1. Salmonellosis Sumitr Sutra
ป ร ะ ชุ ม วิ ช า ก า ร ค ณ ะ แ พ ท ย ศ า ส ต ร์ ม ห า วิ ท ย า ลั ย ข อ น แ ก่ น วั น ที่ – ตุ ล า ค ม

2. DIARRHEA Foodborne or waterborne Child care Centers Immunocom promised
Hospitalization
Travel
Antimicrobiol
agents
DIARRHEA

3. ACUTE INFLAMMATORY DIRRHEA
Salmonella spp.
Shigella spp.
Vibrio parahemoliticus
Aeromonas hydrophila
Plesiomonas shigelloides
Campylobacter jejuni/coli
Enterohemorrhagic Escherichia coli
Yersinia enterocolitica
Entamoeba histolitica
Strongyloides stercolalis
Vibrio parahemoliticus
Trichinella spiralis
Cryptosporidium parvum
Balantidium coli
Schistosoma
Bacteria
Parasite
Cytomegalovirus
Enterovirus
Virus

8. DIAGNOSIS: FOOD AND WATER BORNE INFECTION
MICROBIAL CAUSES
Nausea, Vomiting or Diarrhea within 1-16 hours
Staphylococcus aureus
Bacillus cereus
Clostridium perfringens
Diarrhea and Abdominal Cramps within hours
Viruses
Vibrio
Enterotoxogenic E. coli
Fever, Diarrhea, Abdominal Cramps within hours
Salmonella
Shigella
C. jejuni
Yersinia
Abdominal Cramps, Bloody diarrhea, no fever hours
Enterohemorrhagic E. coli O157 : H7

9. ชนิดของเชื้อ จำนวนตัวอย่าง เปอร์เซ็นต์
ผลการเพาะเชื้อจากอุจจาระของผู้ป่วยจากรายงานของ NSSC ปี พ.ศ.2544
ชนิดของเชื้อ
จำนวนตัวอย่าง
เปอร์เซ็นต์
Non-typhoidal Salmonella
Typhoidal Salmonella
Shigella
Other Bacteria
No growth
7,329
228
728
147 26
84.53
2.70
8.62
1.74
6.31
รวม
8,458
(คัดลอกจาก WHO National Salmonella and Shigella center : NSSC โดย อรุณ บ่างตระกูลนนท์)

10. Salmonella Nomenclature
CDC
Designation
Common
Clinical Usage
Complete Name
S. enterica subsp. enterica ser. Typhi
S. enterica subsp. enterica ser. Typhimurium
S. enterica subsp. enterica ser. Enteritidis
S. enterica subsp. enterica ser. Dublin
S. enterica subsp. arizonae ser. 18:z4, Z23:-
S. enterica subsp. houtenae ser. Marina
Salmonella ser. Typhi
S. ser. Typhimurium
S. ser. Enteritidis
S. ser. Dublin
S. IIIa 18: Z4, Z23:-
S. ser. Marina
S. typhi
S. typhimurium
S. enteritidis
S. dublin
Arizona hinshawii ser. 7a, 7b:1, 2, 5:-
S. marina or S. IV 48: g, Z51:

11. Salmonella Bacteremia Gastroenteritis Enteric fever Asymptomatic
Carrier
Metastatic
focal
infection
Gastroenteritis
Enteric fever

12. MULTIPLY IN MACROPHAGES
PATHOGENESIS
INGESTION
Salmonella
INVADE M cells
MOST NON-TYPHOIDAL
SALMONELLA
MULTIPLY IN MACROPHAGES
AND LYMPH NODE
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
SURVIVAL IN BLOOD
STREAM
PRODUCE ENTEROTOXIN
S. Typhi
S. Typhimurium

13. MULTIPLY IN MACROPHAGES
PATHOGENESIS
INGESTION
Salmonella
INVADE M cells
MOST NON-TYPHOIDAL
SALMONELLA
MULTIPLY IN MACROPHAGES
AND LYMPH NODE
S. Typhi
S. Dublin
S. Cholerasuis
S. Paratyphi
SURVIVAL IN BLOOD
STREAM
PRODUCE ENTEROTOXIN
S. Typhi
S. Typhimurium

