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{{Short description|Infection caused by Salmonella bacteria}}
{{Infobox medical condition (new)
| name          = Salmonellosis
| image         = SalmonellaNIAID.jpg
| caption       = [[Electron micrograph]] showing ''Salmonella typhimurium'' (red) invading cultured human cells
| field         = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms      = [[Diarrhea]], [[fever]], [[abdominal pain|abdominal cramps]], [[vomiting]]<ref name=CDC2015Pro/>
| complications = [[Reactive arthritis]], [[irritable bowel syndrome]]<ref name=Ha2013/>
| onset         = 0.5–3 days post exposure<ref name=CDC2015Pro/>
| duration      = 4–7 days<ref name=CDC2015Pro/>
| types         = Typhoidal, nontyphoidal<ref name=CDC2015Pro/>
| causes        = ''[[Salmonella]]''<ref name=CDC2015Pro/>
| risks         = Old, young, [[immunocompromised|weak immune system]], [[bottle feeding]], [[proton pump inhibitors]]<ref name=CDC2015Pro/>
| diagnosis     = [[Stool test]], [[blood tests]]<ref name=NIH2017/><ref name="CDC2015Pro" />
| differential  = Other types of [[gastroenteritis]]<ref name=Ha2013/>
| prevention    = Proper preparation and cooking of food and supervising contact between young children and pets <ref name=WHO2016Fact/>
| treatment     = [[Oral rehydration therapy|Fluids by mouth]], [[intravenous therapy|intravenous fluids]], [[antibiotic]]s<ref name=CDC2015Pro/>
| medication    =
| prognosis     =
| frequency     = 1.2 million non–typhoidal cases per year (US)<ref name=CDC2015Pro/>
| deaths        = 90,300 (2015)<ref name=GBD2015De/>
| alt           =
}}
<!-- Definition and symptoms -->
'''Salmonellosis''' is a [[symptomatic infection]] caused by [[bacteria]] of the ''[[Salmonella]]'' type.<ref name=CDC2015Pro>{{cite web|title=Salmonella|url=https://www.cdc.gov/salmonella/general/technical.html|website=CDC|access-date=7 May 2017|language=en-us|date=9 March 2015|url-status=live|archive-url=https://web.archive.org/web/20170525021005/https://www.cdc.gov/salmonella/general/technical.html|archive-date=25 May 2017}}</ref> The most common symptoms are [[diarrhea]], [[fever]], [[abdominal pain|abdominal cramps]], and [[vomiting]].<ref name=CDC2015Pro/> Symptoms typically occur between 12 hours and 36 hours after exposure, and last from two to seven days.<ref name=WHO2016Fact/> Occasionally more significant disease can result in [[dehydration]].<ref name=WHO2016Fact/> The old, young, and others with a [[immunocompromised|weakened immune system]] are more likely to develop severe disease.<ref name=CDC2015Pro/> Specific types of ''Salmonella'' can result in [[typhoid fever]] or [[paratyphoid fever]].<ref name=CDC2015Pro/><ref name=NIH2017/>

<!-- Cause and diagnosis -->
There are two [[species]] of ''Salmonella'': ''[[Salmonella bongori]]'' and ''[[Salmonella enterica]]'' with many [[subspecies]].<ref name=WHO2016Fact/> Infection is usually spread by eating contaminated meat, eggs, or milk.<ref name=WHO2017>{{cite web|title=Salmonella|url=https://www.who.int/topics/salmonella/en/|website=World Health Organization|access-date=7 May 2017|url-status=live|archive-url=https://web.archive.org/web/20170417223002/http://www.who.int/topics/salmonella/en/|archive-date=17 April 2017}}</ref> Other foods may spread the disease if they have come into contact with [[manure]].<ref name=WHO2016Fact/> A number of pets including cats, dogs, and reptiles can also carry and spread the infection.<ref name=WHO2016Fact/> Diagnosis is by a [[stool test]] or [[blood tests]].<ref name=CDC2015Pro/><ref name=NIH2017>{{cite web|title=Salmonella Infections|url=https://medlineplus.gov/salmonellainfections.html|website=MedlinePlus|access-date=7 May 2017|language=en|url-status=live|archive-url=https://web.archive.org/web/20170430075116/https://medlineplus.gov/salmonellainfections.html|archive-date=30 April 2017}}</ref>

<!-- Prevention and treatment -->
Efforts to prevent the disease include the proper washing, preparation, and cooking of food.<ref name=WHO2016Fact>{{cite web|title=Salmonella (non-typhoidal)|url=https://www.who.int/mediacentre/factsheets/fs139/en/|website=World Health Organization|access-date=7 May 2017|date=December 2016|url-status=live|archive-url=https://web.archive.org/web/20170420130035/http://www.who.int/mediacentre/factsheets/fs139/en/|archive-date=20 April 2017}}</ref> Mild disease typically does not require specific treatment.<ref name=WHO2016Fact/> More significant cases may require treatment of [[electrolyte problems]] and [[intravenous therapy|intravenous fluid replacement]].<ref name=CDC2015Pro/><ref name=WHO2016Fact/> In those at high risk or in whom the disease has spread outside the intestines, [[antibiotics]] are recommended.<ref name=WHO2016Fact/>

