SALMONELLOSIS

Odsigue, Clarissa

Rama, Alea Albert

Rosales, Joy Sybil
 SAL MON EL L OSIS

Salmonella sp.
Members are capable of producing disease of the GIT as well
as septicaemia.
Members secrete exotoxins, each affecting the target cell
(usually an epithelial cell of the intestine).
The reservoir for members of the genus Salmonella is the GIT
of warm- and cold-blooded animals.
 SAL MON EL L OSIS

Salmonella sp.
Sources of infection include contaminated soil, vegetation, water,
and components of animal feeds and the faeces of infected animals.
Infection occurs following the ingestion of viable salmonellae.
Disease may follow infection immediately; in an animal already
infected, disease may follow a change in the intestinal environment.
 SAL MON EL L OSIS

Adult horses are most commonly affected with Salmonella. The

pattern is diarrhoea, though septicaemia is seen occasionally. Colic,
GI surgery, and antimicrobial agents predispose the horse to the
development of clinical signs. The agent is carried normally (as in
approx. 3% of clinically normal horses) or acquired from other
sources (e.g., a vet hospital). S. typhimurium and S. anatum are most
commonly isolated.
 SAL MON EL L OSIS
Salmonella spp. are ubiquitous geographically and zoologically.
Clinical outbreaks are correlated with depressed immune states,
as in new born animals (calves, foals) and stressed adults – for
example, parturient cows, equine surgical patients, and swine with
systemic viral diseases. All animals are at increased risk of developing
disease if their normal flora is disrupted (stress, antibiotics). These
circumstances render animals susceptible to exogenous exposure or
activation of silent infections.
SAL MON EL L OSIS
Lesions in the Colon:
•Shortening of villi with loss of the
epithelium to complete loss of intestinal
architecture.
•Neutrophilic reaction in the lamina propria
•Thrombi may be seen in blood vessels in
this region.
•Hemorrhage and fibrin strands are usually
seen.
 SAL MON EL L OSIS

PATIENT INFO

Name: Account of Greece

Specie: Equine
Sex: Male (stallion)
Weight: 475kg
 SAL MON EL L OSIS

CAUSE: Salmonella sp.

CLINICAL SIGNS:
fever cardiovascular function compromised
depressiondue to dehydration (10%)
colic-type signs and endotoxemia
watery diarrhea tachycardia
RR & HR elevated injected mucous membranes
leukopenia cold extremities
hypoproteinemia
 SAL MON EL L OSIS
DIAGNOSIS
Clinical Findings: Salmonella Culture from feces
• Obtain at the onset of depression and fever
• Minimum of 5 cultures, 10-30g feces Enrichment technique
• Tetrathionate brilliant agar broth (allow growth) and selenite broth (inhibit
growth)
Metabolic acidosis
CBC: Hemoconcentration
Leukopenia
Serum Chemistry: Hypokalemia
Hypocalcemia
Serum albumin <20g/L or 2g/dl
 SAL MON EL L OSIS

MEDICATIONS
1. Penicillin – Gentamicin 1. KCl 20-40 mmol/L (mEq/L)

combination 2. Na Bicarbonate

2. TMP-S 3. Hypertonic fluid

3. Flunixin meglumine 4. Plasma transfusion

4. DMSO 5. Salmonella antisera

5. Plasma therapy 6. Bismuth Salicylate

6. Fluid therapy 7. Mineral oil via NGT

 ADDITIONAL MEDICAL MANAGEMENT

Catheter Placement
• NOTE: Always check for
thrombophlebitis due to endotoxemia,
irritation due to infusion of medications and
bacterial colonization of the catheter tip.
 T R E AT M E N T

Antibiotic therapy:
YES, Why?
• To kill the bacteria
• To prevent the likelihood of septicemia
• To prevent seeding of other tissues with the
bacteria
 DISCUSSION
Are the treatment/management procedures prescribed
insufficient, inappropriate, excessive, etc? Explain your answer.
Some of the treatment/management procedures are inappropriate
and excessive.

