Salmonella infection in the Internationally adopted child


There are two main types of salmonella there is the “normal salmonella that we think of in this country which is acquired through undercooked foods. There is also something called salmonella typhi or typhoid fever.

They are both salmonella infections. Normally however when we say salmonella infection it is nontyphoidal salmonellosis.

Without knowing the clinical context it is hard to know exactly what is going on with your child, for example was this in the blood, stool, or spinal fluid ?

I will quickly summarize what happens with salmonella infections.

It can present in 5 ways.

1. Acute or chronic asymptomatic infection salmonella has an ability to hide in the gut and to be shed it the stool for a prolonged time. This ability seems to be facilitated through the early use of antibiotics. This is why in this country we do not jump to treat all cases of salmonella. We do treat however if we feel the child is at risk for a severe illness. A child may be hospitalized to isolate him/her from the other children so that they do not start an outbreak.
2. Gastroenteritis- an illness of vomiting and diarrhea with fever. This can be recurrent if they are exposed more than once.
3. Focal infection salmonella can spread about the body after an enteric illness but then the salmonella would not necessarily be found in the stool after treatment, but it can be found recurrently in the blood.
4. Bacteremia- salmonella in the blood, normally once it is treated it is gone unless it finds a home in the bone for example.
5. Enteric fever a prolonged bacteremic illness where the child appears very ill usually needing hospitalization. 

The factors that determine if a child gets really ill are young age, virulent organism, hemoglobinopathy (such as sickle cell), leukemia/lymphoma(rare so young and ruled out by a blood test), immunosuppressive drugs, problems of the immune system either they are born with (scid) or acquired (HIV).  Without a more thorough history it is impossible to say with any certainty what is going on with this child and unfortunately this is the risk that we are faced with many times in international adoption.

A child should not have serious long term effects from an uncomplicated infection from salmonella in general, But it is important to know therefore was the illness a normal gastroenteritis or was it something else.

By James Reilly of and

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