A statewide outbreak of Salmonella in Kentucky has moved its way into the eastern part of the state (Boyd County to be exact). Nine cases of Salmonella have been confirmed in Olive Hill, Kentucky, and at least 4 of them are thought to be part of a statewide outbreak that has sickened 44 kentucky residents.
Illnesses appear to have begun around July 11. No new illnesses have been reported since July 31. According to Boyd County health officials, all of the people involved in this salmonella outbreak have recovered and are in good health. A statewide investigation is underway to try to find the source of the cases.
Everybody may in fact be in good health, but the acute gastrointestinal illness is oftentimes not the last problem associated with Salmonella infection. Two potentially chronic or permanent problems that can follow Salmonella infection are post infectious IBS and reactive arthritis.
The observation that the onset of IBS symptoms can be precipitated by gastrointestinal infection dates to the 1950s. Different studies have shown that 7-31% of individuals who have experienced an episode of infectious gastroenteritis, whether bacterial or viral, may develop symptoms of IBS.
One recent meta-analysis (a study that combines results from previously published research studies and analyzes the larger number) of 8 studies published between 1950 and 2005 found a positive association between gastrointestinal infection and the onset of IBS in 6 of the studies. In this meta-analysis alone, the average occurrence of post-infectious IBS was 9.8%, compared to 1.2% in the control group. This equates to a sevenfold increase in the odds of developing IBS after gastrointestinal infection.
There appear to be several risk factors associated with the development of post-infectious IBS, including female sex, severity and duration of the acute infectious illness, whether the person suffered from bloody stools, and psychological profile. As with non-post-infectious IBS, the precise mechanism that produces the symptoms is not specifically known. The pathogens known to precipitate post-infectious IBS symptoms include specifically, though not necessarily exclusively, Enterotoxigenic E. coli strains, Shiga toxin-producing E. coli strains (including E. coli O157:H7), Campylobacter, Shigella, and Salmonella.
Reactive Arthritis is the name used to describe an uncommon, but potentially debilitating group of symptoms that follows a gastrointestinal, genitourinary, or viral infection. The most common gastrointestinal bacteria involved are Salmonella, Campylobacter, Yersinia, Shigella, E. coli, and Vibrio. The most common genitourinary causes are sexually transmitted diseases such as Chlamydia and Gonorrhea. The most common viral causes are the common flu, HIV, and Parvovirus.
The specific triad of arthritis, conjunctivitis, and urethritis was known as Reiter’s Syndrome. In many patients, however, only one or two of these symptoms many be present, such as arthritis and urethritis or arthritis and conjunctivitis. A reactive arthritis may develop after a person eats food that has been tainted with the pathogenic bacteria. Many patients will get severe bloating, abdominal pain, and watery diarrhea. However in some patients, the initial infection may be milder and not easily recognized, but the reactive arthritis may still occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis) or several joints (oligoarthritis), preferentially affecting those of the lower extremities. The most common joints affected are the knees and ankles. The pattern of joint involvement is usually asymmetric. Inflammation can also be commonly seen at an enthesis (a place where ligaments and tendons attach to bone), especially the front of the knee or the back of the ankle where the Achilles attaches to the calcaneal bone. This is referred to as an enthesopathy. It causes local swelling and pain with walking or exercise.
Salmonella has been the most frequently studied bacterium associated with reactive arthritis.