If your baby has lost his appetite, he has become apathetic, he is capricious a lot, there are problems with bowel movements and pale skin, be sure to consult with doctor. It is possible that the baby caught an intestinal infection.

Based on statistical data, intestinal infections are a very common occurrence in infants after ARVI. Today we will talk about salmonellosis.

What is the causative agent of the disease?

The causative agent of the disease is Salmonella bacteria, which enter the child’s body through the mouth and then penetrate the stomach. When these bacteria enter the body of an adult, in most cases they are killed by gastric juice. However, in children, especially if they have weakened organism, pathogens are sent to the small intestine, where they begin to multiply. After this, they spread through the blood. When these bacteria die, they produce a toxin, causing the body to become deprived of fluids and salts.

How does the disease progress?

The development of the disease occurs gradually. Each stage salmonellosis has its own characteristics. In most cases, the child becomes indifferent to everything, he stops playing with his favorite toys, and sounds provoke anxiety. He loses his appetite and refuses food. The body temperature in the first few days of the disease remains normal, but the toddler may feel nauseated and visit the toilet about 5-6 times a day. Over time, the child becomes worse: the body temperature increases, diarrhea occurs, the stool becomes green in color and has a watery consistency.

Quantity bowel movements increases up to 10 times a day, and mucus and blood may be observed in the stool. It is very important to ensure that the child’s oral mucous membranes do not dry out. If he is constantly thirsty, this is a sign of dehydration, which occurs as a result of the fact that vomiting and diarrhea leave the body with a large amount of fluid, as well as salts. In infants, especially those with a weakened body, the disease can last for several weeks, and in some cases, months.

In addition, in children with a weak immune system, this disease can develop into a severe form, which is accompanied by quite serious complications. Under any circumstances, after salmonellosis, a child may complain of pain in the intestines and may experience digestive problems. And in children who are susceptible to allergies, allergies to this or that food may worsen. In addition, bloating, regurgitation will occur, and unstable stools will persist for a long time.

At the first signs illness, call a doctor immediately.

How to prevent the occurrence of the disease?

Disease prevention is carried out by special services that control the quality of products supplied to stores and markets. However, we all know that some products do not pass this test. For this reason, parents must take action themselves appropriate measures which will help prevent the development of the disease. First of all, it is necessary to provide the child with a correct lifestyle, as well as strengthen his body with the help of vitamin complexes.

In addition to this, there are several rules, compliance with which will protect your baby from salmonellosis:

1. Products must be purchased only in trusted stores. Under no circumstances buy meat and eggs at markets.

2. If you doubt the quality of the product, you can ask the seller to show you documents, which confirm its safety and compliance with regulations.

3. Do not give your baby raw or soft-boiled eggs. It is also necessary to ensure that the child does not drink raw water or unboiled milk.

4. Store only good foods in the refrigerator, which should be sorted by purpose.

5. Don't forget about hygiene rules. Clean your home as often as possible, using disinfectants.

6. If there are pets in the house, keep them clean and healthy.

7. Be sure to make sure that everything care items the child's care was clean. Don't forget to sterilize your baby's nipples, pacifiers, and bottles. Before you pick up your baby, feed him or change his diaper, wash your hands with soap and water.

Especially in summer, when bacteria find themselves in a favorable atmosphere of heat and humidity. Therefore, parents should clearly know what to do and how to assess the child’s condition if such a nuisance occurs.

Causes of infection

The causative agent of the disease is the Salmonella bacterium, which affects not only people, but also animals that themselves do not get sick, but are its carriers.

The peculiarity of Salmonella is its high resistance to low temperatures, environmental influences and most antibiotics. But they quickly die when boiled or exposed to disinfectants.

The routes of transmission of infection are as follows:

1. When eating animal products that are not sufficiently thermally processed.
2. Through unwashed hands with which the child handled food.
3. Infants become infected through their parents' dirty hands or care items due to poor hygiene.
4. When drinking raw water from wells, springs and other sources.

Salmonellosis can also be transmitted to a child during childbirth if the expectant mother is a carrier of the bacteria.

Types and signs

Localized form

The localized or gastrointestinal form can be represented by the following options:

• Gastroenteritis;
• Gastroenterocolitic;
• Gastric.