(will be explained/elaborated as we go along the discussion)

 P E N I C I L L I N - G E N TA M I C I N C O M B I N AT I O N

Penicillin
INDICATION: generally for Gram positive bacteria.
-synergistic with aminoglycosides.
Gentamicin
INDICATION: The inherent toxicity of the aminoglycosides limit their
systemic (parenteral) use to the treatment of serious gram negative
infections when there is either a documented lack of susceptibility to
other less toxic antibiotics or when the clinical situation dictates
immediate treatment of a presumed gram negative infection before
culture and susceptibility results are reported.
Gentamicin is only approved for intrauterine infusion in horses.
 TMP-S (TRIMETHOPRIM-SULFONAMIDES)

INDICATION: Only approved for use in dogs and horses to treat

infections caused by susceptible organisms.
ADVERSE EFFECTS: In horses, transient pruritus has been noted
after IV injection. Oral therapy has resulted in diarrhoea
development in some horses. If the 48% injectable product is injected
IM, SQ, or extravasates after IV administration, swelling, pain and
minor tissue damage may result.
DRUG INTERACTION: Sulfonamides may displace other highly
bound drugs, such as methotrexate, phenylbutazone, thiazide
diuretics, salicylates, probenicid and phenytoin.
 PEN-GEN COMBI VS TMP-S
Proponents of antibiotic usage recommend a member of the
fluoroquinolone class of drug in non food animal species and
human patients.
Treatment of the sytemic form of salmonellosis includes
nursing care and appropriate antimicrobial therapy as
determined by retrospectively acquired susceptibility data.
Since salmonellae survive in the phagocytic cell, the
antimicrobial drug should be one that penetrates the cell.
Examples of those that distribute in this manner include
ampicillin, enrofloxacin, trimethoprim-sulfonamides, and
chloramphenicol.
 TMP-S (TRIMETHOPRIM-SULFONAMIDES)

 Dose: 22 mg/kg (Upson 1988)

 Dosage form: injectable

 Route: IV
 Duration: q24hrs; 1-2weeks

may be continued until 4weeks

 Specific brand: Septotryl
 FLUNIXIN MEGLUMINE

INDICATION: Its use in the horse are for the alleviation of inflammation and pain
associated with musculoskeletal disorders and alleviation of visceral pain associated
with colic in the horse.
CONTRAindication: When using to treat colic, it may mask the behavioral and
cardiopulmonary signs associated with endotoxemia or intestinal devitalization and
must be used with caution.
DRUG INTERACTIONS: It should be used cautiously with highly protein bound
drugs such as phenytoin, valproic acid, oral anticoagulants, other anti-inflammatory
agents, salicylates, sulfonamides, and the sulfonylurea antidiabetic agents.
 DIMETHYL SULFOXIDE

INDICATION: the only FDA-approved veterinary indication for DMSO is:

“...as a topical application to reduce acute swelling due to trauma”. Other
possible indications for DMSO include: adjunctive treatment in transient
ischemic conditions, CNS trauma and cerebral edema, skin
ulcers/wounds/burns, adjunctive therapy in intestinal surgeries, and analgesia
for post-operative or intractable pain, amyloidosis in dogs, reduction of
mammary engorgement in the nursing bitch, enhancement of antibiotic
penetration in mastitis in cattle, and limitation of tissue damage following
extravasation injuries secondary to chemotherapeutic agents.
CONTRAindication: may mask existing pathology with its anti-inflammatory
and analgesic activity. DMSO should be used cautiously in animals suffering
from dehydration or shock as its diuretic and peripheral vasodilatory effects
may exacerbate these conditions.
 FLUMEG VS DMSO
DMSO
When DMSO is administered intravenously to horses it may
cause hemolysis and hemoglobinuria. These effects can be
minimized by using concentrations of 20% or less (not less than 2% in
water) and slowly administering. Reports of hepatotoxicity and renal
toxicity have also been reported for various species and dosages.
FluMeg
Flunixin appears to be a relatively safe agent for use in the
horse, but the potential does exist for GI intolerance, hypoproteinemia,
and hematologic abnormalities to occur.
Flunixin does not appreciably alter GI motility in horses and
may improve hemodynamics in animals with septic shock.
 FLUNIXIN MEGLUMINE

 Dose: 1.1mg/kg
 Dosage form: injectable

 Route: IV
 Duration: sid up to 5days

 Specific brand: Banamine

 PLASMA THERAPY/TRANSFUSION

INDICATION: Equine plasma may be administered to correct

hypoproteinemia and to supply coagulation factors and,
depending on the source of the plasma, specific antibodies to
endotoxins.
 FLUID THERAPY

 KCl 20-40mmol
INDICATION: Potassium supplementation is used to prevent or
treat potassium deficits.
PRECAUTIONS: Assess renal and cardiac function prior to
therapy and closely monitor serum potassium levels.
Supplementation should generally occur over 3-5 days to allow
equilibration to occur between extracellular and intracellular
fluids. Some clinicians feel that if acidosis is present, use
potassium acetate, citrate or bicarbonate.
 FLUID THERAPY

 Na Bicarbonate (systemic antacid)

