SALMONELLA TYPHI

Salmonella Typhi infections result in Typhoid, (Enteric fever). This is the more serious form of
Salmonella infection, with 75% of cases requiring hospitalisation.
The bacteria are found only in humans.
Cases are rare in New Zealand and are usually related to people returning from overseas travel.
However one case in NZ has been associated with the consumption of raw shellfish, privately
harvested.

What is Salmonella Typhi?

Salmonella typhi is a serotype of the species Salmonella enterica.
It grows best between 35 and 37°C but can grow between 7 and 45°C.
It grows through a pH range of 3.8 to 9.5, has a minimum water activity
level of 0.94, grows in either the presence or absence of oxygen and
growth under nitrogen is only slightly less than that under oxygen.
It is killed by heating, 70°C for 1 minute or less.
Salmonella survives well in foods and on surfaces, 190 days on
chocolate biscuits, 230 days on sweets, for 4 days in shellfish at 10 to
13°C and in excess of 90 days in ice.
Growth is greatly reduced at less than -15°C.
This bacteria is thought to undergo transition to the VNC (Viable but Non-Culturable) state in
water.

What are the symptoms?

Symptoms begin 7 to 28 days, (but usually around 14 days) after ingesting the bacteria and
consist of fever, malaise and spots on the trunk of the body. These occur commonly with pea-
like diarrhoea or constipation. Patients may also become delirious.
The diagnosis is confirmed by laboratory tests on a faecal specimen.
All people are prone to infection but in non-endemic areas children under 5 yrs are at the
greatest risk.

Where does it come from?

! Humans are the sole reservoir of this organism and it is thought that carriers may harbour
the bacteria in their gall bladders.
! Food may become contaminated from infected food handlers or through the use of
contaminated water during processing.
! Shellfish grown in polluted waters may also accumulate the bacteria in their tissue.
! Water can be contaminated by human faecal pollution and the bacteria can survive for up
to 9 days in seawater, weeks in sewage and survival in groundwater is better than in
pond, stream or lake water.
! Faecal-oral, person-to-person transmission from infected individuals can take place.

How long does it last?

Recovery is slow, taking from 1 to 8 weeks. Hospitalisation occurs in around 75% of cases.

How is it treated?
The infection is usually self-limiting although fluid replacement may be required.
Quinolone and Cephalosporin antibiotics can be used.
Vaccines are available.
Can I get this infection again?
Yes, as no resistance or immunity is gained against re-infection.

Can it spread to others?

This disease can be spread to others at any time through the
entire period of infection and excretion (often lasting weeks)
and strict attention to personal hygiene must be paid.

What about work, school, pre-school and child-care?

Everyone with this infection should stay off work or school
while they have symptoms. Those in High Risk groups,
occupations or institutions (infants or children in day-care,
school pupils, students, food workers, child-care workers, teachers, and health/care
workers) should only return to them after they have been completely free of symptoms for 2
days, and they must stay away again if any symptoms return.
Salmonella infection is a Notifiable disease in NZ and those employed in High Risk groups may
be required to stay away from work until tested free from infection.

How Can it be prevented or the risk reduced?

Transmission of disease is mainly through water or human carriers.
Foods implicated Overseas include ~
Chicken and rice, sandwiches, pork products, milk, and orange juice.

Preventive measures that can be taken to help avoid the illness include ~
! Thorough hand washing ~
! Before handling or preparing food, or eating and after going to the toilet,
! Thoroughly washing fruit and vegetables with clean water of drinking standard before use.
! Not drinking untreated water supplies, or consuming ice made from untreated sources.
! Thorough cooking of food products.
! Not keeping high-risk foods at room temperature but above 60°C if served hot, 4°C if cold.
! Reheating foods until they are steaming hot.