[Salmonella osteomyelitis - a rare differential diagnosis of bone tumors]. / Salmonellenosteomyelitis ­ eine seltene Differenzialdiagnose eines Knochentumors.

This case describes a rare salmonella infection suspected to be an osseous lymphoma. A 27-year-old female presented herself with painful swelling of her knee, with prednisolone-treated Crohn's disease as her only pre-existing condition. Salmonella species group C were detected in the osseous material derived from an extraction. The disease was treated with intravenous ceftriaxone, oral cotrimoxazole as well as multiple debridements. The working diagnosis should thus always be questioned and bone pain in patients who are immunosuppressed should be further investigated.

Association between use of proton pump inhibitors and non-typhoidal salmonellosis identified following investigation into an outbreak of Salmonella Mikawasima in the UK, 2013.

In November 2013, national public health agencies in England and Scotland identified an increase in laboratory-confirmed Salmonella Mikawasima. The role of proton pump inhibitors (PPIs) as a risk factor for salmonellosis is unclear; we therefore captured information on PPI usage as part of our outbreak investigation. We conducted a case-control study, comparing each case with two controls. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Thirty-nine of 61 eligible cases were included in the study. The median age of cases was 45 years; 56% were female. Of these, 33% were admitted to hospital and 31% reported taking PPIs. We identified an association between PPIs and non-typhoidal salmonellosis (aOR 8·8, 95% CI 2·0-38·3). There is increasing evidence supporting the existence of an association between salmonellosis and PPIs; however, biological studies are needed to understand the effect of PPIs in the pathogenesis of Salmonella. We recommend future outbreak studies investigate PPI usage to strengthen evidence on the relevance of PPIs in Salmonella infection. These findings should be used to support the development of guidelines for patients and prescribers on the risk of gastrointestinal infection and PPI usage.

Proton pump inhibitors and gastroenteritis.

An association between proton pump inhibitor (PPI) therapy and bacterial gastroenteritis has been suggested as well as contradicted. The aim of this study was to examine the association between the use of PPIs and occurrence of bacterial gastroenteritis in the prospective Rotterdam Study. The Rotterdam Study is a population-based cohort study among 14,926 subjects aged 45 years and older with up to 24 years of follow-up. Analyses were performed with a generalized estimating equations method in participants who handed-in a diagnostic stool sample. Furthermore, a nested case-control analysis was performed using the total cohort as a reference group. A bacterial microorganism was isolated in 125 samples, whereas 1174 samples were culture negative. In the generalized estimating equations analysis, we found that participants with a bacterial gastroenteritis were more likely than controls to be current users of PPIs (adjusted OR 1.94; 95 % CI 1.15-3.25). Different sensitivity analyses did not change this result. A considerably higher effect was observed (adjusted OR 6.14; 95 % CI 3.81-9.91), using the total cohort as a reference in a nested case-control analysis. Current PPI therapy is associated with an increased risk of bacterial gastroenteritis. However, by reducing the risk of selection and information bias in our study design, we demonstrated that the effect is lower than previously assumed.

Association between recent use of proton pump inhibitors and nontyphoid salmonellosis: a nested case-control study.

BACKGROUND: The association between proton pump inhibitors (PPIs) and nontyphoid salmonellosis (NTS) continues to be debated. The current study was designed to determine the association between use of oral PPIs and the diagnosis of NTS. METHODS: The Taiwan National Health Insurance Research Database from 2000 to 2010 was searched for cases of NTS, defined by the International Classification of Disease, Ninth revision, Clinical Modification. A nested case-control study in hospitalized population was conducted using 4 controls for each case patient (14 736 case patients and 58 944 controls), matched for age, month and year of entry, Charlson comorbidity index score, and well-known predisposing factors for NTS, including autoimmune diseases, acquired immunodeficiency syndrome, diabetes, cirrhosis, transplantation, gastrointestinal operations or diseases, and malignancies. RESULTS: Persons with NTS had a higher rate of using oral PPIs within the prior year (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.95-2.24; P < .001). The association was greatest for current PPI use (adjusted OR, 5.39; 95% CI, 4.79-6.06; P < .001). Although use of H2-receptor antagonists (adjusted OR, 1.84; 95% CI, 1.71-1.98), antibiotics (5.21; 4.81-5.64), steroids (3.18; 2.99-3.39), and nonsteroidal anti-inflammatory drugs (2.37; 2.26-2.48) within the 30 days were also associated with NTS, the linkage between PPI use and NTS remained significant in the subgroup without these medications. CONCLUSIONS: The use of oral PPIs was associated with the occurrence of NTS. The risk waned with time after discontinuation.

