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Sumitr Sutra

Salmonell osis. 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 1 0 – 1 4 ตุ ล า ค ม 2 5 4 8. Foodborne or waterborne. Child care Centers. Immunocom promised. Hospitalization. Travel. Antimicrobiol agents.

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Sumitr Sutra

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  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 1 0 – 1 4 ตุ ล า ค ม 2 5 4 8

  2. 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

  4. 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 16-48 hours • Viruses • Vibrio • Enterotoxogenic E. coli Fever, Diarrhea, Abdominal Cramps within 16-48 hours • Salmonella • Shigella • C. jejuni • Yersinia Abdominal Cramps, Bloody diarrhea, no fever 72-120 hours • Enterohemorrhagic E. coli O157 : H7

  5. 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)

  6. 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:

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

  8. 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 S. Typhi S. Typhimurium PRODUCE ENTEROTOXIN

  9. 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 S. Typhi S. Typhimurium PRODUCE ENTEROTOXIN

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

  11. Bacterial Isolation In Khon Kaen 2000-2002 Year Organisms 2000 2001 2002 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) 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) 29 (5.3) 8 (1.5) 549 1,051 Total 380

  12. 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 16 14 18 2 (12.5) 0 0 2 (14.3) 2 (11.1) 74 (18.4) 6 (7.3) Total 403 82

  13. Salmonella isolated from food handlers and others in Khon Kaen, 2002. Food handlers Healthy population Salmonella Isolation(%) Salmonella Isolation(%) Specimens Specimens Sex Males Females Age (year) < 30 31 - 40 41 - 50 51 - 60 > 60 14 76 14 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) 0 12 (7.1) 5 (5.3) 2 (6.3) 0 10 (11.0) 19 (4.7) Total 90 403

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

  15. Salmonellaserovars isolated from pork and chicken (fresh market) Port Chicken Serovar Strains(%) Serovar Strains(%) 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) 9 (7.9) 7 (6.1) 6 (5.2) 4 (3.5) 3 (2.7) 3 (2.7) 3 (2.7) 10 (15.7) 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) 2 (1.6) 2 (1.6) 2 (1.6) 2 (1.6) 2 (1.6) 2 (1.6) 3 (2.5) 121 114 Total Total

  16. Salmonella serovars and serogroups isolated in 2002 from pork and chicken from Khon Kaen supermarkets Port Chicken Serovar (serogroup) Serovar (serogroup) Strains(%) Strains(%) 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) 12 (15.8) 12 (15.8) 5 (6.6) 4 (5.3) 4 (5.3) 3 (3.9) 2 (2.6) 2 (2.6) 2 (2.6) 2 (2.6) 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) 5 (3.8) 4 (3.0) 4 (3.0) 3 (2.5) 3 (2.5) 2 (1.5) 2 (1.5) 2 (1.5)

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

  18. Salmonella isolation of diarrheal cases from hospitals in Khon Kaen and Region 6 2002. Khon Kaen Regional 6 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 C D D C B E B E 120 62 46 32 29 17 10 9 9 8 87 (27.9) (14.4) (10.7) (7.4) (6.7) (3.9) (2.3) (2.1) (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 E1 B B D1 B C1 C1 22 12 11 10 9 9 7 6 5 5 37 (16.5) (9.0) (8.2) (7.5) (6.7) (6.7) (5.2) (4.5) (3.7) (3.7) (2.7) Total 429 Total 133

  19. Carrier Children Salmonellosis Cure Extraintestinal 2 - 45 % 8-24 % Case Fatality Focal Infection Bacteremia 3 - 10 % • Meningitis • Osteoarthritis • Pneumonia • Cholangitis Cycle of Salmonellosis

  20. Intrafamily • Carrier • Prior diarrhea Supplement foods • Orange • Iron • Under cooked meat Day care Pets Carrier Children Salmonellosis Cure Extraintestinal 2 - 45 % 8-24 % Case Fatality Focal Infection Bacteremia 3 - 10 % • Meningitis • Osteoarthritis • Pneumonia • Cholangitis Cycle of Salmonellosis

  21. Permanent Convalescent • Immuno compromised • Antibiotic • Gall stone • Serotype Intrafamily Carrier • Carrier • Prior diarrhea Supplement foods • Orange • Iron • Under cooked meat Children Salmonellosis Cure Day care Pets Extraintestinal 2 - 45 % 8-24 % Case Fatality Focal Infection Bacteremia 3 - 10 % • Meningitis • Osteoarthritis • Pneumonia • Cholangitis Cycle of Salmonellosis

  22. Host Stereotypes • Infant • Immuno compromised • S. Typhimurium • S. Choleraesuis • S. Enteritidis • Immunocompromised • Age < 3 Mo. Intrafamily • Carrier • Prior diarrhea Permanent Convalescent Supplement foods Carrier • Orange • Iron • Under cooked meat • Antibiotic • Immuno compromised • Gall stone • Serotype Salmonellosis Cure Children Day care Pets Extraintestinal 2 - 45 % 8-24 % Bacteremia Case Fatality Focal Infection 3 - 10 % • Meningitis • Osteoarthritis • Pneumonia • Cholangitis Cycle of Salmonellosis

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

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

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