<!-- Epidemiology -->
Salmonellosis is one of the most common causes of diarrhea globally.<ref name=Ha2013>{{cite book|last1=Hald|first1=T.|title=Advances in microbial food safety: 2. Pathogen update: Salmonella|date=2013|publisher=Elsevier Inc. Chapters|isbn=9780128089606|page=2.2|url=https://books.google.com/books?id=qw10DAAAQBAJ&pg=PT6|language=en|url-status=live|archive-url=https://web.archive.org/web/20170910171411/https://books.google.com/books?id=qw10DAAAQBAJ&pg=PT6|archive-date=2017-09-10}}</ref> In 2015, 90,300 deaths occurred from [[Salmonella#Nontyphoidal Salmonella|nontyphoidal salmonellosis]], and 178,000 deaths from [[Salmonella#Typhoidal Salmonella|typhoidal salmonellosis]].<ref name=GBD2015De>{{cite journal|last1=GBD 2015 Mortality and Causes of Death|first1=Collaborators.|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.|journal=Lancet|date=8 October 2016|volume=388|issue=10053|pages=1459–1544|pmid=27733281|doi=10.1016/s0140-6736(16)31012-1|pmc=5388903}}</ref> In the United States, about 1.2 million cases and 450 deaths occur from nontyphoidal salmonellosis a year.<ref name=CDC2015Pro/> In Europe, it is the second most common [[foodborne disease]] after [[campylobacteriosis]].<ref name=Ha2013/>

==Signs and symptoms==
===Enteritis===
{{See also |Enteritis#Infectious enteritis}}
After a short incubation period of a few hours to one day, the bacteria multiply in the [[small intestine]], causing an intestinal inflammation ([[enteritis]]). Most people with salmonellosis develop diarrhea, fever, vomiting, and abdominal cramps 12 to 72 hours after infection.<ref name=Santos>{{cite journal|last=Santos|first=Renato L.|author2=Shuping Zhang |author3=Renee M. Tsolis |author4=Robert A. Kingsley |author5=L. Gary Adams |author6=Andreas J. Baumler |title=Animal models od Salmonella infections: enteritis versus typhoid fever|journal=Microbes and Infection|year=2001|volume=3|issue=14–15|pages=1335–1344 |doi=10.1016/s1286-4579(01)01495-2|pmid=11755423}}</ref> Diarrhea is often watery and non-bloody but may be mucoid and bloody.<ref>{{Cite news|url=https://www.merckmanuals.com/en-ca/professional/infectious-diseases/gram-negative-bacilli/nontyphoidal-salmonella-infections|title=Nontyphoidal Salmonella Infections - Infectious Diseases - Merck Manuals Professional Edition|work=Merck Manuals Professional Edition|access-date=2018-09-15|language=en-CA}}</ref> In most cases, the illness lasts four to seven days, and does not require treatment. In some cases, though, the diarrhea may be so severe that the patient becomes dangerously dehydrated and must be hospitalized. At the hospital, the patient may receive [[intravenous therapy|fluids intravenously]] to treat the dehydration, and may be given medications to provide symptomatic relief, such as fever reduction. In severe cases, the ''Salmonella'' infection may spread from the intestines to the blood stream, and then to other body sites, and can cause death, unless the person is treated promptly with antibiotics.{{citation needed|date=January 2021}}

In otherwise healthy adults, the symptoms can be mild. Normally, no [[sepsis]] occurs, but it can occur exceptionally as a complication in the [[immunocompromised]]. However, in people at risk such as infants, small children, and the elderly, ''Salmonella'' infections can become very serious, leading to complications. In infants, [[dehydration]] can cause a state of severe [[toxicity]]. Extraintestinal localizations are possible, especially ''Salmonella'' meningitis in children, [[osteitis]], etc. Children with [[Sickle-cell disease|sickle-cell anemia]] who are infected with ''Salmonella'' may develop [[osteomyelitis]]. Treatment of osteomyelitis, in this case, will be to use [[fluoroquinolones]] ([[ciprofloxacin]], [[levofloxacin]], etc., and [[nalidixic acid]]).{{citation needed|date=January 2021}}

Those whose only symptom is diarrhea usually completely recover, but their bowel habits may not return to normal for several months.<ref>{{cite web|url=https://www.cdc.gov/salmonella/general/|publisher=US Center of Disease Control and Prevention|title=What is Salmonellosis?|url-status=live|archive-url=https://web.archive.org/web/20140331162352/http://www.cdc.gov/salmonella/general/|archive-date=2014-03-31|date=2019-02-08}}</ref>

===Typhoid fever===
{{See also|Typhoid fever|Paratyphoid fever}}
Typhoid fever occurs when ''Salmonella'' bacteria enter the lymphatic system and cause a [[systemic disease|systemic]] form of salmonellosis. Endotoxins first act on the vascular and nervous apparatus, resulting in increased permeability and decreased tone of the vessels, upset thermal regulation, vomiting, and diarrhea. In severe forms of the disease, enough liquid and electrolytes are lost to upset the [[fluid balance]], cause an [[electrolyte imbalance]], decrease the circulating blood volume and arterial pressure, and cause [[hypovolemia|hypovolemic shock]]. [[Septic shock]] may also develop. Shock of mixed character (with signs of both hypovolemic and septic shock) are more common in severe salmonellosis. [[Oliguria]] and [[azotemia]] develop in severe cases as a result of renal involvement due to [[hypoxia (medical)|hypoxia]] and [[Bacteremia#Consequences|toxemia]].<ref name=Santos />