The Impact of Deoxynivalenol on Pigeon Health: Occurrence in Feed, Toxicokinetics and Interaction with Salmonellosis.

Seed-based pigeon diets could be expected to result in exposure of pigeons to mycotoxins such as deoxynivalenol (DON). Ingestion of low to moderate contamination levels of DON may impair intestinal health, immune function and/or pathogen fitness, resulting in altered host-pathogen interactions and thus different outcome of infections. Here we demonstrate that DON was one of the most frequently detected mycotoxins in seed-based racing pigeons feed, contaminating 5 out of 10 samples (range 177-1,466 µg/kg). Subsequently, a toxicokinetic analysis revealed a low absolute oral bioavailability (F) of DON in pigeons (30.4%), which is comparable to other avian species. Furthermore, semi-quantitative analysis using high-resolution mass spectrometry revealed that DON-3α-sulphate is the major metabolite of DON in pigeons after intravenous as well as oral administration. Following ingestion of DON contaminated feed, the intestinal epithelial cells are exposed to significant DON concentrations which eventually may affect intestinal translocation and colonization of bacteria. Feeding pigeons a DON contaminated diet resulted in an increased percentage of pigeons shedding Salmonella compared to birds fed control diet, 87 ± 17% versus 74 ± 13%, respectively. However, no impact of DON was observed on the Salmonella induced disease signs, organ lesions, faecal and organ Salmonella counts. The presented risk assessment indicates that pigeons are frequently exposed to mycotoxins such as DON, which can affect the outcome of a Salmonella infection. The increasing number of pigeons shedding Salmonella suggests that DON can promote the spread of the bacterium within pigeon populations.

Avaliação microbiológica, histológica e imunológica de frangos de corte desafiados com Salmonella Enteritidis e Minnesota e tratados com ácidos orgânicos / Microbiology, histology and immunology evaluation of broiler chickens challenged against Salmonella Enteritidis and Minnesota and treated with organic acids

Dois experimentos foram desenvolvidos para avaliar a eficiência de ácidos orgânicos frente a Salmonella enterica enterica sorovar Enteritidis (SE) e Minnesota (SM) em frangos. No primeiro experimento foram avaliados 3 tratamentos: T1 - ração adicionada de ácido orgânico, T2 - ração adicionada de ácido orgânico e ácido orgânico na água de bebida, T3 - grupo controle. Todos os animais foram inoculados com SE, via oral. A utilização de ácidos orgânicos na ração (T1) e na ração e na água (T2) diminuíram a excreção de Salmonella no papo e no ceco 7 dias pós inoculação com SE e houve redução de células CD3+ no jejuno dos frangos. No segundo experimento foram avaliados 4 tratamentos sendo T1 - controle, T2 - controle inoculado via oral com Salmonella Minnesota (SM), T3 - animais inoculados via oral com SM e ácidos orgânicos na ração e T4 - animais inoculados via oral com SM e ácidos orgânicos na ração e na água de bebida. Ácidos orgânicos a ração (T3) e na ração e na água (T4) reduziram a excreção de SM em papo de frangos de corte desafiados, 7 dias após inoculação. O uso de ácidos orgânicos na ração e na ração e na água foram mais eficientes em reduzir SE do que SM.

Two experiments were carried out to evaluate effectiveness of organic acids against Salmonella enterica enterica serovars Enteritidis (SE) and Minnesota (SM) in broilers. In the first experiment three treatments were evaluated: T1 - feeding with organic acids, T2 - feeding with organic acids and organic acids in drink water, and T3 - control group. All animals were oral challenged with SE. Organic acids in diet (T1) and organic acids in diet and drink water (T2) reduced the shadding of Salmonella in crop and cecum 7 days post challenged with SE and reduced the CD3+ cells in jejunal mucosa of broilers. In the second experiment four treatments were evaluated, T1 - control group, T2 - control group oral challenged with Salmonella Minnesota (SM); T3 - oral challenged animals with SM and treated with organic acids in diet; T4 - oral challenged animals with SM and treated with organic acids in diet and in drink water. Organic acids in diet (T3) and organic acids in diet and in drink water (T4) reduced the shadding of SM in crop of challenged broilers, 7 days post inoculation The use of organic acids in diet and in water was more effective to control SE than SM.

Septic arthritis due to Salmonella enteritidis associated with infliximab use.

