Ispahani P, Slack R C
Department of Microbiology, University Hospital, Queen's Medical Centre, Nottingham, UK.
Eur J Clin Microbiol Infect Dis. 2000 Sep;19(9):679-87. doi: 10.1007/s100960000341.
The clinical spectrum of extraintestinal salmonellosis comprises enteric fever (typhoid and paratyphoid) and invasive infections due to nontyphoidal salmonellae. This study describes the clinical spectrum, management and outcome of all confirmed cases of extraintestinal salmonellosis in patients admitted to University Hospital, Nottingham, UK, between 1980 and 1997. There were 142 cases (children, 42; adults, 100) of extraintestinal salmonellosis, of which 38 (children, 20; adults, 18) were enteric fever, consisting of 21 cases of typhoid, 12 of paratyphoid A and five of paratyphoid B. All patients with typhoid and paratyphoid A fever were from Indian or Pakistani families and, except for two adults, all were considered to be previously fit. The outcome in patients with enteric fever was excellent, and there were no complications. Of the 104 patients (children, 22; adults, 82) with nontyphoidal salmonellosis, 69 were bacteraemic secondary to gastroenteritis, 10 were bacteraemic without an obvious focus of infection and 25 had focal infections. The three major sites of focal infections were meningitis in five infants, osteomyelitis in two children and three adults, and arterial infections in ten adults. The three most frequently isolated organisms were Salmonella enteritidis (40%), Salmonella typhimurium (25%) and Salmonella virchow (14%). Sixty-seven percent of these patients had underlying disease(s)/risk factors. In contrast to the outcome of enteric fever, there were 19 deaths (children, 2; adults, 17) in patients with nontyphoidal salmonellosis. Sixteen of the 17 adults who died were over the age of 60 years. Eight (25%) of 32 males over the age of 60 years with nontyphoidal Salmonella bacteraemia had arterial infections. In some patients, the diagnosis of Salmonella arterial infection is likely to be delayed or missed altogether if blood cultures are not obtained. Mortality in patients over the age of 60 years with nontyphoidal Salmonella infections was 28%.
肠外沙门氏菌病的临床谱包括肠热病（伤寒和副伤寒）以及非伤寒沙门氏菌引起的侵袭性感染。本研究描述了1980年至1997年间英国诺丁汉大学医院收治的所有确诊肠外沙门氏菌病患者的临床谱、治疗及转归情况。共有142例肠外沙门氏菌病患者（儿童42例，成人100例），其中38例（儿童20例，成人18例）为肠热病，包括21例伤寒、12例甲型副伤寒和5例乙型副伤寒。所有伤寒和甲型副伤寒热患者均来自印度或巴基斯坦家庭，除2名成人外，均被认为既往健康。肠热病患者的转归良好，无并发症发生。104例非伤寒沙门氏菌病患者（儿童22例，成人82例）中，69例因胃肠炎继发菌血症，10例无明显感染灶的菌血症患者，25例有局灶性感染。局灶性感染的三个主要部位是5例婴儿的脑膜炎、2例儿童和3例成人的骨髓炎以及10例成人的动脉感染。最常分离出的三种菌株是肠炎沙门氏菌（40%）、鼠伤寒沙门氏菌（25%）和维尔肖沙门氏菌（14%）。这些患者中有六十七%有潜在疾病/危险因素。与肠热病的转归不同，非伤寒沙门氏菌病患者中有19例死亡（儿童2例，成人17例）。17例死亡成人中有16例年龄超过60岁。60岁以上患非伤寒沙门氏菌菌血症的32名男性中有8例（25%）发生动脉感染。在一些患者中，如果未进行血培养，沙门氏菌动脉感染的诊断可能会延迟或完全漏诊。60岁以上非伤寒沙门氏菌感染患者的死亡率为28%。