===Long-term===
Salmonellosis is associated with later [[irritable bowel syndrome]]<ref>{{cite journal|last1=Smith|first1=JL|last2=Bayles|first2=D|title=Postinfectious irritable bowel syndrome: a long-term consequence of bacterial gastroenteritis.|journal=Journal of Food Protection|date=July 2007|volume=70|issue=7|pages=1762–9|pmid=17685356|doi=10.4315/0362-028X-70.7.1762|s2cid=42240663|url=https://semanticscholar.org/paper/05a0379208ca375bfee3ef6972827f76b2c6d699}}</ref> and [[inflammatory bowel disease]].<ref name=Mann2012>{{cite journal|last1=Mann|first1=EA|last2=Saeed|first2=SA|title=Gastrointestinal infection as a trigger for inflammatory bowel disease.|journal=Current Opinion in Gastroenterology|date=January 2012|volume=28|issue=1|pages=24–9|pmid=22080823|doi=10.1097/mog.0b013e32834c453e|s2cid=800248}}</ref> Evidence however does not support it being a direct cause of the latter.<ref name=Mann2012/>

A small number of people afflicted with salmonellosis experience reactive arthritis, which can last months or years and can lead to chronic arthritis.<ref name="Schmitt2017">{{cite journal|last1=Schmitt|first1=SK|title=Reactive Arthritis|journal=Infectious Disease Clinics of North America|date=November 2017|volume=31|issue=2|pages=265–77|doi=10.1016/j.idc.2017.01.002|pmid=28292540|type=Review}}</ref> In sickle-cell anemia, [[osteomyelitis]] due to ''Salmonella'' infection is much more common than in the general population. Though ''Salmonella'' infection is frequently the cause of osteomyelitis in people with sickle-cell, it is not the most common cause, which is ''Staphylococcus'' infection.<ref>{{Cite journal|last1=Cook|first1=Bruce A.|last2=Md|first2=James W. Bass|last3=Burnett|first3=Mark W.|date=1998-02-01|title=Etiology of Osteomyelitis Complicating Sickle Cell Disease|url=http://pediatrics.aappublications.org/content/101/2/296|journal=Pediatrics|language=en|volume=101|issue=2|pages=296–297|doi=10.1542/peds.101.2.296|issn=0031-4005|pmid=9445507}}</ref>

Those infected may become asymptomatic carriers, but this is relatively uncommon, with shedding observed in only 0.2 to 0.6% of cases after a year.<ref name=":2">{{Cite web|url=https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/nontyphoidal-salmonella-infections|title=Nontyphoidal Salmonella Infections|publisher=Merck Manual|access-date=2016-09-19|url-status=live|archive-url=https://web.archive.org/web/20160919092549/https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/nontyphoidal-salmonella-infections|archive-date=2016-09-19}}</ref>

== Causes ==
[[File:Prevention of Salmonella from the farm to table infographic.png|thumb|upright=1.3|An infographic illustrating how ''Salmonella'' bacteria  spread from the farm]]
* Contaminated food, often having no unusual look or smell<ref>{{cite web |url=http://now.tufts.edu/articles/food-bacteria-smell-taste-bad-illness |title=Are the bacteria that make food smell and taste bad the same ones that make you sick? |website=Tufts.edu |date=24 February 2012  |author=Jeanne Goldberg |access-date= 28 May 2018}}</ref>
* Poor kitchen hygiene, especially problematic in institutional kitchens and restaurants because this can lead to a significant outbreak
* Excretions from either sick or infected but apparently clinically healthy people and animals (especially dangerous are caregivers and animals)
* Polluted surface water and standing water (such as in shower hoses or unused water dispensers)
* Unhygienically thawed poultry (the meltwater contains many bacteria)
* An association with reptiles (pet tortoises, snakes, iguanas,<ref>{{cite journal|title=Reptile-Associated Salmonellosis—Selected States, 1998–2002|journal=Centers for Disease Control and Prevention|date=12 December 2003|access-date=9 October 2011|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a3.htm|url-status=live|archive-url=https://web.archive.org/web/20111006191405/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a3.htm|archive-date=6 October 2011}}</ref><ref>{{cite journal|title=Iguanas and Salmonella marina infection in children: a reflection of the increasing incidence of reptile-associated salmonellosis in the United States|journal=Pediatrics|date=March 1997|pmid=9041295|volume=99|issue=3|pages=399–402|vauthors=Mermin J, Hoar B, Angulo FJ |doi=10.1542/peds.99.3.399}}</ref> and aquatic turtles) is well described.<ref>{{cite journal|title=Ongoing investigation into reptile associated salmonella infections|journal=Health Protection Report|volume=3|issue=14|date=9 April 2009|access-date=12 April 2009|url=http://www.hpa.org.uk/hpr/archives/2009/news1409.htm#reptiles|url-status=live|archive-url=https://web.archive.org/web/20090429110621/http://www.hpa.org.uk/hpr/archives/2009/news1409.htm#reptiles|archive-date=29 April 2009}}</ref>
* Amphibians such as frogs

