Gastroenteritis Salmonellosis

Overview

Salmonella gastroenteritis is an infection of the gut caused by a germ called Salmonella. It is one of the many types of 'food poisoning'. The germ gets into your body through food or water, or from your hands or surfaces that have touched animal poo. Once inside, it irritates the lining of your bowel, which causes diarrhoea, tummy cramps and often a fever. Most healthy people get better on their own within about a week, but the infection can be more serious for babies, older people and anyone whose body finds it harder to fight infections.

Yes, it is common. Salmonella is one of the most frequent causes of food poisoning worldwide, and health services in many countries see cases every week. Many mild cases are never reported because people recover at home without seeing a doctor.

Anyone can get it, but it is most common in young children, and it can be more serious in babies and children under 5, adults over 65, pregnant women, people with a weakened immune system (the body's germ-fighting system), and people taking medicines that reduce stomach acid.

Symptoms

Common symptoms

• Watery diarrhoea, which may come on suddenly and happen many times a day
• Stomach cramps and pain, often coming in waves
• Feeling sick (nausea) and sometimes being sick (vomiting)
• A high temperature (fever), often with chills or shivering
• Headache and aching muscles
• Feeling tired and washed out
• Sometimes blood or mucus in the poo, which needs a doctor's check

Symptoms in children

• More vomiting than adults, which makes dehydration come on faster
• Fewer wet nappies, or not needing the toilet as often
• Dry mouth and lips, no tears when crying, or sunken eyes
• Being unusually sleepy, floppy or hard to wake
• Being irritable or restless, or crying more than usual
• A sunken soft spot on the head in babies
• Refusing feeds or drinks

Symptoms in older adults

• Dehydration can build up quickly and cause confusion or dizziness
• Feeling weak, unsteady on your feet, or more prone to falls
• Existing heart, kidney or diabetes problems becoming harder to manage
• Less obvious symptoms such as just feeling 'not right' or very tired
• A lower than usual temperature instead of a fever

Causes

Main causes

• Eating food that is not cooked properly, especially chicken, turkey, eggs, pork or minced meat
• Cross-contamination (germs spreading between foods), for example using the same knife or board for raw chicken and then for salad
• Raw or unpasteurised milk and dairy products, and untreated water
• Unwashed fruit and vegetables, or salad that has been handled without hand washing
• Touching animals or their poo, especially reptiles, chicks, ducks, farm animals and pets, and then not washing your hands
• Passing the germ from person to person when hands are not washed well, particularly when changing nappies or caring for someone who is ill

Risk factors

• Being a baby or a young child
• Being over 65
• Having a weakened immune system, for example from some illnesses or treatments
• Taking medicines that reduce stomach acid, which normally helps kill germs
• Having recently taken antibiotics, which can change the germs in your gut
• Eating out, travelling abroad, or eating raw or lightly cooked animal foods
• Living in crowded settings such as shared housing or residential care

When to see a doctor

See a doctor urgently if:

• You have blood in your poo
• You show signs of dehydration and cannot keep fluids down
• You have a very high fever, or one that lasts more than a few days
• You have severe or worsening tummy pain
• Your baby is under 6 months old, or a baby or child looks floppy, drowsy or is not drinking
• You are pregnant, over 65, or have a weakened immune system and you have these symptoms
• You have recently been in hospital or been treated with antibiotics

Book a routine appointment if:

• The diarrhoea has not settled after about 7 days
• Symptoms keep coming back, or you have had several bouts recently
• You want advice about what to eat and drink while you recover
• You need a fit note (sick note) for work, or advice about when it is safe to return to work, school or childcare

Diagnosis

In most cases your doctor can tell it is a tummy infection from your symptoms and what you have recently eaten or been in contact with. A test is often not needed. If your symptoms are severe, are lasting a long time, contain blood, or if you are in a higher-risk group, your doctor may ask for a poo sample to find out which germ is causing it. This helps make sure you get the right advice and helps public health teams spot outbreaks.

Tests that may be done

• A stool (poo) sample sent to a laboratory to look for Salmonella and other germs
• Blood tests if you are very unwell or your doctor thinks the infection may have spread
• A urine test or other tests in some cases, depending on your symptoms
• Your doctor may also ask about recent travel, meals eaten out, and contact with animals

What to expect at your appointment

If you are asked for a poo sample, you will be given a small pot and simple instructions, and you can do this at home. Results usually take a few days. While you wait, you should keep drinking fluids and wash your hands carefully. In most cases you will not need to go to hospital, and your doctor will discuss the results with you and whether anyone else in your household needs to be checked.

Treatment

Treatment mostly means helping your body recover while it clears the infection. That means replacing the fluid and salts you lose through diarrhoea and vomiting, and resting. In healthy adults and children, antibiotics (medicines that kill bacteria) are usually not needed and are only considered in certain situations, because they do not usually make the illness shorter and can cause side effects. Your doctor will decide what is right for you.