Sodium bicarbonate is indicated to treat metabolic acidosis
and to alkalinize the urine.
Use with extreme caution and give very slowly in patients
with hypocalcemia.
Acidotic horses with colic tend also to be dehydrated, may be
preferable to give as isotonic sodium bicarbonate (150mEq/L).
(Stover 1987)
 FLUID THERAPY

 Hypertonic Fluid

- used for resuscitation in cases of extreme shock

 FLUID THERAPY

LACTATED RINGER’S SOLUTION

-isotonic
-alkalinizer pH 6.5
-electrolyte composition (mEq/L): potassium 4
calcium 3
-crystalloid solution
 SALMONELLA ANTISERA

- given to treat endotoxemia

 B I S M U T H S A L I C Y L AT E

INDICATION: It is used to treat diarrhea and is thought to posses

protectant, anti-endotoxic and weak antibacterial properties.
Adsorbents, given by mouth, are claimed to adsorb toxins from
the gastro-intestinal tract and thereby may prevent irritation and
erosion of the mucosa. Adsorbents also increase the bulk of the faeces.
They have little or no effect on fluid or electrolyte losses.
WARNING: May change stool color to a gray-black or greenish-black;
do not confuse with melena.
As bismuth is radiopaque, it may interfere with GI tract
radiologic examinations.
 MINERAL OIL VIA NGT

INDICATION: Mineral oil is commonly used in horses to treat

constipation and fecal impactions. It is also employed as a laxative in
other species as well, but used less frequently. Mineral oil has been
administered after ingesting lipid-soluble toxins (e.g., kerosene,
metalaldehyde) to retard the absorption of these toxins through its
laxative and solubility properties.
 B . S A L I C Y L AT E V S M . O I L

Although the two substances are both to aid recovery from GI

disorders, mineral oil is used for constipation and our case has
diarrhea. Also, NGT is difficult to place and the condition of the horse
is considered. Bismuth salicylate on the hand is used to treat diarrhea
and is thought to posses protectant, anti-endotoxic and weak
antibacterial properties.
 B I S M U T H S A L I C Y L AT E

 Dose: 60ml/dose
 Dosage form: paste

 Route: PO
 Duration: bid for 2days

 Specific brand: Corrective Mixture (Beescham)

Description treatment dose Dosage Brand price Duration Total
form of Tx
antibiotic therapy TMP-S 22mg/kg Inj, Septotryl 1-2weeks,
100ml upto 4wks
bottle
NSAID FluMeg 1.1mg/kg Inj, Banamine P3270.00 sid, 5d P3270.00
100ml
FLUIDS: LRS IV Euro-Med P57.00 P3534.00
addresses infusion +
dehydration; ,
hypokalemia & 1000ml
hypocalcemia;
metabolic acidosis
addresses Plasma IV
hypoproteinemia solution
addresses Salmonella IVSol’n BD Horse P5,128.0
endotoxemia antisera , 100ml Bld Defibrin 0
anti-diarrheal; Bismuth 60ml/ paste Corective bid-tid, til P348.00
GIT protectant salicylate dose Mixture diarrhea
(Beescham) disappears
P

C O S T O F M E D I C AT I O N
 MANAGEMENT AND NURSING CARE

The cost of the treatment may appear expensive but is still practical
because the chosen drug components of the medications are
NECESSARY to alleviate the infection of the animal.
Take in consideration that treating diseases in large animals, like
horses, may require large amount of money.
 MANAGEMENT AND NURSING CARE

This disease is management related.

How do we deal with it:
• Transient animals should not be comingled with permanent
residents
• Control movement of people and equipment
• Keep the stable clean and sanitized
• Once an outbreak occur, cleaning and disinfecting protocols
should be reviewed and strictly enforced.
 MANAGEMENT AND NURSING CARE

How do we deal with it:

• Cleanliness of the surroundings.
• Management protocols such as vaccination schedule, diet and
breeding schedule should be manipulated such that it would
lessen the stress experienced by the animal.
• During antimicrobial therapy, always consider drug resistance,
safety, contraindications and side effects.
 REFERENCES

Plumb, D. Plumb’s Veterinary Drug Handbook. 6th ed.

Bishop, Y. The Veterinary Formulary. 6th ed. 2006.
Hirsh, D. Veterinary Microbiology. 1999.
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/
20900.htm&word=equine%2csalmonellosis
Thomas, HS. Salmonella in Horses. Article #5686. 2005.
Philippine Veterinary Drug Handbook. 11th ed. 2009.
MIMS Philippines. 121st ed. 2009.
Robinson, N.E. and Sprayberry, K. Current Therapy in Equine Medicine. 6th
ed. 2009.