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Salmonellosis (A) is one of the most common causes of foodborne illness in the United States. Depending on the specific species, infection can result in a variety of clinical syndromes, including gastroenteritis, septicemia, typhoid fever, and an asymptomatic carrier state. Infection usually results in stools that are watery, foul, and brownish-green often with blood. Shigellosis (B) (aka, bacillary dysentery) is highly infectious and is primarily spread by fecal-oral transmission. Patients present with high fever, crampy abdominal pain, and diarrhea that is watery and greenish-yellow. Bloody mucoid stools (dysentery) occur in approximately one-third of patients. A CBC with a leukocytosis and marked left shift (absolute band count > 800) is characteristic of shigellosis.

Shigella causes enteritis within 12 - 18 hours after ingestion of as few as 200 organisms. This clinical syndrome consists of acute onset fever and abdominal cramps which are followed by an enterotoxin-mediated acute onset of copious watery diarrhea. Within 24 - 48 hours, dysentery occurs as a result of mucosal invasion. Shigella sonnei is the most common etiologic agent of shigellosis in industrialized countries.

A stool examination reveals polymorphonuclear leukocytes.

What is the most common cause of dysentery in the United States?
Answer: Shigella sonnei.

In the United States, nontyphoidal Salmonellosis is the most common cause of foodborne disease. It is associated with consumption of milk products, poultry and eggs. Transmission can also occur from pets, specifically reptiles. Patients initially present with diarrhea and colitis. Therapy involves replacing fluids and electrolytes. Patients with severe symptoms including high fever, more than 9-10 stools per day or those requiring hospitalization should be treated with a course of antibiotic therapy. Choice of antimicrobial should be made based on antibiotic resistance patterns and can include fluoroquinolones, trimethoprim-sulfamethoxazole, amoxicillin or intravenous third-generation cephalosporins.

Which bacterial gastroenteritis is associated with febrile seizures?
Answer: Shigella

Salmonella enterica is a gram-negative bacterium that causes inflammatory diarrhea. Signs and symptoms of inflammatory diarrhea may include the presence of blood or mucus in the stool, severe abdominal pain and fever. Salmonellosis is typically associated with consumption of raw meat or poultry, but can also be associated with fresh produce such as bean sprouts, tomatoes, lettuce, and melons. The illness is self-limited and treatment generally is with fluid replacement, although antibiotics are used in certain cases (i.e. immunocompromised patients and children).