Self-care at home

• Drink small sips of fluid often throughout the day — water is fine, and oral rehydration drinks from a pharmacy can help replace salts
• Keep feeding babies and children as normal; continue breastfeeding, and offer extra fluids
• Eat when you feel able — simple, plain foods are easiest, and there is no need to avoid food completely
• Rest as much as you can; tiredness is normal for a few days
• Wash your hands with soap and water after using the toilet and before preparing food
• Do not share towels, cutlery, cups or food while you are unwell
• Stay off work, school or childcare until 48 hours after your last episode of diarrhoea or vomiting, and away from swimming pools and hospitals during that time
• Ask your pharmacist before using any over-the-counter anti-diarrhoea medicine, as some are not suitable for certain people or for this type of infection

Medical treatments

Most people do not need medical treatment beyond fluids. If you become dehydrated, your doctor may recommend oral rehydration solution, and in more severe cases fluid can be given through a drip in hospital. Antibiotics are only used in selected situations, such as severe illness, certain high-risk groups, or when the infection has spread beyond the gut — your doctor will weigh this up carefully. Medicines to stop diarrhoea are generally avoided unless a doctor advises them, because slowing the bowel can sometimes make things worse.

When is surgery considered?

Surgery is very rarely needed. In a small number of serious cases, the infection can cause a tear or a collection of pus in the bowel, which may need an operation. If you develop severe, worsening tummy pain with a hard or tender belly, seek urgent medical help.

Living with this condition

The first few days are about resting, sipping fluids and staying close to a toilet. It is normal to feel wiped out and to have less appetite. Most people start to feel better within a week. Keep your hands clean, avoid preparing food for other people while you are unwell, and give yourself permission to take it slowly. If you care for someone else, watch them for signs of dehydration and offer drinks often.

Lifestyle tips

• Build hand washing into your daily routine — after the toilet, after nappy changes, before cooking and before eating
• Clean kitchen surfaces, knives and chopping boards with hot soapy water after preparing raw meat
• Keep raw meat away from cooked and ready-to-eat foods in the fridge
• Wash your hands after touching pets, farm animals and reptiles
• Wait until you have been symptom-free for 48 hours before returning to work, school or childcare
• Avoid swimming pools until 2 weeks after your last symptom, as the germ can spread in water

Diet and exercise

There is no special diet that cures Salmonella, and you do not need to starve yourself. Eat small amounts of plain, familiar food when you feel hungry — for example toast, rice, pasta, soups, bananas or crackers. Avoid very fatty, spicy or rich meals until you feel better, and be careful with alcohol and caffeine, which can make dehydration worse. Take gentle exercise such as short walks once you feel up to it, but wait until you have been symptom-free for a couple of days before going back to intense exercise, and build up slowly.

Mental health and emotional wellbeing

Tummy infections can be surprisingly draining. Being up in the night, feeling unwell and worrying about passing the infection to others can leave you anxious or low. Some people also feel embarrassed about diarrhoea or worried about returning to work. These feelings usually ease as you recover. If low mood, worry or sleep problems last more than a few weeks or start to affect daily life, talk to your doctor. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis support service in your country straight away — you deserve support and you do not have to manage alone.

Prevention

Yes, you can greatly lower your risk. Good hand washing, cooking meat and eggs thoroughly, keeping raw foods separate, chilling food properly and avoiding unpasteurised dairy and untreated water all make a real difference. If you are unwell, staying away from work, school or childcare until 48 hours after your last symptom also helps protect others.

Vaccines

There is currently no routine vaccine for people to prevent Salmonella gastroenteritis. Vaccines are not part of standard care, so prevention relies on food safety and hand hygiene.

Screening programmes

There is no routine screening test for Salmonella. Testing is only done when someone has symptoms and their doctor thinks a test would help.

Complications

If left untreated

• Dehydration (losing too much fluid), which is the most common complication and can be serious in babies and older adults
• The infection spreading from the gut into the bloodstream, which is rare but serious and needs hospital treatment
• Reactive arthritis (joint pain and swelling that appears weeks after the infection) in a small number of people
• Irritable bowel symptoms, such as loose stools or tummy discomfort, for a while after recovery
• Rarely, long-lasting tiredness or ongoing gut problems

Long-term outlook

The outlook is very good for most people. With rest and fluids, the majority feel much better within 4 to 7 days and return to normal life within a couple of weeks. Some people have loose stools or feel tired for a little longer, and this usually settles. If you are in a higher-risk group, or if your symptoms are severe or not improving, your doctor can offer extra support — and seeking help early is a sensible step, not a sign of weakness.

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