The symptoms of nontyphoidal gastroenteritis include low-grade fever, chills, nausea, vomiting, diarrhea, and abdominal cramps. The incubation period is typically 6-72 hours, and illness lasts up to a week. One report of children with this infection noted that 29% had bloody diarrhea, many had fever and vomiting, and some presented with signs of dehydration.
An asymptomatic carrier state may exist for months after recovery from infection. In most cases, antibiotic therapy is not necessary. Rarely (<8% of cases), nontyphoidal gastroenteritis is complicated by bacteremia. For some patients, antibiotic therapy for gastroenteritis might be prescribed if they are felt to be at increased risk for extra-intestinal infection (eg, neonates, the elderly, or immunosuppressed patients). In one small case series, children with bacteremia typically had dysentery and fever on admission. Some had convulsions. Also rare is a reactive arthritis following Salmonella infection. This can be associated with iritis and urethritis.
The CDC has classified drug-resistant nontyphoidal Salmonella and drug-resistant Salmonella serotype typhi as serious concerns. They note that 67% of S. typhi are drug-resistant.
See Typhoid Fever for discussion of Salmonella enterica serotype typhi and Salmonella enterica serotype paratyphi A, B and C, which produce the most severe forms of the illness (typhoid and paratyphoid fevers) and are found in most parts of the world except in industrialized regions.
A02.0 – Salmonella enteritis
302231008 – Salmonellosis
Differential Diagnosis & Pitfalls
- Acute bacterial gastroenteritis (Campylobacter, Shigella, Escherichia coli O157:H7)
- Viral gastroenteritis is usually not associated with dysentery or high fever.
- Other toxin-mediated gastroenteritides
- Gastroenteritis due to protozoan infection (Giardia, Cryptosporidium, Cystoisospora, Cyclospora) is usually not associated with dysentery or high fever.