1. بسم الله الرحمن الرحيم Salmonella Rawanturky

2. Classification and general characteres Kingdom: Bacteria Phylum: Proteobacteria Class: Gamma Proteobacteria Order: Enterobacteriales Family: Enterobacteriaceae Genus: Salmonella salmonella is a genus of rod-shaped, Gram-negative, non-spore forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which project in all directions rawanturky

3. They are chemoorganotrophs, obtaining their energy from oxidation and reduction reactions using organic sources and are facultative anaerobes; most species produce hydrogen sulfide, which can readily be detected by growing them on media containing ferrous sulfate, such as TSI. Most isolates exist in two phases; phase I is the motile phase and phase II the non-motile phase. Cultures that are non-motile upon primary culture may be swithched to the motile phase using a Craigie tube. Salmonella are closely related to the Escherichia genus and are found worldwide in warm- and cold-blooded animals, in humans, and in nonliving habitats. They cause illnesses in humans and many animals, such as typhoid fever, paratyphoid fever, and the foodborne illness salmonellosis. Rawanturky

4. Diagnosis The diagnosis of salmonellosis requires bacteriologic isolation of the organisms from appropriate clinical specimens. Laboratory identification of the genus Salmonella is done by biochemical tests; the serologic type is confirmed by serologic testing. Feces, blood, or other specimens should be plated on several nonselective and selective agar media (blood, MacConkey, eosin-methylene blue, bismuth sulfite, Salmonella-Shigella, and brilliant green agars) as well as intoenrichment broth such as selenite or tetrathionate. Any growth in enrichment broth is subsequently subcultured onto the various agars. The biochemical reactions of suspicious colonies are then determined on triple sugar iron agar and lysine-iron agar, and a presumptive identification is made. Biochemical identification of salmonellae has been simplified by systems that permit the rapid testing of 10-20 different biochemical parameters simultaneously. The presumptive biochemical identification of Salmonella then can be confirmed by antigenic analysis of O and H antigens using polyvalent and specific antisera. Fortunately, approximately 95% of all clinical isolates can be identified with the available group A-E typing antisera. Salmonella isolates then should be sent to a central or reference laboratory for more comprehensive serologic testing and confirmation. Rawanturky

5. Invasion of intestinal mucosa by Salmonella. Rawanturky

6. Pathogenesis Salmonellosis includes several syndromes (gastroenteritis, enteric fevers, septicemia, focal infections, and an asymptomatic carrier state. Particular serovars show a strong propensity to produce a particular syndrome (S typhi, S paratyphi-A, and S schottmuelleri produce enteric fever; S choleraesuis produces septicemia or focal infections; S typhimurium and S enteritidis produce gastroenteritis); however, on occasion, any serotype can produce any of the syndromes. In general, more serious infections occur in infants, in adults over the age of 50, and in subjects with debilitating illnesses. Most non-typhoidal salmonellae enter the body when contaminated food is ingested. Person-to-person spread of salmonellae also occurs. To be fully pathogenic, salmonellae must possess a variety of attributes called virulence factors. These include the ability to invade cells a complete lipopolysaccharide coat, the ability to replicate intracellularly, and possibly the elaboration of toxin(s) Rawanturky

7. . After ingestion, the organisms colonize the ileum and colon, invade the intestinal epithelium, and proliferate within the epithelium and lymphoid follicles. The mechanism by which salmonellae invade the epithelium is partially understood and involves an initial binding to specific receptors on the epithelial cell surface followed by invasion. Invasion occurs by the organism inducing the enterocyte membrane to undergo "ruffling" and thereby to stimulate pinocytosis of the organisms. Invasion is dependent on rearrangement of the cell cytoskeleton and probably involves increases in cellular inositol phosphate and calcium. Attachment and invasion are under distinct genetic control and involve multiple genes in both chromosomes and plasmids. Rawanturky

8. After invading the epithelium, the organisms multiply intracellularly and then spread to mesenteric lymph nodes and throughout the body via the systemic circulation; they are taken up by the reticuloendothelial cells. The reticuloendothelial system confines and controls spread of the organism. However, depending on the serotype and the effectiveness of the host defenses against that serotype, some organisms may infect the liver, spleen, gallbladder, bones, meninges, and other organs. Fortunately, most serovars are killed promptly in extraintestinal sites, and the most common human Salmonella infection, gastroenteritis, remains confined to the intestine. After invading the intestine, most salmonellae induce an acute inflammatory response, which can cause ulceration. They may elaborate cytotoxins that inhibit protein synthesis. Whether these cytotoxins contribute to the inflammatory response or to ulceration is not known. Rawanturky

9. However, invasion of the mucosa causes the epithelial cells to synthesize and release various proinflammatory cytokines, These evoke an acute inflammatory response and may also be responsible for damage to the intestine. Because of the intestinal inflammatory reaction, symptoms of inflammation such as fever, chills, abdominal pain, leukocytosis, and diarrhea are common. The stools may contain polymorphonuclear leukocytes, blood, and mucus. Much is now known about the mechanisms of Salmonella gastroenteritis and diarrhea.. Only strains that penetrate the intestinal mucosa are associated with the appearance of an acute inflammatory reaction and diarrhea (Fig. 4); the diarrhea is due to secretion of fluid and electrolytes by the small and large intestines. The mechanisms of secretion are unclear, but the secretion is not merely a manifestation of tissue destruction and ulceration. Salmonella penetrate the intestinal epithelial cells but, unlike Shigella and invasive E. coli, do not escape the phagosome. Rawanturky

10. Thus, the extent of intercellular spread and ulceration of the epithelium is minimal. Salmonella escape from the basal side of epithelial cells into the lamina propria. Systemic spread of the organisms can occur, giving rise to enteric fever. Invasion of the intestinal mucosa is followed by activation of mucosal adenylatecyclase; the resultant increase in cyclic AMP induces secretion. The mechanism by which adenylatecyclase is stimulated is not understood; it may involve local production of prostaglandins or other components of the inflammatory reaction. In addition, Salmonella strains elaborate one or more enterotoxin-like substances which may stimulate intestinal secretion. However, the precise role of these toxins in the pathogenesis of Salmonella enterocolitis and diarrhea has not been established. Rawanturky

11. Scheme of the Pathogenesis of Salmonella enterocolitis and diarrhea. Rawanturky

12. What can I do to prevent salmonellosis? * Cook poultry, ground beef, and eggs thoroughly. Do not eat or drink foods containing raw eggs, or raw (unpasteurized) milk. * If you are served undercooked meat, poultry or eggs in a restaurant, don't hesitate to send it back to the kitchen for further cooking. * Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry. * Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised. * Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces. * Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons. * Don't work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time. * Mother's milk is the safest food for young infants. Breastfeeding prevents salmonellosis and many other health problems. rawanturky