CLINICAL MANIFESTATIONS OF SALMONELLOSIS IN HIV
- Self-limited gastroenteritis; A more severe and prolonged diarrheal disease, associated with fever, bloody diarrhea, weight loss, and possible bacteremia (bloody diarrhea is more frequent with Shigella but also can occur with Campylobacter or Salmonella;
- Septicemia, which can exhibit extra-intestinal involvement with or without concurrent or preceding gastrointestinal illness.
The risk for more profound illness increases with the degree of immunosuppression. Relapses in infections with Salmonella and other gram-negative bacteria after appropriate treatment have been well-documented in HIV-infected patients. Molecular typing of non-typhoid Salmonella strains isolated from HIV-infected patients with recurrent salmonellosis.
Salmonella is a particularly common cause of septicemia, which is prone to relapse. Recurrent Salmonella septicemia constitutes an AIDS-defining illness and might require chronic suppressive therapy. The development of antimicrobial resistance during therapy, often associated with clinical deterioration or relapse, can also occur among HIV-infected persons with gram-negative enteridities.
DIAGNOSIS IN THE STUDY OF SALMONELLOSIS IN HIV
The diagnosis of gram-negative bacteria infection is established through cultures of stool and blood. Because of the high rate of bacteremia associated with Salmonella gastroenteritis in HIV-infected patients, blood cultures should be obtained from any patient with diarrhea and fever.
PREVENTION/TREATMENT IN THE STUDY OF SALMONELLOSIS IN HIV
The initial treatment of choice for Salmonella infection is a fluoroquinolone. Ciprofloxacin is the preferred agent (505); other fluoroquinolones (levofloxacin and moxifloxacin) also would likely be effective in treatment of salmonellosis among HIV-infected persons, but these agents have not been well-evaluated in clinical studies. Depending on antibiotic susceptibility, alternatives to the fluoroquinolones might include TMP-SMX or expanded spectrum cephalosporins