14. FACTORS PREDISPOSING TO
SALMONELLOSIS & DISSEMINATION
Dose and Serotype
Hypochlorhydria
Inflammed Bowel
Alter Gut Flora
Defected CMI
Defected RE System

15. Bacterial Isolation In Khon Kaen 2000-2002
Year
Organisms
2000
2001
2002
Salmonella spp.
Vibrio cholerae
V. paraheamolyticus
Aeromonas spp.
Plesiomonas spp.
Shigella spp.
Others
345 (62.8)
50 (9.1)
73 (13.3)
29 (5.3)
15 (2.7)
8 (1.5)
112 (29.5)
35 (9.2)
204 (53.6)
12 (3.2)
1 (0.3)
7 (1.8)
9 (2.4)
336 (32.0)
235 (22.4)
188 (17.8)
120 (11.4)
94 (8.9)
29 (2.8)
49 (4.7)
Total
549
380
1,051

16. Salmonella isolated from food and drinking water
in five communities in Khon Kaen, 2002.
Food
Drinking water
Community
Salmonella
Isolation(%)
Salmonella
Isolation(%)
Specimens
Specimens 1 2 3 4 5 84 74 69
105 71
12 (14.3)
14 (18.9)
16 (23.2)
20 (19.0)
12 (16.7) 16 18 14
2 (12.5)
2 (14.3)
2 (11.1)
Total
403
74 (18.4) 82
6 (7.3)

17. Salmonella isolated from food handlers and others in Khon Kaen, 2002.
Healthy population
Salmonella
Isolation(%)
Salmonella
Isolation(%)
Specimens
Specimens
Sex
Males
Females
Age (year)
< 30
> 60 14 76 20 35 21 - 6
4 (3.3)
2 (14.3)
4 (20.0)
3 (8.6)
1 (4.8) -
2.5
168 96
170 95 32 10
11 (4.7)
8 (4.8)
12 (7.1)
5 (5.3)
2 (6.3)
Total 90
10 (11.0)
403
19 (4.7)

18. Salmonella isolated from pork and chicken from fresh markets in Khon Kaen.
Month
Specimens
Specimens
Positive (%)
Positive (%)
February
June
October 32 34 25
29 (90.6)
34 (100)
24 (96.0) 28 30 26
28 (100)
28 (93.3)
25 (96.2)
Total 91
87 (95.6) 84
81 (96.4)

19. Salmonella serovars isolated from pork and chicken (fresh market)
Port
Chicken
Serovar
Strains(%)
Serovar
Strains(%)
S. Anatum
S. Rissen
S. Panama
S. Albany
S. Amsterdam
S. Derby
S. Subspecies 19, 12: 1 V:-
S. Worthington
S. Subspecies 14, 15, 12:I:-
S. Saintpaul
Others
57 (47.1)
30 (25.1)
17 (14.1)
2 (1.6)
3 (2.5)
S. Virchow
S. Enteritidis
S. Panama
S. Hadar
A. Anatum
S. Blockley
S. Agona
S. Albany
S. Saintpaul
S. Typhimurium
Others
31 (27.2)
21 (18.4)
9 (7.9)
7 (6.1)
6 (5.2)
4 (3.5)
3 (2.7)
10 (15.7)
Total
121
Total
114

20. Salmonella serovars and serogroups isolated in from pork and chicken from Khon Kaen supermarkets
Port
Chicken
Serovar
(serogroup)
Serovar
(serogroup)
Strains(%)
Strains(%)
S. Anatum (E)
S. Rissen (C)
S. Panama (D)
S. Weltevreden (E)
S. Worthington (G)
S. Derby (B)
S. Stanley (B)
S. Virchow (C)
S. Cerro (K)
S. Albany (C)
S. Scwarzengrum (B)
S. Typhimurium (B)
43 (32.6)
34 (25.8)
10 (7.6)
5 (3.8)
4 (3.0)
3 (2.5)
2 (1.5)
S. Rissen (C)
S. Virchow (C)
S. Anatum (E)
S. Panama (D)
S. Stanley (B)
H. Hadar (C)
S. Havana (G)
S. Enteritidis (D)
S. Scwarzengrun (B)
S. Blockley (C)
S. Senftenberg (G)
12 (15.8)
5 (6.6)
4 (5.3)
3 (3.9)
2 (2.6)

