Editing Salmonellosis (section)

==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>