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Salmonella heidelberg enteritis and bacteremia. An epidemic on two pediatric wards
Insights
Salmonella Heidelberg infections caused an outbreak in hospitalized children, leading to bacteremia in many. Early recognition of nontyphoid Salmonella bacteremia is crucial for young patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- A significant outbreak of Salmonella Heidelberg infection occurred in pediatric wards of two adjacent hospitals.
- Many affected children were initially hospitalized for unexplained diarrhea.
Purpose of the Study:
- To investigate the epidemiology and clinical features of a Salmonella Heidelberg outbreak in hospitalized children.
- To identify risk factors and outcomes associated with Salmonella bacteremia in this population.
Main Methods:
- Retrospective analysis of patient records during the outbreak.
- Clinical data collection on demographics, symptoms, and laboratory findings.
- Microbiological investigation of the epidemic strain.
Main Results:
- 55 children developed symptomatic Salmonella Heidelberg infection; 25 had documented Salmonella bacteremia.
- Eight children died, four of whom had bacteremia. Neonates had a higher bacteremia rate.
- Person-to-person spread sustained the outbreak for four months; cohort nursing and isolation halted it.
Conclusions:
- Nontyphoid Salmonella bacteremia can be clinically unsuspected and self-limiting in hospitalized children.
- Salmonella enteritis in young hospitalized children should prompt consideration of bacteremia.
- Effective infection control measures, including cohort nursing and isolation, are vital in managing hospital outbreaks.
Abstract:
Symptomatic infection with Salmonella heidelberg developed in 55 children after their admission to the pediatric wards of two adjacent hospiatls in San Juan, Puerto Rico. Many of these children had been hospitalized for the treatment of diarrhea of unidentified etiology. In 25 of these patients, Salmonella bacteremia was documented. Five had clinically unsuspected and untreated bacteremia with no evidence of complications during the follow-up period of four and a half months. The remaining 30 had "standard" symptomatic infection due to S. heidelberg. Eight children died; four of these proved to be bacteremic. The index patient, who also introduced the infection into one of the hospitals, was identified. Person to person spread perpetuated the outbreak within and between the two hospitals for nearly four months. Although neonates with salmonellosis had a higher rate of bacteremia than other children, no other specific predisposing factors for Salmonella bacteremia were identified. Laboratory studies of the epidemic strain revealed neither invasive nor enterotoxic properties of the organisms, nor enhanced virulence in laboratory mice. Cohort nursing and isolation of patients with positive cultures halted the epidemic. Nontyphoid Salmonella bacteremia, sometimes clinically unsuspected and self-limited, should be recognized as a frequent accompaniment of Salmonella enteritis in young hospitalized children.