Salmonellosis is an infection with a bacteria called  Salmonella. We had a chat with Dr Shehan Silva, a Consultant Physician with Special Interest in Geriatrics and Senior Lecturer in Medicine on Salmonellosis.

Q WHAT IS SALMONELLOSIS? Salmonellosis is an illness caused by ingesting the bacteria Salmonella. It is the most common type of foodborne illness resulting in infective gastroenteritis.

Q HOW IS IT TRANSMITTED IN SRI LANKA? As with anywhere else in the world, Salmonella in Sri Lanka is transmitted primarily through contaminated food and water. Salmonella is not confined to a specific location in Sri Lanka. However, contaminated food sources are common culprits for salmonellosis in the country. Particularly ingestion of uncooked or poorly cooked meat products from poultry to red meat may result in this illness.

Some studies have found that Salmonella contamination occurs in the broiler chicken meat industry. Raw table eggs sold at retail outlets have also been identified as a potential source of Salmonella infection. Drinking untreated water or water contaminated with sewage can introduce Salmonella into the body. While less likely than animal products, fruits and vegetables can become contaminated if they come into contact with infected animals or manure in the field.

Washing produce thoroughly before consumption helps reduce this risk. Improper food handling creates an environment for bacteria to spread. Poor washing of hands thoroughly before handling food or after using the toilet is an important means of spread. Not cooking meats to safe internal temperatures, cross-contamination between raw and cooked foods on utensils or surfaces and improper storage or refrigeration of leftovers, and allowing bacteria to multiply are other means.

Q WHAT ARE THE SYMPTOMS OF SALMONELLOSIS? The hallmark symptom of salmonellosis is diarrhoea which can range from mild to severe. In some cases, there may be blood in the stools. High-grade fever with chills and abdominal cramps are telltale signs. This may be associated with nausea and vomiting. These can occur as the body tries to purge itself of the bacteria. A general feeling of malaise and headache can be present. It is important to note that not everyone experiences all of these symptoms, and some people may have no symptoms at all.

The severity of symptoms can also vary depending on the individual’s health and the specific strain of Salmonella they are infected with. If you are experiencing these symptoms after consuming food or water that you suspect may be contaminated, it is best to seek medical attention to get a diagnosis and discuss treatment options. Dehydration can be a serious complication of salmonellosis, especially in young children and older adults.

Q HOW LONG DOES THE SALMONELLA INFECTION LAST? The duration of a Salmonella infection can vary depending on the individual and the severity of the illness. Most healthy adults typically resolve within 3-7 days. Symptoms like diarrhoea, fever, and cramps gradually subside as the body fights off the bacteria. In some instances, symptoms may linger for up to 2 weeks.

However, there are exceptions: Severe illness: People with weakened immune systems, young children, or older adults might experience a longer illness. Shedding bacteria: Even after symptoms disappear, some individuals may continue to shed Salmonella bacteria in their stool for weeks or even months after infection. This does not necessarily mean they are still sick, but they can still transmit the bacteria to others during this period. It can take some time for your bowels to return to normal after a Salmonella infection. Do not be surprised if it takes a few weeks for your stool habits to completely normalise.

Q HOW SERIOUS IS GETTING SALMONELLOSIS? It can range from a manageable illness to a serious health risk depending on several factors

a) Your overall health: People with weakened immune systems, infants, young children, and older adults are more susceptible to severe complications from Salmonella.

b) The severity of the infection: Not all Salmonella strains cause the same level of illness. Some people may only experience mild discomfort, while others can become quite ill. For most healthy adults, salmonellosis is unpleasant but resolves on its own within a few days to a week.

The body’s natural defences fight off the bacteria, and symptoms like diarrhoea, fever, and cramps gradually subside. Here, the main concern is staying hydrated by drinking plenty of fluids to replace what is lost through vomiting and diarrhoea.

