Salmonella is the Organism that Causes Cholera-like Diarrhea with 20-30% Bone and Joint Involvement
Salmonella is the organism that causes cholera-like diarrhea and is associated with bone and joint effects in 20-30% of patients, making option B the correct answer. 1
Clinical Presentation of Salmonella Infection
Salmonella can present with a spectrum of clinical manifestations:
- Gastrointestinal manifestations: Salmonella can cause acute watery diarrhea that mimics cholera, characterized by profuse, watery stools 2, 3
- Systemic manifestations: Unlike other common diarrheal pathogens, Salmonella has a unique ability to invade the bloodstream through intestinal epithelial cells and disseminate via macrophages 1
- Bone and joint involvement: Approximately 20-30% of patients with Salmonella infection develop bone and joint complications 4, 5
Pathophysiology of Bone and Joint Involvement
Salmonella has specific characteristics that explain its predilection for bone and joint tissues:
- Nontyphoidal Salmonella strains have a special predilection for vascular tissue, particularly in patients with atherosclerotic disease 1
- Salmonella bacteremia can lead to hematogenous seeding of bones and joints 6
- Certain Salmonella serotypes, particularly S. enteritidis and S. choleraesuis, have a particular affinity for vascular tissue 1
- Lumbar spine osteomyelitis has been reported in up to one-third of patients with aortic mycotic aneurysms caused by Salmonella 1
Differential Diagnosis
When considering the options presented:
- Shigella (option A): While Shigella can cause joint inflammation in about 20% of cases 4, it typically causes dysentery (bloody diarrhea) rather than cholera-like watery diarrhea 2
- Salmonella (option B): Causes both cholera-like watery diarrhea 3 and has a high rate (20-30%) of bone and joint involvement 5
- Clostridium difficile (option C): Typically causes pseudomembranous colitis with watery or bloody diarrhea but is not associated with significant bone and joint involvement 2
Risk Factors for Salmonella Bone and Joint Infections
Certain factors increase the risk of developing bone and joint complications with Salmonella:
- Hemoglobinopathies
- Previous joint trauma or surgery
- Connective tissue diseases
- Lymphoma
- Diabetes
- Alcoholism
- Immunosuppressive states
- Extremes of age 6, 5
However, these complications can also occur in immunocompetent individuals without obvious predisposing factors 6.
Clinical Implications
The recognition of Salmonella as the causative agent in patients with cholera-like diarrhea and bone/joint symptoms is crucial because:
- Early diagnosis and appropriate antimicrobial therapy are essential to prevent chronic osteomyelitis 5
- Without appropriate treatment, permanent functional deficits may develop 6
- Treatment of joint infections is usually successful with minimal residual damage, but osteomyelitis can become chronic if inadequately treated 5
In conclusion, Salmonella (option B) is the correct answer as it uniquely combines the ability to cause cholera-like diarrhea with a high rate of bone and joint involvement.