The disease begins, manifested by symptoms characteristic of all intestinal infections - an increase in temperature to 39°C and signs of general intoxication - weakness, headache.

Gastroenteric variant

With this variant of the disease, in addition to the general symptoms, there are:

• cramping pain throughout the abdomen;
• loose, thick, foamy stools with mucus or blood.

Dehydration of 1-3 degrees of severity is also possible.

Gastroenterocolitic

The colitic form of the disease is characterized by:

• diffuse abdominal pain;
• stool with pus, mucus, blood.

Sharp spasms and pain in the sigmoid colon are not detected.

Gastric

The gastric form manifests itself in the same way as all bacterial food poisonings, but the nature of the stool remains virtually unchanged. Recovery occurs in most cases within 2-3 days.

Generalized form

This form occurs in severe cases of the disease, usually in young children and the elderly due to insufficient immunity. It can occur in a typhus-like variant, or in the form of sepsis.

Typhoid-like

The onset of the disease is manifested by a rise in temperature, vomiting, diarrhea, but then characteristic signs of typhoid status appear:

• bradycardia;
• hepatosplenomegaly;
• fever in the form of rises and falls in temperature.

Septic

This option is more typical for infants and newborns. Characteristic features:

• fever with chills;
• hepatosplenomegaly;
• development of pneumonia;
• purulent rash all over the body.

Infants may experience convulsions and tremors of the limbs.

Bacteria-secreting variety

Sometimes, despite adequate medical therapy, a child may remain a bacteria excretor. Therefore, preschool children with signs of carriage remain at home until they are completely free of salmonella.

Older children can attend school after the clinical manifestations of the disease have ceased.

Symptoms of salmonellosis in children

In children, the symptoms of body intoxication prevail over the manifestations of intestinal disorder.

They may appear as follows:

• the child is restless;
• burps frequently;
• there is bloating and rumbling in the abdomen;
• fever.

If a child has loose stools and stops urinating, urinates less often, or produces less urine, then such symptoms should be a reason for parents to immediately call an ambulance.

Consequences

An advanced infection, if not treated in time, can have very adverse consequences for the child, even death. These could be:

Diagnostics

The following methods are used for diagnosis:

• clinical examination, history taking;
• general blood test;
• antibody serology;
• bacteriological examination of vomit and feces;
• analysis for dysbacteriosis;
• coprogram.

Treatment

With a mild form of the disease, the child can be treated at home. The most dangerous symptoms that require hospitalization are:

• frequent uncontrollable vomiting;
• when it is not possible to replenish fluid;
• the temperature is very high and is not reduced by antipyretics.

First aid depends on the age of the child. If this is a small child under one year old, then it is difficult to provide help at home, so it is better to call an ambulance right away.

Medicines

Antibiotics are prescribed for severe generalized forms of the disease. In the normal course of the disease, the following are prescribed:

• to eliminate dehydration - Oralit, Regidron;
• enzymatic preparations - Festal, Enzistal;
• enterosorbents – Smecta, Polysorb;
• bacteriophages.

In case of prolonged carriage of bacteria, immunomodulating therapy using probiotics and bacteriophages is prescribed.

What can and cannot be eaten by a child?

During treatment, it is necessary to exclude foods that lax the intestines from the child’s diet:

All food must be well absorbed and digested, so it is better to wipe food for a child.

How long is the treatment?

The duration of treatment depends on the severity of the disease and can last from 3 to 5 days. In some cases, treatment is delayed up to 7 days.

With timely treatment, the outcome of the disease is quite favorable. Immunity lasts a little less than a year.

Prevention

Prevention measures are as follows:

1. Food for a child should not be heated - it should only be fresh.
2. Dishes made from raw eggs (cream, soufflé, eggnog) are unacceptable, especially for small children.
3. Meat should be cooked for at least 1.5 hours, eggs for at least 15 minutes.

It is not necessary to wash the entire apartment with bleach, but children's toys that a child can put in his mouth should be washed several times a day with detergent. It is advisable to provide a sick child with separate dishes, towels and personal hygiene items.