A unique case of septic arthritis caused by Salmonella enteritidis in a patient receiving infliximab for rheumatoid arthritis is presented. Antimicrobial chemotherapy with surgical intervention was necessary for eradication of the infection. Physicians should be aware of rare manifestations of Salmonella infections associated with infliximab use, especially in endemic areas.

Nosocomial nontyphoidal salmonellosis after antineoplastic chemotherapy: reactivation of asymptomatic colonization?

An increased frequency of nontyphoidal salmonellosis is well established in cancer patients, but it is unclear whether this represents increased susceptibility to exogenous infection or opportunistic, endogenous reactivation of asymptomatic carriage. In a retrospective study, a simple case definition was used to identify the probable presence of reactivation salmonellosis in five cancer patients between 1996 and 2002. Reactivation salmonellosis was defined as the development of nosocomial diarrhea >72 h after admission and following the administration of antineoplastic chemotherapy in an HIV-seronegative cancer patient who was asymptomatic on admission, in the absence of epidemiological evidence of a nosocomial outbreak. Primary salmonellosis associated with unrecognized nosocomial transmission or community acquisition and an unusually prolonged incubation period could not entirely be ruled out. During the same time period, another opportunistic infection, Pneumocystis pneumonia, was diagnosed in six cancer patients. Presumably, asymptomatic intestinal Salmonella colonization was converted to invasive infection by chemotherapy-associated intestinal mucosal damage and altered innate immune mechanisms. According to published guidelines, stool specimens from patients hospitalized for longer than 72 h should be rejected unless the patient is neutropenic or >or=65 years old with significant comorbidity. However, in this study neutropenia was present in only one patient, and four patients were <65 years old. Guidelines should thus be revised in order not to reject stool culture specimens from such patients. In cancer patients, nosocomial salmonellosis can occur as a chemotherapy-triggered opportunistic reactivation infection that may be similar in frequency to Pneumocystis pneumonia.

Infecção experimental de embriões de frango de corte com Salmonella enterica sorovar Enteritidis fagotipo 4 / Experimental infection of broiler embryos with Salmonella enterica sorovar Enteritidis phagotype 4

Avaliou-se a infecção experimental por Salmonella Enteritidis fagotipo 4 (SEpt4) em embriões de frango de corte para averiguar a habilidade de penetração através da casca e o efeito da inoculação no albúmen, considerando-se a mortalidade, a eclodibilidade e a colonização intestinal dos pintos eclodidos. Foram realizados dois experimentos, distribuídos em quatro tratamentos (T) cada, com 200 e 194 ovos incubáveis das linhagens Ross e ISA Label, respectivamente. Utilizaram-se ovos não sanitizados e inoculados na casca com Salmonella Enteritidis (T1) ou com placebo (T2); ou inoculados no albúmen com Salmonella Enteritidis (T3) ou com placebo (T4). Imediatamente após a inoculação, os ovos foram incubados, e a mortalidade embrionária avaliada após 96, 432 e 528 horas. Salmonella Enteritidis inoculada na casca manteve-se viável na casca e nas membranas durante todo o período de incubação e migrou para o interior dos ovos, entretanto não afetou os parâmetros de incubação. O patógeno inoculado no albúmen determinou mortalidade embrionária tardia nas linhagens Ross, 17,0 por cento, e ISA Label, 13,0 por cento, e originou pintos com maior freqüência de colonização intestinal por Salmonella Enteritidis, 76,7 por cento e 26,7 por cento para Ross e ISA Label, respectivamente.

The experimental infection of Salmonella Enteritidis phagotype 4 (SEpt4) was evaluated in broilers embryos to verify the ability of penetration through eggshell and the effect of albumen inoculation considering embryo mortality, hatchability, and intestinal colonization of hatched chicks. Two trials were conducted using in four treatments each, totaling 200 and 194 fertile eggs of Ross and ISA Label lineages, respectively. Non-sanitized eggs were inoculated on the shell with Salmonella Enteritidis (Treatment 1) or placebo (Treatment 2); and eggs were inoculated in albumen with Salmonella Enteritidis (Treatment 3) or placebo (Treatment 4). Immediately after inoculation, the eggs were incubated and embryo mortality was evaluated after 96, 432, and 528 hours. The results showed that Salmonella Enteritidis inoculated on egg shell remained active there and in shell membranes during all incubation period and migrated to the interior of the eggs; however, it did not affect the incubation parameters. It was observed that Salmonella Enteritidis inoculated in albumen caused late embryo mortality in Ross (17.0 percent) and ISA Label (13.0 percent) lineages, and originated chicks with high frequency of intestinal colonization by Salmonella Enteritidis, being 76.7 percent and 26.7 percent for Ross and ISA Label, respectively.