''Salmonella'' bacteria can survive for some time without a host; they are frequently found in polluted water, with contamination from the excrement of carrier animals being particularly important.{{citation needed|date=January 2021}}

The [[European Food Safety Authority]] <!-- (EFSA) --> highly recommends that when handling raw turkey meat, consumers and people involved in the food supply chain should pay attention to personal and food hygiene.<ref>{{Cite journal|title = Multi-country outbreak of Salmonella Stanley infections Update|date = 21 September 2012|journal = EFSA Journal|doi = 10.2903/j.efsa.2012.2893|volume=10|issue = 9|pages=2893|doi-access = free}}</ref>

An estimated 142,000 Americans are infected each year with ''Salmonella'' Enteritidis from [[chicken eggs]],<ref>{{cite news | title = Playing It Safe With Eggs | url = https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm077342.htm | quote = The U.S. Food and Drug Administration (FDA) estimates that 142,000 illnesses each year are caused by consuming eggs contaminated with Salmonella. | work = FDA Food Facts | access-date = 2013-03-02 | date = 2013-02-28 | url-status = live | archive-url = https://web.archive.org/web/20130301230156/https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm077342.htm | archive-date = 2013-03-01 }}</ref> and about 30 die.<ref name="Was2009">{{cite news|url=https://www.washingtonpost.com/wp-dyn/content/article/2009/07/07/AR2009070702343.html?hpid=topnews|title=Administration Urged to Boost Food Safety Efforts|date=2009-07-08|work=[[Washington Post]]|last2=O'Keefe|first2=Ed|quote=Among them is a final rule, issued by the FDA, to reduce the contamination in eggs. About 142,000 Americans are infected each year with ''Salmonella'' enteritidis from eggs, the result of an infected hen passing along the bacterium. About 30 die.|access-date=2009-07-07|first1=Jane|last1=Black|url-status=live|archive-url=https://web.archive.org/web/20110604113540/http://www.washingtonpost.com/wp-dyn/content/article/2009/07/07/AR2009070702343.html?hpid=topnews|archive-date=2011-06-04}}</ref> The shell of the egg may be contaminated with ''Salmonella'' by feces or environment, or its interior (yolk) may be contaminated by penetration of the bacteria through the porous shell or from a hen whose infected ovaries contaminate the egg during egg formation.<ref>{{cite journal | title = Mechanisms of egg contamination by Salmonella Enteritidis | journal = FEMS Microbiology Reviews | date = July 2009 | first = Inne | last = Gantois |author2=Richard Ducatelle |author3=Frank Pasmans |author4=Freddy Haesebrouck |author5=Richard Gast |author6=Tom J. Humphrey |author7=Filip Van Immerseel  | pmid = 19207743 | volume = 33 | issue = 4 | pages = 718–738| doi = 10.1111/j.1574-6976.2008.00161.x| quote = Eggs can be contaminated on the outer shell surface and internally. Internal contamination can be the result of penetration through the eggshell or by direct contamination of egg contents before oviposition, originating from infection of the reproductive organs. Once inside the egg, the bacteria need to cope with antimicrobial factors in the albumen and vitelline membrane before migration to the yolk can occur| doi-access = free }}</ref><ref>{{cite journal | title = Contamination of egg shell and contents with Salmonella enteritidis: a review | journal = International Journal of Food Microbiology | date = January 1994 | first = T. J. | last = Humphrey | pmid = 8155476 | volume = 21 | issue = 1–2 | pages = 31–40| doi = 10.1016/0168-1605(94)90197-X | quote = Salmonella enteritidis can contaminate the contents of clean, intact shell eggs as a result of infections of the reproductive tissue of laying hens. The principal site of infection appears to be the upper oviduct. In egg contents, the most important contamination sites are the outside of the vitelline membrane or the albumen surrounding it. In fresh eggs, only a few salmonellae are present. As albumen is an iron-restricted environment, growth only occurs with storage-related changes to vitelline membrane permeability, which allows salmonellae to invade yolk contents.}}</ref>