A video from Dr. Komarovsky’s school will tell you why salmonellosis is dangerous for children:

Symptoms and treatment of salmonellosis in children

The children's body is most susceptible to various infections and negative factors. This is due to the immune system, which has weak resistance and protection. An unpleasant infectious disease such as salmonellosis often occurs in childhood. And this is not surprising. Children often play on the street, pick up stray animals, put dirty toys in their mouths, all this leads to various infectious diseases, including salmonellosis. But if treatment for this disease is not started in time, serious consequences can arise. Therefore, you need to know the main signs of salmonellosis in children, which will help you quickly determine the presence of this disease and carry out timely treatment.

What is salmonellosis

Salmonellosis in children is one of the most severe and common intestinal infections, which causes dehydration and weakening of the entire body. The main source of infection is Salmonella bacteria.

Salmonellosis often appears in children under one year of age. Children at this age are 5-6 times more likely to be affected by this disease. The main outbreaks of the disease occur in summer and autumn, when it is hot outside.

Factors of occurrence and routes of infection

Salmonellosis can develop not only in the human body, but the disease is also often found in domestic animals. There are about 700 types of pathogens that can cause this disease in humans. These bacteria are quite resistant to the environment, but they can die at elevated temperatures. Active development of bacteria occurs in eggs, meat and dairy products, and butter. Harmful substances released by bacteria have a destructive effect on the intestinal mucosa and also increase the secretion of fluids and salts.

How is salmonellosis transmitted? What ways of contracting this infection exist? Newborns and older children can become infected from pets; in rare situations, infection can occur from adults.

The main sources of infection are identified:

• Food type. The pathogen enters the child’s gastrointestinal tract during consumption of contaminated food. This usually occurs due to undercooked food. Infection can also occur through drinking untreated water.
• Contact and household. This route of infection usually occurs in infants. Infection can occur through the unclean hands of medical staff or parents, through toys, pacifiers, various care products, and also through inhalation of dust particles.
• Transplacental. This type of infection involves infection of a pregnant or lactating woman and, as a result, an unborn child. Pathogens can enter the fetus in utero or through mother's breast milk.

The greatest sensitivity to salmonellosis is in children aged 3 months to 2-3 years. The main localization of the pathogen is the rectal area. During their reproduction, bacteria enter the bloodstream and lymph flow.

General symptoms of salmonellosis

Salmonellosis in a child can manifest itself as a group of infections that have different signs of manifestation and severity. It all depends on the form of the disease.

There are usually two forms of salmonellosis:

1. Typical form. Divided into subtypes of infection - gastrointestinal, septic, typhoid;
2. Atypical form. Subtypes of infection: erased, subclinical, bacterial carriage.

The incubation period for salmonellosis in children can last from 2 hours to a week. The incubation period depends on the level of damage, the form of the disease and the number of bacteria that have entered the body.

The following symptoms are typical for any form of the disease:

1. Acute onset.
2. State of fever.
3. Frequent stools, which are accompanied by a foul odor.
4. Dehydration. Typically, this condition causes dry mucous membranes and skin.

If this lesion occurs in an infant, the newborn may experience abdominal pain due to indigestion. Malfunction of the gastrointestinal tract of infants occurs due to general intoxication. In this case, body temperature may be within acceptable limits. Children experience slow weight gain, they become restless, there may be constant regurgitation, and the fontanelle may become sunken due to dehydration.

Symptoms depending on the form of the disease

Symptoms of salmonellosis in children may vary. Typically, the signs of this infectious lesion depend on the type and extent of the lesion. Each type of form of this pathology occurs differently and may have certain characteristic features.

Gastrointestinal toxic infection

In most cases, gastrointestinal salmonellosis occurs in infants and children under 1 year of age. With this type of pathology, damage to the internal organs of the digestive system occurs. Manifests itself in the form of gastritis, enterocolitis, gastroenteritis.

The first signs of this type of lesion may be as follows:

• an increase in body temperature up to several degrees or it may become subfebrile;
• the occurrence of vomiting;
• pain in the abdomen;
• There may be copious loose stools, which may contain particles of undigested food. The structure of the stool has a greenish tint, accompanied by a sour odor;
• bloating;
• state of dehydration due to frequent vomiting and diarrhea.

