Epidemiology

Salmonellas survive for long periods in the environment. Children are commonly infected by seemingly healthy pets that discharge salmonellas in their feces, such as turtles, iguanas, baby chickens, and ducks. Eggs and poultry are often contaminated with Salmonella strains. Other outbreaks have resulted from contaminated brewer's yeast, alfalfa sprouts, protein supplements, dry milk, and even a red dye used to diagnose intestinal disease. Most cases of Salmonella gastroenteritis have an animal source rather than a human source. Enteric fever strains such as Salmonella Typhi are generally the exception.

While fecal discharge of gastroenteritis-causing strains is usually of short duration, carriers of Salmonella Typhi can eliminate up to 10 billion of the bacteria per gram of their feces for years. The source of these organisms is usually the gallbladder, which Salmonella Typhi colonizes free of competition since much of the normal flora is killed or inhibited by concentrated bile. Mary Mallone, "Typhoid Mary," a young Irish cook living in New York State in the early 1900s, was a notorious carrier. She was responsible for at least 53 cases of typhoid fever over a 15-year period. In her day, about 350,000 cases of typhoid occurred in the United States each year. The low incidence of typhoid fever in the United States today can be attributed to improved sanitation and public health surveillance measures.

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