salmonellosis
| Classification according to ICD-10 | |
|---|---|
| A02.0 | Salmonella enteritis |
| ICD-10 online (WHO version 2019) | |
A salmonellosis or Salmonellenenteritis is one of salmonella (bacteria) caused infectious gastroenteritis , which due to lack of hygiene measures , by eating contaminated drinking water or the consumption of infectious food is caused, and therefore also as a food infection can be referred to.
About 2600 different Salmonella serotypes are known. In April 2004, the subspecies was Salmonella choleraesuis discovered against the most currently available antibiotics resistant is. An infection with this very virulent pathogen can be fatal.
The main human diseases caused by Salmonella are:
- Vomiting diarrhea caused by Salmonella Enteritidis , Salmonella Typhimurium , etc. a. as salmonellosis in the narrower sense or salmonella enteritis
- Typhus due to Salmonella Typhi
- Paratyphoid due to Salmonella Paratyphi
Since typhoid and paratyphoid fever, as systemic diseases with intestinal involvement, differ significantly from common salmonellosis, they are each treated in their own articles.
Epidemiology
In contrast to S. Typhi and S. Paratyphi , whose only known host is humans, animals - poultry, pigs, cattle, reptiles, etc. - are also carriers of the pathogen in the other Salmonella serotypes. These can be found in animal products ( meat , milk , eggs , mussels, etc.). In addition, salmonella can also be transferred to food during slaughter and processing due to poor hygiene and salmonella eliminators in the staff. In contrast, drinking water contaminated by the faeces of infected animals such as humans is another possible source of infection in countries with inadequate hygienic standards. The necessary infection dose for an otherwise healthy adult is between 10,000 and 1,000,000 germs. In the case of immune deficiencies or infants, toddlers and old people, diseases have also been observed at infectious doses of less than 100 germs.
In the United States, the incidence rate has doubled over the past 25 years. Overall, an increase in infections from contaminated chicken eggs is observed. The reason is that S. Enteritidis causes infections of the fallopian tubes and ovaries in chickens , so that the eggs contain the pathogens before a shell forms. The germs can also migrate through particularly thin or damaged egg shells, especially when the air humidity is high and the ambient temperature is high.
In Switzerland, the number of cases reported to the Federal Office of Public Health has been falling since 1999.
In Germany, 13,636 records were reported to the Robert Koch Institute in 2019 , after 16,222 cases in 2014 and around 55,000 cases in 2005, 57,000 in 2004 and around 63,000 in 2003, which continues the downward trend since 1992. In 2014, 17 confirmed deaths related to such an infection were reported, compared to 46 deaths in 2005 (2004: 51). If you consider that the Federal Statistical Office (Fachserie 12 Reihe 4) for ICD-10 A00 - A09 "Infectious intestinal diseases" for 2004 gives 942 deaths, that seems to be relatively few, because the enteritis infectiosa is mainly caused by Salmonella. The National Reference Center for Hospital Hygiene (NRZ) estimates that around 10% of the actual cases of illness were reported. The Enteritidis and Typhimurium serovars are the most commonly detected pathogens.
illness
The symptoms of salmonella infection in the strict sense are vomiting and diarrhea . These can appear a few hours to three (maximum seven) days after consuming the infected food. The mean incubation time is 20–24 hours. The duration of the illness is usually only a few hours or days; in these uncomplicated cases there is no antibiotic treatment - u. a. to prevent the further development of multi-resistant strains. In exceptional cases, however, the illness can last for several months. After the symptoms of the disease have subsided, Salmonella bacteria can still be excreted, which often lasts for several weeks. Bacterial shedding can occur with no evidence of disease.
In up to 5% of those infected, the disease also has a systemic course with a severe clinical picture: fever between 38 and 39 ° C, massive fluid loss and rapid weight loss, so that hospitalization is necessary. Children, elderly and immunocompromised people are particularly at risk here .