21. Salmonella isolated from pork and chicken and internal organs from the Khon kaen abattoir 2002
Specimens
Specimens
Strains
(%)
Strains
(%)
Serovars
Serovars
Meat
Internal organ 20
14 (70)
17 (85)
S. Derby,
S. Virchow,
S Blockley
S. Enteritidis,
S. Panama
S. Agona,
S. Rissen,
S.Entritidis
Meat
Liver
Internal organ 20
17 (85)
14 (70)
11 (55)
S. Rissen,
S. Anatum
S. Derby
S. Senftenberg
Total 40
31 (77.5)
Total 60
42 (70)

22. Salmonella isolation of diarrheal cases from hospitals
in Khon Kaen and Region
Regional 6
Khon Kaen
Serovar
Serogroup
Strains (%)
Serovar
Serogroup
Strains (%)
S. Anatum
S. Rissen
S. Virchow
S. Enteritidis
S. Panama
S. Hadar
S. Derby
S. Amsterdum
S. Saintpaul
S. Welteredenl
31 Other serovars E C D B
120 62 46 32 29 17 10 9 8 87
(27.9)
(14.4)
(10.7)
(7.4)
(6.7)
(3.9)
(2.3)
(2.1)
(1.8)
(20.2)
S. Rissen
S. Weltevreden
S. Enteritidis
S. Anatum
S. Derby
S. Stanley
S. Panama
S. 14, 12, I
S. Braenderup
S. Virchow
23 Other serovars C1 E1 D1 B 22 12 11 10 9 7 6 5 37
(16.5)
(9.0)
(8.2)
(7.5)
(6.7)
(5.2)
(4.5)
(3.7)
(2.7)
Total
429
Total
133

23. Cycle of Salmonellosis
Carrier
Children
Salmonellosis
Cure
Extraintestinal %
8-24 %
Case Fatality
Focal Infection
Bacteremia %
Meningitis
Osteoarthritis
Pneumonia
Cholangitis
Cycle of Salmonellosis

24. Cycle of Salmonellosis
Intrafamily
Carrier
Prior diarrhea
Supplement foods
Orange
Iron
Under cooked meat
Day care
Pets
Carrier
Children
Salmonellosis
Cure
Extraintestinal %
8-24 %
Case Fatality
Focal Infection
Bacteremia %
Meningitis
Osteoarthritis
Pneumonia
Cholangitis
Cycle of Salmonellosis

25. Cycle of Salmonellosis
Gall stone
Immuno compromised
Serotype
Permanent
Convalescent
Antibiotic
Intrafamily
Carrier
Carrier
Prior diarrhea
Supplement foods
Orange
Iron
Under cooked meat
Children
Salmonellosis
Cure
Day care
Pets
Extraintestinal %
8-24 %
Case Fatality
Focal Infection
Bacteremia %
Meningitis
Osteoarthritis
Pneumonia
Cholangitis
Cycle of Salmonellosis

26. Cycle of Salmonellosis
Intrafamily
Carrier
Prior diarrhea
Permanent
Convalescent
Supplement foods
Carrier
Orange
Iron
Under cooked meat
Immuno compromised
Antibiotic
Serotype
Gall stone
Children
Salmonellosis
Cure
Day care
Host
Infant
Immuno compromised
Stereotypes
S. Typhimurium
S. Choleraesuis
S. Enteritidis
Immunocompromised
Age < 3 Mo.
Pets
Extraintestinal %
8-24 %
Case Fatality
Focal Infection
Bacteremia %
Meningitis
Osteoarthritis
Pneumonia
Cholangitis
Cycle of Salmonellosis

27. TREATMENT Gastroenteritis Bacteremia Focal Infection Chronic carrier
Infant : ??
Children : No
Immunocompromised : ?
Bacteremia
Ceftriaxone, cefotaxime
14 Days
Focal Infection
Osteomyelitis
Meningitis
4 - 6 Weeks
4 Weeks
Chronic carrier
Fluoroquinolone
Cholecystectomy

28. การป้องกัน ระดับครอบครัว ระดับชุมชน ล้างมือ อาหารเสริมในทารก
เขียงปรุงอาหาร
ระดับชุมชน
ระบบสุขาภิบาลตลาด
โรงฆ่าสัตว์
โรงเลี้ยงสัตว์
อาหารสัตว์ / ยา