Introduction
Salmonellosis encompasses infections caused by Salmonella species, a diverse group of Gram-negative bacilli within the Enterobacteriaceae family. While typhoid and paratyphoid fevers are systemic manifestations, many non-typhoidal Salmonella infections cause gastroenteritis or focal infections. This article summarizes the diagnostic approaches, therapeutic strategies, and observed evolutionary trends of salmonellosis at CHNEAR (Centre Hospitalier National Eric Kayser) in Dakar, highlighting practical implications for clinicians, microbiologists, and public health teams.
Diagnostic Profile at CHNEAR
Accurate diagnosis hinges on clinical suspicion, laboratory confirmation, and an understanding of local epidemiology. At CHNEAR, the diagnostic workflow typically begins with a careful clinical assessment to differentiate enteric fever from non-typhoidal salmonellosis. Blood cultures remain essential for systemic disease such as typhoid fever, while stool cultures are pivotal for gastroenteritis caused by non-typhoidal Salmonella.
Laboratory confirmation combines culture-based methods with targeted rapid tests. Conventional culture on selective media, followed by biochemical identification, continues to be a cornerstone. In recent years, adherence to standardized susceptibility testing helps guide therapy, particularly in the face of rising antimicrobial resistance. Molecular tools, when available, support rapid confirmation and outbreak detection, complementing traditional methods rather than replacing them.
Clinical presentations at the Dakar center vary from acute gastroenteritis with fever and abdominal pain to less common invasive syndromes. Clinicians at CHNEAR emphasize diagnostic vigilance in vulnerable populations, including young children, the elderly, and individuals with comorbidities, where atypical manifestations may predominate.
Therapeutic Profile and Management
Therapeutic decisions rise from the integration of microbiological results with patient risk factors and disease severity. For uncomplicated non-typhoidal cases, supportive care with hydration and symptom management may suffice, reserving antibiotics for high-risk scenarios, persistent fever, or signs of systemic involvement. In invasive infections or severe gastroenteritis, targeted antimicrobial therapy is warranted.
Antibiotic choice at CHNEAR reflects local resistance patterns and international guidelines. Overall, therapy focuses on effective, time-sensitive regimens while minimizing disruption of the gut microbiota and limiting exposure to broad-spectrum agents. De-escalation to narrow-spectrum antibiotics is preferred when susceptibility data confirm a susceptible organism. The emergence of resistance, including multidrug-resistant strains, underscores the importance of stewardship and ongoing surveillance.
Supportive measures, including fluid management, electrolyte correction, and nutritional support, are integral to successful outcomes. For typhoid and paratyphoid fever, clinicians adhere to established treatment courses, monitoring for complications such as intestinal perforation or organ involvement. Follow-up is important to ensure clinical resolution and to detect relapse or carrier states.
Evolutionary Profile and Public Health Implications
Understanding the evolutionary trajectory of salmonellosis in Dakar involves examining transmission dynamics, environmental reservoirs, and the impact of urbanization and sanitation. CHNEAR’s experience highlights the recurrent interconnectedness of human, animal, and environmental sources of Salmonella. Surveillance, vaccination considerations, and community education contribute to reducing incidence and preventing outbreaks.
Resistance evolution remains a critical challenge. Continued collaboration between clinicians, microbiologists, and public health authorities is needed to tailor empiric therapy, refine diagnostic algorithms, and reinforce infection control practices. Data from CHNEAR inform regional guidelines and contribute to a broader understanding of Salmonella epidemiology in West Africa.
Key Takeaways for Clinicians
- Maintain a high index of suspicion for salmonellosis across clinical presentations, especially in high-risk groups.
- Use stool and blood cultures judiciously to confirm diagnosis and guide therapy.
- Adhere to antimicrobial stewardship principles; tailor treatment to susceptibility results and disease severity.
- Monitor patients closely for complications and ensure appropriate follow-up to prevent relapse or carriage.
- Contribute to local surveillance efforts to track resistance patterns and inform public health actions.
