A 30-year-old Caucasian man with no significant past medical history presents to his primary care physician complaining of nausea, vomiting, diarrhea, abdominal cramping, and fever to 38.3C (100.9F). The symptoms started 12 hours after the man consumed a beverage that contained pureed fruit, powdered protein, and three raw eggs. Physical examination of the man is unremarkable. Salmonella enteritidis is subsequently isolated from his stool culture. What is the best means of managing this patient's care?

Question

A 30-year-old Caucasian man with no significant past medical history presents to his primary care physician complaining of nausea, vomiting, diarrhea, abdominal cramping, and fever to 38.3C (100.9F).  The symptoms started 12 hours after the man consumed a beverage that contained pureed fruit, powdered protein, and three raw eggs.  Physical examination of the man is unremarkable.  Salmonella enteritidis is subsequently isolated from his stool culture.  What is the best means of managing this patient's care?

Quizplus · Accepted Answer

Explanation: Symptomatic individuals found to be infected with Salmonella enteritidis should be given replacement fluid and electrolytes, as they are at risk for becoming dehydrated. Since the gastroenteritis is usually self-limited and antibiotic use has not been shown to hasten the resolution of symptoms or improve the rate of Salmonella clearance from stool, antibiotic usage is not recommended for immunocompetent adults or children older than one year of age. Therefore, supportive therapy and observation (Choice E) would be most appropriate. Salmonella enteritidis In the United States, Salmonella enteritidis is becoming increasingly resistant to ampicillin (Choice A). Even if antibiotic therapy were indicated, ampicillin would be a poor choice. Salmonella enteritidis Preemptive therapy is warranted in patient groups at greater risk for complications. These groups include children younger than twelve months of age (with special attention paid to neonates) and immunocompromised adults. Therapy may be considered for adults at least 50 years old with known atherosclerotic disease, as they are more prone to developing bacteremia and endovascular infection. Effective antibiotics include ciprofloxacin (Choice B), trimethoprim/sulfamethoxazole (Choice C), and ceftriaxone (Choice D). Educational objective: Salmonellosis does not need to be treated with antibiotics in immunocompetent individuals age 12 months or older.

A 30-Year-Old Caucasian Man with No Significant Past Medical History