Triage and Management of Salmonella Infection

Clinical Presentation and Risk Factors

Fever is present in 58-100% of Salmonella infections, and abdominal pain occurs in 75-100% of cases, with bloody stools in 25-51% of cases, and vomiting and/or nausea in 62.5-100% of cases 1, 2
Recent travel history to areas where enteric fever is endemic, consumption of foods prepared by people with recent endemic exposure, and contact with laboratory specimens containing Salmonella are risk factors for Salmonella infection 3, 5
The Centers for Disease Control and Prevention recommends assessing for signs of dehydration, which increases the risk of life-threatening illness and death, and determining the duration of symptoms, as prolonged symptoms may indicate complications 1, 3, 4

Immunocompromising conditions, such as HIV infection, chronic liver disease, hemoglobinopathies, and recent malaria, increase the risk of invasive disease, and a history of cirrhosis predisposes to more severe disease 6
The World Health Organization suggests asking about recent consumption of high-risk foods, such as poultry, eggs, and unpasteurized dairy products, and determining if the patient has had contact with others experiencing similar symptoms 6
The Centers for Disease Control and Prevention recommends inquiring about institutional living situations, such as long-term care facilities and dormitories, and documenting attendance at large gatherings or events where food was served prior to symptom onset 5, 6

Signs of severe illness, such as high fever, severe abdominal pain, tenesmus, or bloody diarrhea, and symptoms of colitis, such as severe fever, abdominal cramps, and bloody diarrhea, should be assessed 1, 2, 7, 8
The Infectious Diseases Society of America recommends considering blood cultures for infants, people with signs of septicemia, immunocompromised individuals, and those with systemic manifestations, and notifying public health authorities if a reportable pathogen like Salmonella is isolated 2, 7, 8
The American College of Gastroenterology suggests submitting a stool sample for culture of invasive enteropathogens, including Salmonella, for patients with symptoms of colitis but no recent antibiotic use 7, 9