Can a patient exhibit signs of salmonella poisoning (e.g., nausea, vomiting, diarrhea, and elevated WBCs) and still have a negative stool culture?
—Leslie Pryor, MSN, CRNP, Shamong, N.J.

The short answer to this question is “Yes,” as there is no test that is 100% sensitive and specific. Stool testing is no exception. The real question is: “Why is salmonella suspected?” If there is reason for strong clinical suspicion (e.g., household members with similar symptoms who have a concrete diagnosis of salmonella, community outbreak, travel to an area with a recent outbreak), it would be reasonable to consider salmonella as the causative agent. Fortunately, the majority of salmonella cases result in a mild clinical course that does not require the use of antibiotics. However, if toxicity results (i.e., severe fever, dehydration, hospitalization), treatment with oral fluoroquinolones, amoxicillin, trimethoprim-sulfamethoxazole, or IV ceftriaxone or cefotaxime should be considered. As with most antibiotics, bacterial resistance is a concern.

Even when salmonella is at the top of a patient’s differential diagnosis list, it is important to consider other causes. Appendicitis, diverticulitis, and inflammatory bowel disease should also be ruled in or out.
—Bruce D. Askey, MSN, CRNP (121-13)