Nevertheless, such interior egg yolk contamination is theoretically unlikely.<ref>{{cite journal | title = Penetration and Growth of Salmonella in Shell Eggs | journal = Journal of Food Science | date = September 1956 | first = J.L. | last = Stokes |author2=W.W. Osborne |author3=H.G. Bayne | volume = 21 | issue = 5 | pages = 510–518| doi = 10.1111/j.1365-2621.1956.tb16950.x| quote = Normally, the oviduct of the hen is sterile and therefore the shell and internal contents of the egg are also free of microorganisms (10,16). In some instances, however, the ovaries and oviduct may be infected with ''Salmonella'' and these may be deposited inside the egg (12). More frequently, however, the egg becomes contaminated after it is laid.}}</ref><ref>{{cite journal | doi = 10.2307/1593012 | title = Differences Among Six Salmonella Serovars in Abilities to Colonize Reproductive Organs and to Contaminate Egges in Laying Hens | journal = Avian Diseases | year = 2001 | first = Masashi | last = Okamura |author2=Yuka Kamijima |author3=Tadashi Miyamoto |author4=Hiroyuki Tani |author5=Kazumi Sasai |author6=Eiichiroh Baba  | volume = 45 | issue = 1 | pages = 61–69| pmid = 11332500  | jstor = 1593012| quote = when hens were artificially infected to test for transmission rate to yolks: "Mature laying hens were inoculated intravenously with 106 colony-forming units of ''Salmonella'' enteritidis, ''Salmonella'' typhimurium, ''Salmonella'' infantis, ''Salmonella'' hadar, ''Salmonella'' heidelberg, or ''Salmonella'' montevideo to cause the systemic infection. ''Salmonella'' Enteritidis was recovered from three yolks of the laid eggs (7.0%), suggesting egg contamination from the transovarian transmission of S. enteritidis."}}</ref><ref>{{cite journal | doi = 10.3382/ps.2009-00440 | title = In vitro penetration of ''Salmonella'' enteritidis through yolk membranes of eggs from 6 genetically distinct commercial lines of laying hens | journal = Poultry Science | date = August 2010 | first = RK | last = Gast | author2 = D.R. Jones | author3 = K.E. Anderson | author4 = R. Guraya | author5 = J. Guard | author6 = P.S. Holt | volume = 89 | issue = 8 | pages = 1732–1736 | pmid = 20634530 | url = http://ps.fass.org/cgi/content/abstract/89/8/1732 | access-date = 2010-08-20 | quote = In this study, egg yolks were infected at the surface of the yolk (vitelline membrane) to determine the percentage of yolk contamination (a measure used to determine egg contamination resistance, with numbers lower than 95% indicating increasing resistance): Overall, the frequency of penetration of Salmonella Enteritidis into the yolk contents of eggs from individual lines of hens ranged from 30 to 58% and the mean concentration of Salmonella Enteritidis in yolk contents after incubation ranged from 0.8 to 2.0 log10 cfu/mL. | url-status = live | archive-url = https://web.archive.org/web/20110724195805/http://ps.fass.org/cgi/content/abstract/89/8/1732 | archive-date = 2011-07-24 | doi-access = free }}</ref><ref>{{cite journal | title = Contamination of eggs of laying hens with S. Enteritidis | journal = Veterinary Survey (Tierärztliche Umschau) | date = Jul–Aug 2009 | first = Gerald | last = Jaeger | volume = 64 | issue = 7–8 | pages = 344–348 | url = https://www.scopus.com/record/display.url?eid=2-s2.0-70249089685&origin=AuthorNamesList&txGid=zUlZlrGCjw9FgQXhSMPv1sc%3a3 | access-date = 2010-08-20 | quote = The migration of the bacterium into the nutritionally rich yolk is constrained by the lysozyme loaded vitelline membrane, and would need warm enough storage conditions within days and weeks. The high concentration on of antibodies of the yolk does not inhibit the ''Salmonella'' multiplication. Only seldom does transovarian contamination of the developing eggs with S. enteritidis make this bacterium occur in laid eggs, because of the bactericidal efficacy of the antimicrobial peptides}}</ref> Even under natural conditions, the rate of infection was very small (0.6% in a study of naturally contaminated eggs<ref>{{cite journal | title = Numbers of Salmonella enteritidis in the contents of naturally contaminated hens' eggs | journal = Epidemiology and Infection | year = 1991 | first = T.J. | last = Humphrey | author2 = A. Whitehead | author3 = A. H. L. Gawler | author4 = A. Henley | author5 = B. Rowe | pmid = 2050203 | volume = 106 | issue = 3 | pmc = 2271858 | pages = 489–496 | doi = 10.1017/S0950268800067546 | quote = Over 5700 hens eggs from 15 flocks naturally infected with Salmonella enteritidis were examined individually for the presence of the organism in either egg contents or on shells. Thirty-two eggs (0·6%) were positive in the contents. In the majority, levels of contamination were low. }}</ref> and 3.0% among artificially and heavily infected hens<ref>{{cite journal | title = Colonization of specific regions of the reproductive tract and deposition at different locations inside eggs laid by hens infected with Salmonella Enteritidis or Salmonella Heidelberg | journal =  Avian Diseases| date = March 2007 | first = Richard | last = Gast | author2 = Rupa Guraya | author3 = Jean Guard | author4 = Peter Holt | author5 = Randle Moore | volume = 51 | issue = 1 | pages = 40–44 | pmid = 17461265 | url = http://www.ars.usda.gov/research/publications/Publications.htm?seq_no_115=196876 | access-date = 2010-08-20 | quote = when hens are artificially infected with unrealistically large doses (according to the author): In the present study, groups of laying hens were experimentally infected with large oral doses of Salmonella Heidelberg, Salmonella Enteritidis phage type 13a, or Salmonella Enteritidis phage type 14b. For all of these isolates, the overall frequency of ovarian colonization (34.0%) was significantly higher than the frequency of recovery from either the upper (22.9%) or lower (18.1%) regions of the oviduct. No significant differences were observed between the frequencies of Salmonella isolation from egg yolk and albumen (4.0% and 3.3%, respectively). | doi = 10.1637/0005-2086(2007)051[0040:cosrot]2.0.co;2 | url-status = live | archive-url = https://web.archive.org/web/20100310002101/http://www.ars.usda.gov/research/publications/publications.htm?SEQ_NO_115=196876 | archive-date = 2010-03-10 }}</ref>).