It is problematic that certain Salmonella strains can cause permanent excretion .
proof
As a rule, the disease is detected by growing the pathogen from stool .
differentiation
Germs isolated from stool can be differentiated from other enterobacteria on the following selective culture media:
The identification of the subtype over the Grubersche antigen analysis after the isolated germs first with a omnivalenten antibodies - suspension (typhoid paratyphoid Enteritidis serum, in short: TPE serum) were pre-tested, followed by group-specific antibody suspensions and last monospecific antibodies. In this way, the pathogen can gradually be classified in the Kauffmann-White scheme , which is useful for epidemiological aspects. The O-antigens (somatic antigens), which are specific for each subtype, are used as parameters for the classification .
prevention
Salmonella multiply at temperatures of 10 to around 50 ° C. Storing raw food in the refrigerator (at approx. 7 ° C) prevents the pathogen from spreading further. Salmonella are only safely killed if temperatures of over 70 ° C are reached inside the food for at least 10 minutes. Salmonella do not multiply in deep-freeze storage, but survive. This is why the defrosting liquid must be thrown away in the case of foods such as poultry. The widespread practice of thawing frozen food more quickly by placing it in warm water is particularly disadvantageous because the warm water promotes a rapid increase in salmonella.
Often there is also an unconscious recontamination with Salmonella, for example poultry is fried properly, but then placed back on the previously contaminated cutting board and portioned with previously used cutlery ( cross-contamination ). Hands must also be washed immediately after coming into contact with raw poultry meat.
Industrially manufactured egg products must be pasteurized .
According to EU law , food business operators have to ensure compliance with microbiological food safety criteria, particularly in the case of salmonella, at all stages of the production, processing and distribution of food by means of procedures based on the HACCP principles and by observing the rules of good hygiene practice Take samples from the processing areas and equipment and have them tested for this pathogen. You have to ensure that in certain sensitive products such as minced meat, raw milk products or ready-to-eat foods with raw eggs no salmonella can be detected during the promised shelf life. Otherwise, a food is considered unsafe and not marketable , so that production or placing on the market is prohibited, the entire batch of this food is to be withdrawn from the market and products that have been sold are to be recalled. Anyone who nevertheless produces or markets such contaminated food is liable to prosecution in Germany for negligence.
In Germany, all direct or indirect evidence of an acute infection must be reported to the health authorities in order to enable monitoring and a response to threatened major outbreaks or poor hygiene . Failure to do this can have serious consequences if a person who works in the food sector is affected or an epidemic connection can be suspected. It is estimated that a maximum of 10% of the illnesses are reported, partly because many people affected do not recognize these as salmonellosis when symptoms occur and do not consult a doctor.
Salmonellosis in animals
While cattle salmonellosis is subject to notification in Germany, there is a notification requirement for salmonella diseases in other animal species.
Web links
- Salmonellosis - information from the Robert Koch Institute
- Information from the Swiss Federal Office of Public Health
- Salmonellosis in animals ( Memento from February 9, 2006 in the Internet Archive )
- Series of images: Salmonellosis in pigs
Individual evidence
- ↑ RKI: Epidemiological Bulletin 3/2020 of January 16, 2020, p. 16
- ↑ on this and on the following: Art. 3 Para. 1 of Regulation (EC) No. 2073/2005 of the Commission of November 15, 2005 on microbiological criteria for food (consolidated version of February 28, 2019), in its Appendix 1 from No. .1.4 on Salmonella
- ↑ Art. 7 Regulation (EG) 2073/2005 "Unsatisfactory results"
- ↑ §58 Abs. 2 and §5 Abs. 1 LFGB in connection with Art. 14 VO (EG) No. 178/2002
- ↑ § 7 para. 1 no. 42 to 44 Infection Protection Act , see p. typhi and s. paratyphi, however, only with direct evidence
- ↑ Ordinance on notifiable animal diseases in the version published on 19 July 2011 ( Federal Law Gazette I p. 1404 ), amended by Article 3 of the Ordinance of 3 May 2016 ( Federal Law Gazette I p. 1057 ).
- ↑ Annex to Section 1 of the Ordinance on Notifiable Animal Diseases (TKrMeldpflV) in the version published on February 11, 2011 ( Federal Law Gazette I p. 252 ), last amended by Article 381 of the Ordinance of August 31, 2015 ( Federal Law Gazette I p. 1474 ).
