2025 – PAGE 330 – INFECTIOUS DISEASES
SALMONELLA
- SALMONELLA NON-TYPHI: Lookfor a febrile patient with green, malodorous diarrhea. This may be associated with blood in the stool. This is definitely associated with food, so look for a history of a recent picnic. Specific foods include ice cream, poultry, and eggs. It can also be transmitted by a pet IGUANA. This type of Salmonella is self-limited and does NOT require antibiotic treatment. In fact, treating can cause a carrier state and prolong shedding.
- PEARL: If it’s diagnosed in an immunocompromised patient, treat with Ceftriaxone.
- SALMONELLA TYPHI (S. TYPHI): This causes TYPHOID FEVER. This causes fever, diarrhea, abdominal pain, and “ROSE SPOTS.” The PERSISTENT FEVER after the diarrhea has resolved is quite unique and is from persistence in the liver, gallbladder, and spleen. It’s transmitted through the fecal-oral route and REQUIRES treatment with ceftriaxone or cefotaxime. If you need a study break, consider reading about Typhoid Mary at www.pbrlinks.com/SALMONELLA1.
- PEARL: ROSE SPOTS occur on the chest and abdomen. They are small, flat, rose-colored macules.
- IMAGE: www.pbrlinks.com/SALMONELLA2
CAMPYLOBACTER JEJUNI
Campylobacter jejuni has a similar presentation to Shigella. Look for CRAMPY abdominal pain, fever, and an inflammatory diarrhea that can be bloody. Diagnose by stool culture. Treat with erythromycin.
MNEMONIC: Think of being at a CAMP near a FLAME (inflammatory diarrhea) when you begin having CRAMPY CAMPY symptoms.
STAPHYLOCOCCUS AUREUS AND BACILLUS CEREUS
The diarrhea associated with Staphylococcus aureus or Bacillus cereus starts QUICKLY due to preformed toxins! Onset is as short as 1 hour, and as long as 8 hours. Bacillus cereus is associated with ingestion of RICE. Diagnosis is primarily clinical and treatment is supportive since it resolves within 24–48 hours.
MNEMONIC: 8acillus cereus and sta8h aureus. Onset is within 8 hours.
MNEMONIC: Ever heard of BC Headache Powder? It’s basically WHITE POWDERED aspirin and caffeine. Associating BC Headache Powder with WHITE POWDER could help remind you that Bacillus Cereus is associated with WHITE RICE ingestion.