== Prevention ==
{{See also|Critical control point}}
The US [[Food and Drug Administration]] (FDA) has published guidelines to help reduce the chance of food-borne salmonellosis.<ref>{{cite web|url= http://www.fsis.usda.gov/Fact_Sheets/Salmonella_Questions_&_Answers/index.asp|title= Salmonella Questions and Answers|access-date= 2009-01-21|publisher= USDA Food Safety and Inspection Service|date= 2006-09-20|url-status= dead|archive-url= https://web.archive.org/web/20090115230327/http://www.fsis.usda.gov/Fact_Sheets/Salmonella_Questions_%26_Answers/index.asp|archive-date= 2009-01-15}}</ref> Food must be cooked to {{convert|145|-|165|°F}}, and liquids such as soups or gravies should be boiled when reheating. Freezing kills some ''Salmonella'', but it is not sufficient to reliably reduce them below infectious levels. While ''Salmonella'' is usually [[heat]]-sensitive, it acquires heat-resistance in high-fat environments such as peanut butter.<ref>{{cite news | url=https://www.reuters.com/article/healthNews/idUSTRE5296H420090310 | work=Reuters | title=FDA issues peanut safety guidelines for foodmakers | date=2009-03-10 | url-status=live | archive-url=https://web.archive.org/web/20090312034238/http://www.reuters.com/article/healthNews/idUSTRE5296H420090310 | archive-date=2009-03-12 }}</ref>

=== Vaccine ===
Antibodies against nontyphoidal ''Salmonella'' were first found in [[Malawi]] children in research published in 2008. The Malawian researchers identified an antibody that protects children against bacterial infections of the blood caused by nontyphoidal ''Salmonella''. A study at Queen Elizabeth Hospital in [[Blantyre, Malawi|Blantyre]] found that children up to two years old develop antibodies that aid in killing the bacteria. This could lead to a possible ''Salmonella'' vaccine for humans.<ref>{{cite journal |vauthors=MacLennan CA, Gondwe EN, Msefula CL, etal |title=The neglected role of antibody in protection against bacteremia caused by nontyphoidal strains of Salmonella in African children |journal=J. Clin. Invest. |issue=4 |pages=1553–62 |date=April 2008 |pmid=18357343 |pmc=2268878 |doi=10.1172/JCI33998 |volume=118 }}</ref>

A 2014 study tested a vaccine on chickens which offered efficient protection against salmonellosis.<ref name=" pmid = 24176491 ">{{cite journal | first1 = Rahul M. | last1 = Nandre | first2 = John Hwa | last2 = Lee | title = Construction of a recombinant-attenuated Salmonella Enteritidis strain secreting Escherichia coli heat-labile enterotoxin B subunit protein and its immunogenicity and protection efficacy against salmonellosis in chickens. | journal = Vaccine | volume = 32 | issue = 2 |date=Jan 2014 | pmid = 24176491 | pages = 425–431 | doi=10.1016/j.vaccine.2013.10.054}}</ref>

Vaccination of chickens against ''Salmonella'' essentially wiped out the disease in the [[United Kingdom]].  A similar approach was considered in the United States, but the Food and Drug Administration decided not to mandate vaccination of hens.<ref>{{Cite news|url=https://www.nytimes.com/2010/08/25/business/25vaccine.html|title=U.S. Forgoes Salmonella Vaccine for Egg Safety|last=Neuman|first=William|date=2010-08-24|newspaper=The New York Times|issn=0362-4331|access-date=2016-03-12|url-status=live|archive-url=https://web.archive.org/web/20160417063146/http://www.nytimes.com/2010/08/25/business/25vaccine.html|archive-date=2016-04-17}}</ref>

=== Industrial hygiene ===
Since 2011, Denmark has had three cases of human salmonella poisoning.<ref name=":0">{{Cite web|url=http://www.oregonlive.com/health/index.ssf/2014/03/denmark_cracks_down_on_salmone.html|title=Contaminated chicken: After illnesses soar, Denmark attacks salmonella at its source|access-date=2016-09-18|url-status=live|archive-url=https://web.archive.org/web/20150609224448/http://www.oregonlive.com/health/index.ssf/2014/03/denmark_cracks_down_on_salmone.html|archive-date=2015-06-09|date=2014-03-18}}</ref> The country eradicated salmonella without vaccines and antibiotics by focusing on eliminating the infection from "breeder stocks", implementing various measures to prevent infection, and taking a zero-tolerance policy towards salmonella in chickens.<ref name=":0" />

==Treatment==
Electrolytes may be replenished with oral rehydration supplements (typically containing salts sodium chloride and potassium chloride).{{citation needed|date=January 2021}}