However, the disease can become serious in some cases. The following should be concerning to seek medical attention:

• Symptoms last more than a  few days.
• Severe dehydration by diarrhoea and vomiting especially in vulnerable populations like young children and older adults. Signs of dehydration include dizziness, light-headedness, infrequent urination, and dark-coloured urine.
• High fever above 102°F (38.9°C).
• Blood-stained stools: Blood in your stool can be a sign of internal bleeding and requires medical attention.

In rare instances, Salmonella can spread from the intestines to the bloodstream and other parts of the body, leading to serious health problems like typhoid fever.

Q WHO IS AT HIGHER RISK OF GETTING A SALMONELLA INFECTION? Several factors can increase your risk of contracting Salmonella:

• Age: Children under 5 and adults over 65 are generally more vulnerable to Salmonella due to weaker immune systems.
• Underlying health conditions: People with weakened immune systems due to illnesses like HIV/AIDS or undergoing chemotherapy are at higher risk of serious complications from Salmonella.
• Travellers: If you are visiting Sri Lanka or any other tropical country, be extra cautious about consuming potentially risky foods, especially if your digestive system isn’t accustomed to the local cuisine.
• Dietary choices: Consuming raw or undercooked animal products, particularly chicken, eggs, and unpasteurized milk, significantly increases your risk.
• Hygiene practices: Not washing hands thoroughly before eating or after using the toilet, or not following safe food handling procedures can expose you to Salmonella contamination.
• Access to clean water: Drinking untreated tap water or water contaminated with sewage can introduce Salmonella into the body.

Q WHAT IS THE BEST TREATMENT FOR IT? For most healthy adults, Salmonella resolves on its own within a week. The focus is on managing symptoms and preventing dehydration. This may involve:

• Rest: Allowing your body to recover is crucial.
• Fluids: Replenishing fluids lost through diarrhoea and vomiting is essential. Drink plenty of water, clear broths, or oral rehydration products.

If you have severe symptoms like high fever, bloody stools, or dehydration that you can’t manage with fluids alone, hospitalisation and intravenous fluids may be necessary. In some cases, particularly for high-risk individuals or severe infections, doctors may prescribe antibiotics to combat the Salmonella bacteria. However, it is important to note that overuse of antibiotics can contribute to antibiotic resistance, so they are not a first-line treatment for everyone unless in septicaemia judged by a doctor. Injudicious use of over-the-counter medications such as antidiarrheal medication should not be done as it may harbour the bacteria in the gut impairing the natural means of elimination.

Q HOW CAN YOU PREVENT GETTING A SALMONELLA INFECTION IN SRI LANKA? Preventing Salmonella infection in Sri Lanka is all about smart choices regarding food hygiene and handling. Here are some key strategies:

Food choices:

• Practice caution with animal products: Be wary of undercooked or raw meat, poultry, and eggs. Ensure meats reach safe internal temperatures during cooking.
• Avoid unpasteurised dairy products: Stick to pasteurized milk and dairy products to avoid potential contamination.
• Wash fruits and vegetables thoroughly: This removes dirt and any lingering bacteria that might be present.

Hygiene practices:

• Wash hands frequently: This is the single most effective way to prevent the spread of Salmonella. Wash with soap and water for at least 20 seconds before handling food, after using the toilet, and after changing diapers.
• Avoid cross-contamination: Use separate cutting boards and utensils for raw meat and cooked foods. Wash surfaces thoroughly after handling raw meat.
• Maintain clean utensils and surfaces: Keep your kitchen clean and sanitised to minimise the risk of bacterial growth.

Water safety:

• Drink bottled water or purified water: This is especially important if you’re unsure about the safety of tap water.
• Avoid untreated tap water: Boil tap water for at least one minute if you must consume it.
• Additional tips: Be cautious with street food: While tempting, exercise caution with food vendors whose hygiene practices might be questionable. Opt for vendors with good reputations and visible cleanliness standards.
• Travellers: Be extra mindful of food choices, especially if your digestive system isn’t accustomed to local cuisine.

By Kshalini Nonis