingest many items at a restaurant or party, contamination of a single food item can be the source of transmission. The bacteria can proliferate in eggs or egg products, for example, that are refrigerated in large containers, since the center of the container may be inadequately cooled. Infection may present clinically as gastroenteritis, fever, bacteremic syndrome, or as a focal disease. Bacteremia can be a sustained syndrome lasting for weeks or months and result in positive blood cultures. Focal manifestations are also associated with bacteremia, or may be present without positive blood cultures. Localized infection may occur, involving the gastrointestinal tract (liver, gallbladder, and appendix), endothelial surfaces, pericardium, meninges, lungs, joints, bones, genitourinary tract, or soft tissues. In addition, each affected individual can be the source of contamination to any person with whom they came in contact. The infectious dose is highly variable, depending largely on the strain, the food, and the susceptibility of the host. Recent evidence suggests that as few as one to ten Salmonella cells can cause infection in humans. In very young children the infection can spread to the bloodstream, and then to other areas of the body, such as the bone marrow or the meningeal linings of the brain, and in the most extreme cases can lead to a severe and occasionally fatal illness unless treated promptly with antibiotics.
Many cases of Salmonellosis are not reported. In some cases, the infection may be entirely subclinical. In addition, not all infected persons develop symptoms severe enough that they seek medical attention. Finally, the possibility of missed diagnoses or false negatives on cultures taken is significant. In this regard, it is estimated that there are an additional 20 to 100 cases of salmonellosis for every reported case in the United States each year. Children often suffer the worst consequences from infection, i.e. severe trauma to their gastrointestinal, cardiovascular, and immunological systems. Since Salmonella may be harbored in the body for extended periods of time, there is a significant risk of relapse, perhaps even years in the future. Those children who suffer relapses (or experience symptoms that are not readily and clearly attributable to an alternative cause) should be monitored more often and for a longer period of time. Immunologic conditions, such as reactive arthritis, can be manifested at any time in the future, due to localized infiltration of Salmonella in joints, bones, organs, and tissues.
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