Infections from Salmonella species continue to be a major cause of foodborne illness (Peques, 2012). Six serotypes, including Salmonella subtypes yphimurium and enteritidis, account for most cases in the United States. Nontyphoid Salmonella gastroenteritis is contracted through contaminated food. Symptoms that include nonbloody diarrhea, abdominal pain, fever, chills, nausea, and vomiting begin 6 to 48 hours after exposure. Diagnosis is made by stool studies (Chap. 54, p. 1048). Intravenous crystalloid solutions are given for rehydration. ntimicrobials are not given in uncomplicated infections because they do not commonly shorten illness and may prolong the convalescent carrier state. If gastroenteritis is complicated by bacteremia, antimicrobials are given as discussed below. Rare case reports have linked Salmonella bacteremia with abortion (Coughlin, 2002).
Typhoid fever caused by Salmonela yphi remains a global health problem, although it is uncommon in the United States. Infection is spread by oral ingestion of contaminated food, water, or milk. In pregnant women, the disease is more likely to be encountered during epidemics or in those with HIV infection (Hedriana, 1995). In former years, antepartum typhoid fever resulted in abortion, preterm labor, and maternal or fetal death (Dildy, 1990).
Fluoroquinolones and third-generation cephalosporins are the preferred treatment. For enteric (typhoid) fever, antimicrobial susceptibility testing is important because of the development of drug-resistant strains (Crump, 2015). Typhoid vaccines appear to exert no harmful efects when administered to pregnant women and are given in an epidemic or before travel to endemic areas.
Bacillary dysentery caused by Shigela is a relatively common, highly contagious cause of inlammatory exudative diarrhea in adults. Shigellosis is more common in children attending daycare centers and is transmitted via the fecal-oral route. Clinical manifestations range from mild diarrhea to severe dysentery, bloody stools, abdominal cramping, tenesmus, fever, and systemic toxicity. Although shigellosis may be self-limited, careful attention to treatment of dehydration is essential in severe cases. We have cared for pregnant women in whom secretory diarrhea exceeded lO•Ll day! Antimicrobial therapy is imperative, and efective treatment during pregnancy includes fluoroquinolones, ceftriaxone, or azithromycin. Antimicrobial resistance is rapidly emerging, and antibiotic susceptibility testing can help guide appropriate therapy (Centers for Disease Control and Prevention, 2016). Shigellosis can stimulate uterine contractions and cause preterm birth (Parisot, 2016).
Also known as leprosy, this chronic infection is caused by Mycobacterium leprae and is rare in this country. Diagnosis is confirmed by PCR. Multidrug therapy with dapsone, rifampin, and clofazimine is recommended for treatment and is generally safe during pregnancy (Gimovsky, 2013; Ozturk, 2017). Duncan (1980) reported an excessive incidence oflow-birthweight newborns among infected women. The placenta is not involved, and neonatal infection apparently is acquired from skin-to-skin or droplet transmission (Duncan, 1984). Vertical transmission is common in untreated mothers (Moschella, 2004).