Appropriate antibiotics, such as [[ceftriaxone]], may be given to kill the bacteria, but are not necessary in most cases.<ref name=":2" /> Azithromycin has been suggested to be better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. There are recommendations on choice of antibiotic to avoid promoting [[antibiotic resistance]].{{citation needed|date=January 2021}}

There is no evidence of benefit of treating healthy people with diarrhea due to non-typhoidal salmonellosis. However, the evidence for the very young, very old or people with severe diseases are uncertain.<ref>{{Cite journal|title=Antimicrobials for Treating Symptomatic Non-Typhoidal Salmonella Infection|url=https://pubmed.ncbi.nlm.nih.gov/23152205/?dopt=Abstract|last1=Onwuezobe|first1=IA|last2=Oshun|first2=PO|date=2012-11-14|journal=The Cochrane Database of Systematic Reviews|language=en|pmid=23152205|access-date=2020-05-31|last3=Odigwe|first3=CC|volume = 11|pages = CD001167|doi = 10.1002/14651858.CD001167.pub2|pmc = 6532567}}</ref>

== Epidemiology ==

=== United States ===
{{Main|Salmonellosis in the United States}}
About 142,000 people in the United States are infected each year with ''[[Salmonella enterica enterica|Salmonella]]'' Enteritidis from chicken eggs, and about 30 die.<ref name="Was2009" />

In 2010, an analysis of death certificates in the United States identified a total of 1,316 ''Salmonella''-related deaths from 1990 to 2006. These were predominantly among older adults and those who were immunocompromised.<ref>{{cite journal|last=Cummings|first=PL|date=November 2010|title=Salmonellosis-related mortality in the United States, 1990–2006|journal=Foodborne Pathogens and Disease|volume=7|issue=11|pages=1393–9|doi=10.1089/fpd.2010.0588|pmid=20617938|author2=Sorvillo F|author3=Kuo T}}</ref> The U.S. government reported as many as 20% of all chickens were contaminated with ''Salmonella'' in the late 1990s, and 16.3% were contaminated in 2005.<ref>{{cite news|url=https://www.nytimes.com/2006/03/08/dining/08well.html?ex=1179288000&en=1f7944fcd0d6fc64&ei=5070|title=More Salmonella Is Reported in Chickens|last=Burros|first=Marian|date=March 8, 2006|work=The New York Times|access-date=2007-05-13|url-status=live|archive-url=https://web.archive.org/web/20160109034133/http://www.nytimes.com/2006/03/08/dining/08well.html?ex=1179288000&en=1f7944fcd0d6fc64&ei=5070|archive-date=January 9, 2016}}</ref>

The United States has struggled to control salmonella infections, with the rate of infection rising from 2001 to 2011. In 1998, the USDA moved to close plants if salmonella was found in excess of 20 percent, which was the industry's average at the time, for three consecutive tests.<ref name=":1">{{Cite web|url=http://foodsafety.news21.com/2011/risks/salmonella/|title=Salmonella Lurks From Farm to Fork « News21 2011 National Project|website=foodsafety.news21.com|access-date=2016-09-18|url-status=live|archive-url=https://web.archive.org/web/20160602180014/http://foodsafety.news21.com/2011/risks/salmonella/|archive-date=2016-06-02}}</ref> Texas-based Supreme Beef Processors, Inc. sued on the argument that Salmonella is naturally occurring and ultimately prevailed when a federal appeals court affirmed a lower court.<ref name=":1" /> These issues were highlighted in a proposed [[Kevin's Law]] (formally proposed as the Meat and Poultry Pathogen Reduction and Enforcement Act of 2003), of which components were included the [[FDA Food Safety Modernization Act|Food Safety Modernization Act]] passed in 2011, but that law applies only to the FDA and not the USDA.<ref name=":1" /> The USDA proposed a regulatory initiative in 2011 to [[Office of Management and Budget]].<ref>{{Cite web|url=http://www.foodsafetynews.com/2011/08/ground-turkey-recall-shows-we-still-need-kevins-law/#.V97IVpMrKRt|title=Ground Turkey Recall Shows We Still Need Kevin's Law {{!}} Food Safety News|date=2011-08-12|language=en-US|access-date=2016-09-18|url-status=live|archive-url=https://web.archive.org/web/20161009130352/http://www.foodsafetynews.com/2011/08/ground-turkey-recall-shows-we-still-need-kevins-law/#.V97IVpMrKRt|archive-date=2016-10-09}}</ref>

=== Europe ===
An outbreak of salmonellosis started in Northern Europe in July 2012, caused by ''Salmonella thompson''. The infections were linked to [[smoked salmon]] from the manufacturer Foppen, where the contamination had occurred. Most infections were reported in the Netherlands; over 1060 infections with this subspecies and four fatalities were confirmed.<ref>''Veelgestelde vragen Salmonella Thompson 15 oktober 2012, Rijksinstituut voor Volksgezondheid en Milieu'' [Frequently asked questions Salmonella Thompson 15 October 2012, Netherlands Institute for Public Health and the Environment].</ref><ref>"Salmonella besmetting neemt verder af, 2 november 2012, Rijksinstituut voor Volksgezondheid en Milieu" [Salmonella infections continue to decline 2 November 2012, Netherlands Institute for Public Healthand the Environment].</ref>

