Typhoidal & Non-typhoidal Salmonellosis, 5TH MBBS, By Dr Gideon Anigbo, M4

Typhoidal Salmonella (S. Typhi, S. Paratyphi) → enteric fever (typhoid/paratyphoid). Human-only reservoir. Faecal-oral transmission. Incubation days to weeks. Presents with prolonged fever, headache, relative bradycardia, coated tongue, hepatosplenomegaly, rose spots (unreliable). Complications: ileal perforation (weeks 2–3), bleeding, encephalopathy, myocarditis. Diagnosis: blood culture (gold standard), bone marrow culture (most sensitive). Widal test is unreliable (false positives/negatives). Treatment: ceftriaxone, azithromycin; avoid fluoroquinolones if resistance suspected (MDR/XDR typhoid). Prevention: WASH + typhoid vaccine. Non-typhoidal Salmonella (NTS) → mainly acute gastroenteritis (6–72 hours incubation) from animal reservoirs (poultry, eggs, reptiles). Usually self-limited. Invasive disease (bacteraemia, meningitis, osteomyelitis) occurs in infants, elderly, HIV, sickle cell, malnutrition. Diagnosis: stool culture for gastroenteritis; blood culture if invasive suspected. Treatment: uncomplicated diarrhoea → fluids only, NO antibiotics. Severe/invasive disease → ceftriaxone, azithromycin, etc. Prevention: food safety (cook, separate, clean, chill), no vaccine. Key clinical pearls: Do NOT treat a positive Widal alone. Do NOT give antibiotics for uncomplicated NTS diarrhoea. Suspect invasive NTS in sickle cell or HIV with fever + diarrhoea. Suspect typhoid perforation in a patient with fever, abdominal distension, and sudden worsening.