What is the treatment and prevention for Salmonella and Campylobacter infections transmitted through handling feces or raw food?

Treatment and Prevention of Salmonella and Campylobacter Infections

For Salmonella and Campylobacter infections transmitted through handling feces or raw food, proper hand hygiene is the cornerstone of prevention, while fluoroquinolones (primarily ciprofloxacin) are the treatment of choice for confirmed infections requiring antimicrobial therapy. 1

Clinical Manifestations

Infections with Salmonella and Campylobacter typically present as one of three clinical syndromes:

1. Self-limited gastroenteritis
2. More severe prolonged diarrheal disease with fever, bloody diarrhea, weight loss, and possible bacteremia
3. Septicemia with potential extra-intestinal involvement 1

The risk for severe disease increases with immunosuppression, particularly in HIV-infected individuals 1.

Diagnosis

• Diagnosis is established through stool cultures and blood cultures
• Blood cultures should be obtained from any patient with diarrhea and fever due to high rates of bacteremia, especially in immunocompromised patients 1
• Special culture conditions may be needed for some Campylobacter species 1

Treatment Algorithm

For Immunocompetent Adults with Uncomplicated Gastroenteritis:

• Most cases are self-limiting and do not require antimicrobial therapy
• Supportive care with fluid and electrolyte replacement is the primary treatment

For Severe Disease or High-Risk Patients:

• Antimicrobial therapy is indicated for:
  • Severe illness with high fever, bloody diarrhea
  • Immunocompromised patients (especially HIV-infected)
  • Elderly patients
  • Infants under 3 months
  • Pregnant women with Salmonella (due to risk of placental infection) 1

First-line Treatment:

• Ciprofloxacin 750 mg twice daily for 14 days is the drug of choice for susceptible organisms 1, 2
• For children: TMP-SMZ, ampicillin, cefotaxime, ceftriaxone, or chloramphenicol; fluoroquinolones should be used with caution 1
• For pregnant women: Avoid fluoroquinolones; use ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ 1

Secondary Prophylaxis:

• HIV-infected persons with Salmonella septicemia require long-term therapy to prevent recurrence
• Ciprofloxacin is usually the drug of choice for susceptible organisms 1

Prevention Strategies

Hand Hygiene:

• Wash hands thoroughly with soap and water:
  • After using the toilet
  • After changing diapers
  • Before and after preparing food
  • Before eating
  • After handling garbage or soiled laundry
  • After touching animals or their feces 1, 3
• Handwashing with soap and water reduces bacterial contamination to 8%, compared to 23% with water alone and 44% with no handwashing 3

Food Safety:

• Avoid eating:
  • Raw or undercooked eggs and foods containing raw eggs
  • Raw or undercooked poultry, meat, and seafood (especially raw shellfish)
  • Unpasteurized dairy products and fruit juices
  • Raw seed sprouts 1
• Prevent cross-contamination:
  • Use separate cutting boards for meat and non-meat items
  • Wash hands between handling raw meat and other foods 4
  • Clean and sanitize kitchen equipment properly to prevent cross-contamination between raw and cooked foods 5
  • Do not wash raw poultry before cooking (can spread contamination through splashing) 6
  • Store raw poultry properly in refrigerator 6
  • Use a food thermometer to ensure proper cooking temperature 6

Pet-Related Prevention:

• Avoid contact with animals that have diarrhea
• Wash hands after handling pets, especially before eating
• Seek veterinary care when pets develop diarrheal illness
• When obtaining a new pet, avoid animals under 6 months of age (1 year for cats) 1

Special Populations:

For HIV-infected individuals:

• Household contacts of HIV-infected persons with salmonellosis should be evaluated for asymptomatic carriage 1
• HIV-infected children should have supervised handwashing after handling pets 1

For children:

• Antiperistaltic drugs are not recommended 1
• Supervise handwashing 1

For pregnant women:

• Avoid fluoroquinolones 1
• Treat Salmonella gastroenteritis to prevent placental infection 1

Common Pitfalls to Avoid

1. Not treating when indicated: Immunocompromised patients, especially those with HIV, should receive antimicrobial therapy for Salmonella gastroenteritis to prevent extraintestinal spread 1

2. Inappropriate use of antidiarrheals: Antiperistaltic agents should be discontinued if symptoms persist beyond 48 hours and should not be used in patients with high fever or bloody stools 1

3. Inadequate hand hygiene: Inconsistent handwashing between preparation of meat and non-meat items significantly increases risk of illness (adjusted odds ratio = 8.3) 4

4. Washing raw poultry: Nearly 70% of consumers wash raw poultry before cooking, which can spread contamination through splashing 6

5. Improper food storage: Only 17.5% of consumers correctly store raw poultry in the refrigerator 6

By following these treatment and prevention guidelines, the risk of Salmonella and Campylobacter infections can be significantly reduced, leading to improved morbidity and mortality outcomes.