What questions should be asked during triage to assess the risk of Salmonella infection?

Triage Questions for Assessing Salmonella Infection Risk

When triaging patients with suspected Salmonella infection, focus on specific clinical features and epidemiological risk factors that help identify those at highest risk for complications or severe disease.

Clinical Presentation Assessment

• Ask about fever, which is present in 58-100% of Salmonella infections 1
• Inquire about abdominal pain, which occurs in 75-100% of cases 1
• Document presence of bloody stools (occurs in 25-51% of Salmonella cases) 1
• Ask about vomiting and/or nausea (present in 62.5-100% of cases) 1
• Assess for signs of dehydration, which increases risk of life-threatening illness and death 1
• Determine duration of symptoms, as prolonged symptoms may indicate complications 1

Risk Factor Assessment

• Ask about recent travel history, particularly to areas where enteric fever is endemic 1
• Inquire about consumption of foods prepared by people with recent endemic exposure 1
• Document any history of contact with laboratory specimens containing Salmonella 1
• Ask about recent consumption of high-risk foods (poultry, eggs, unpasteurized dairy) 2, 3
• Determine if patient has had contact with others experiencing similar symptoms 1
• Ask about recent antibiotic use (within previous 30 days) to help differentiate from C. difficile colitis 1

Comorbidity Assessment

• Identify immunocompromising conditions that increase risk of invasive disease 1
• Ask about chronic liver disease, which increases risk of severe infection 1
• Document history of hemoglobinopathies or recent malaria, which increase risk for invasive infection 1
• Ask about history of cirrhosis, which predisposes to more severe disease 1
• Inquire about structural abnormalities of the urinary tract, which may predispose to Salmonella UTI 4
• Document history of HIV infection, which increases risk for severe or recurrent infection 1

Outbreak Assessment

• Ask if others in the household or close contacts have similar symptoms 1
• Inquire about institutional living situations (long-term care facilities, dormitories) 1
• Document attendance at large gatherings or events where food was served prior to symptom onset 1
• Ask about any known foodborne illness outbreaks in the community 1
• Determine if patient works in high-risk occupations (food service, healthcare, childcare) 1
• Inquire about animal contact, recreational water exposure, or high-risk sexual practices 1

Severity Assessment

• Ask about signs of severe illness: high fever, severe abdominal pain, tenesmus, or bloody diarrhea 1
• Assess for symptoms of colitis (severe fever, abdominal cramps, bloody diarrhea) 1
• Document symptoms suggesting potential complications like pancreatitis (severe abdominal pain) 5
• Ask about symptoms of dehydration (decreased urination, excessive thirst, dizziness) 1
• Inquire about symptoms suggesting bacteremia (high fever, chills, severe weakness) 4
• Assess for signs of extraintestinal manifestations 1

Management Decision Points

• For patients with fever or bloody diarrhea, prioritize evaluation for enteropathogens including Salmonella, as antimicrobial agents may confer clinical benefit 1
• For patients with symptoms of colitis but no recent antibiotic use, submit stool sample for culture of invasive enteropathogens including Salmonella 1
• Consider blood cultures for infants, people with signs of septicemia, immunocompromised individuals, and those with systemic manifestations 1
• Notify public health authorities if a reportable pathogen like Salmonella is isolated 1
• Consider empiric antibiotic treatment only in high-risk patients, as antibiotics may prolong shedding and increase adverse effects in otherwise healthy individuals 6