A case of widespread infection was detected mid-2012 in seven EU countries. Over 400 people had been infected with ''Salmonella enterica'' serovar Stanley (''S''. Stanley) that usually appears in the regions of Southeast Asia. After several DNA analyses seemed to point to a specific Belgian strain, the "Joint ECDC/E FSA Rapid Risk Assessment" report detected turkey production as the source of infection.<ref>[http://www.efsa.europa.eu/en/efsajournal/pub/2893 Multi-country outbreak of Salmonella Stanley infections Update] {{webarchive|url=https://web.archive.org/web/20140413150036/http://www.efsa.europa.eu/en/efsajournal/pub/2893|date=2014-04-13 }} EFSA Journal 2012;10(9):2893 [16 pp.]. Retrieved 04/23/2013</ref>

In Germany, food poisoning infections must be reported.<ref>§ 6 and § 7 of the German law on infectious disease prevention, ''Infektionsschutzgesetz''</ref> Between 1990 and 2005, the number of officially recorded cases decreased from about 200,000 to about 50,000.{{citation needed|date=January 2021}}

=== Elsewhere ===
In March 2007, around 150 people were diagnosed with salmonellosis after eating tainted food at a governor's reception in Krasnoyarsk, Russia. Over 1,500 people attended the ball on March 1 and fell ill as a consequence of ingesting ''Salmonella''-tainted sandwiches.{{citation needed|date=January 2021}}

About 150 people were sickened by ''Salmonella''-tainted chocolate cake produced by a major bakery chain in Singapore in December 2007.<ref>{{cite web | url=http://www.channelnewsasia.com/stories/singaporelocalnews/view/316110/1/.html | title=PrimaDeli food poisoning cases increase to 153 | date=7 December 2007 | author=Hong, Lynda | archive-url=https://web.archive.org/web/20071208144640/http://www.channelnewsasia.com/stories/singaporelocalnews/view/316110/1/.html | archive-date=8 December 2007 | work=Channel NewsAsia}}</ref>

== History ==
Both salmonellosis and the microorganism genus ''Salmonella'' derive their names from a modern Latin coining after [[Daniel E. Salmon]] (1850–1914), an American veterinary surgeon. He had help from [[Theobald Smith]], and together they found the bacterium in pigs.{{citation needed|date=January 2021}}

Salmonella enterica was possibly the cause of the [[1576 Cocoliztli epidemic|1576 ''cocliztli'' epidemic]] in [[New Spain]].<ref name=nature>{{cite journal|last1=Vågene|first1=Åshild J.|last2=Herbig|first2=Alexander|last3=Campana|first3=Michael G.|last4=Robles García|first4=Nelly M.|last5=Warinner|first5=Christina|last6=Sabin|first6=Susanna|last7=Spyrou|first7=Maria A.|last8=Andrades Valtueña|first8=Aida|last9=Huson|first9=Daniel|last10=Tuross|first10=Noreen|last11=Bos|first11=Kirsten I.|last12=Krause|first12=Johannes|title=Salmonella enterica genomes from victims of a major sixteenth-century epidemic in Mexico|journal=Nature Ecology & Evolution|volume=2|issue=3|pages=520–528|year=2018|issn=2397-334X|doi=10.1038/s41559-017-0446-6|pmid=29335577|s2cid=3358440}}</ref>

=== Four-inch regulation ===
The "Four-inch regulation" or "Four-inch law" is a colloquial name for a regulation issued by the U.S. FDA in 1975, restricting the sale of turtles with a [[carapace]] length  less than four inches (10&nbsp;cm).<ref>{{cite web | title = Human Health Hazards Associated with Turtles | publisher = U.S. Food and Drug Administration | url = https://www.fda.gov/cvm/turtlereg.htm | access-date = 2007-06-29 |archive-url = https://web.archive.org/web/20070609071736/https://www.fda.gov/cvm/turtlereg.htm <!-- Bot retrieved archive --> |archive-date = 2007-06-09}}</ref>

The regulation was introduced, according to the FDA, "because of the public health impact of turtle-associated salmonellosis". Cases had been reported of young children placing small turtles in their mouths, which led to the size-based restriction.{{citation needed|date=January 2021}}

==See also==
* [[1984 Rajneeshee bioterror attack]]
* [[2012 salmonella outbreak]]
* [[2018 outbreak of Salmonella]]
* [[List of foodborne illness outbreaks]]

== References ==
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== External links ==
{{Medical resources
|  ICD10 = {{ICD10|A|02|0|a|00}}
|  ICD9 = {{ICD9|003.0}}
|  MedlinePlus = 000294
| DiseasesDB=11765
}}
{{Commons category|Salmonellosis}}
* CDC website, Division of Bacterial and Mycotic Diseases, Disease Listing: [https://www.cdc.gov/nczved/dfbmd/disease_listing/salmonellosis_gi.html Salmonellosis]

{{Bacterial diseases}}
{{Bacterial cutaneous infections}}
{{Authority control}}

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[[Category:Bacterium-related cutaneous conditions]]
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