Exclusión competitiva entre Salmonella enteriditis y Salmonella gallinarum en pollito de 1 día de edad infectados simultáneamente o consecutivamente / Competitive exclusion between Salmonella enteritidis and Salmonella gallinarium in one day-old broiler chicken challenged consecutive-or simultaneously

Se evaluó la inducción a la resistencia de desafíos consecutivos o simultáneos entre Salmonella enteritidis (SE) y Salmonella gallinarum (SG). En los experimentos con desafíos consecutivos, siempre se observó que la primera variedad de Salmonella administrada, predominó casi exclusivamante en la invasión del hígado, bazo y tonsilas cecales. Cuando se administraron simultáneamente ya sea al día uno o dos, ambas variedades fueron recuperadas del hígado, bazo y tonsilas cecales. Estos resultados indican que aun cuando las aves son susceptibles a ambas infecciones de Salmonella sp (24 horas), éstas pueden ser refractarias a un segundo desafío con otra variedad, y que si ocurriera una exposición simultánea, son posibles las infecciones mixtas. Los resultados obtenidos en el presente estudio confirman y extienden informes previos de la rápida inducción a la resistencia a desafíos consecutivos con diferentes variedades de Salmonella

Penetración de Salmonella enteriditis a través de huevos fértiles e infértiles sometidos a diferentes estadios de incubación / Salmonella enteritidis penetration in fertile and infertile chicken eggs at progressive stages of incubation

Se evaluó la penetración de Salmonella enteritidis fagotipo 13, realizada mediante la inoculación experimental en la cutícula de huevos fértiles e infértiles provenientes de gallinas Babcock B-300 de 59 semanas de edad y libres de Salmonella sp. El estudio fue realizado a los 8, 12 y 16 días de incubación. Se estudió la penetración de la bacteria dentro de las tres áreas del cascarón después de 24 h de incubación a 37.7ºC. Hacia los 8 días de incubación, no se encontraron diferencias estadísticas significativas entre los huevos fértiles e infértiles en todas las áreas estudiadas (P> 0.05); sin embargo, así hubo diferencias en los huevos fértiles que fueron penetrados (P< 0.05) a los 12 y 16 días de incubación, lo cual indica que el desarrollo embrionario retarda considerablemente la susceptibilidad a la invasión por Salmonella. La penetración a través de la cutícula fue similar en ambos huevos, en contraste con la marcada diferencia observada en las estructuras más internas. Los resultados indican que los hevos incubables no fértiles pueden ser considerados más susceptibles a la penetración por Salmonella que en aquellas que están en desarrollo embrionario

Efecto de la adición del acido cápsico, proveniente de la semilla de paprika (Capsicum annuum) en la dieta de pollo de engorda infectado experimentalmente por Salmonella gallinarum / Effect of Paprika seed (Capsicum annum) diet on Salmonella gallinarum infection in broiler chicks

Para evaluar el efecto del ácido cápsico en la dieta de pollos de engorda, se utilizaron 150 pollitos mixtos de un día de edad, que fueron divididos aleatoriamente en 5 grupos con 30 aves cada uno. Los grupos 1 y 2 fueron alimentados con una dieta basal, mientras que los grupos 3, 4 y 5 recibieron una dieta basal con 18, 27 y 35 ppm de ácido cáspico respectivamante. A los 15 días de edad se registraron los pesos de todos los grupos y se inocularon a las aves de los grupos 2, 3, 4 y 5 con 10 ufc/ml de Salmonella gallinarum resistente a ácido nalidíxico y novobiocina. Las aves se sacrificaron 24 h posinoculación y se realizó la lectura del pH cecal; se obtuvieron muestras de tonsilas cecales para determinar la colonización cecal y de hígado y bazo (muestra mixta) para determinar la invasión a órganos. Tanto la colonización como la invasión por S. gallinarum fue menor (P< 0.001) en los tres grupos que recibieron ácido cápsico en la dieta, en comparación con el grupo inoculado que recibió una dieta basal. El pH cecal disminuyo significativamante (P< 0.05) en los grupos tratados, en relación con los grupos testigo. Los resultados obtenidos en este estudio concuerdan con estudios previos donde se observó que la capsaicina aumentó la resistencia a la invasión de S. enteritidis en órganos. Esta resistencia estuvo asociada con el pH cecal y sugiere que la capsaicina presente en la semilla de paprika es también efectiva en la invasión causada por S. gallinarum en órganos