In addition, Salmonella E. coli causes general intoxication and rapid heartbeat in children. Sometimes cramps and cold sweat may occur. A state of asthenia and low blood pressure may persist for a long time after the acute symptoms have completely disappeared.

Typhoid-like type

With this type of disease, a child from one to 3 years of age may experience fever and gloom. This condition may appear within 14 days. Seizures may come and go.

Signs accompanying this condition:

1. Loose stools with a watery structure, which can occur 3-5 times a day.
2. Attacks of vomiting.
3. Flatulence.
4. Intoxication with malaise, weakness and headaches.
5. Dryness appears in the mouth, and thickening of the tongue may also occur.
6. Hemorrhagic rashes appear on the skin.
7. The liver enlarges.

Septic form

This form is quite rare; salmonellosis in infants usually occurs in the septic form.

What symptoms accompany the septic form?

• Increase in body temperature to 40 degrees and above.
• Vomiting and diarrhea, loose stools may contain mucus and blood clots.
• Damage to the brain and its membranes.
• Fever and excessive sweating often occur;
• Increased heart rate.

After complete recovery, children can shed infection bacteria for a month. If such carriage is observed for more than three months, then the consequences of salmonellosis in children become chronic.

What complications can there be?

Is salmonellosis dangerous? The main danger of this disease is that pathogenic organisms can spread throughout the body and cause the formation of local foci of infectious lesions on internal organs. This disease causes a decrease in the immune system; in addition, with this disease there is an exacerbation of chronic pathologies and the accumulation of new ones.

So why is salmonellosis dangerous? The following complications may occur with this disease:

1. Edema of the brain and lungs.
2. Kidney failure.
3. Peritonitis.
4. Arthritis in reactive form.
5. Abscess of internal organs.

Diagnostic features

At the first symptoms of salmonellosis in a child, it is recommended to show him to an infectious disease specialist or gastroenterologist. It is important that diagnosis is carried out as early as possible, this will help to identify the disease in a timely manner and provide the necessary treatment.

In order to make a diagnosis, the doctor conducts the following types of examinations:

• Stool analysis, which determines the presence of dysbacteriosis.
• General blood test.
• Culture of vomit.
• Coprogram.
• RNGA - examination of the reaction of indirect hemagglutination of blood.

Treatment

Once salmonellosis is diagnosed in a child, treatment should begin. Curing salmonellosis in a child is not easy, but necessary, since this disease can cause serious consequences or become chronic.

It is important that treatment therapy for each patient is carried out individually, because this disease occurs differently in everyone and has some distinctive features depending on the form of the disease. In addition, many types of pathogens have increased resistance to antibiotics, so they are prescribed only in exceptional cases. The main treatment should be aimed at proper and healthy nutrition, as well as eliminating dehydration. If mild signs of infection are observed, treatment can be done at home. If there are complications, then hospitalization of the patient with subsequent treatment in a hospital is indicated.

How to treat a child with nutrition? Children 2-3 years old and younger should be fed only natural foods. From the first days of the disease, it is recommended to follow the diet of table No. 4. The food must be pureed and cooked.

Authorized products include the following:

1. Boiled oatmeal or rice. They should be cooked in water.
2. Boiled fish.
3. Steamed cutlets.
4. Fruit-based jelly.
5. Meatballs.
6. Cottage cheese.
7. Hard cheese with 0% fat content.

It is prohibited to consume animal fats, milk, and coarse fiber.

The diet should be followed for 30 days. The diet should be expanded gradually; it is allowed to add some foods. After a month, you can switch to your usual diet, but provided that all signs of infection have completely disappeared.

How to detoxify

A person sick with salmonellosis should be given first aid - gastric lavage. This procedure will alleviate the condition and also remove toxic elements from the body that have a poisonous effect. Self-rinsing can be done for children over 3 years of age.

Features of home cleansing:

1. To clean, you will need a 2% sodium bicarbonate solution or water (2-3 liters).
2. The cleansing liquid should be warm, its temperature should be about 20 degrees Celsius.
3. Next, you need to give the child a glass of water so that he drinks it.
4. You can induce vomiting by pressing on the root of the tongue.
5. Rinsing is carried out until the water is completely clear.

How to correct dehydration

After gastric lavage, oral rehydration is performed. For the rehydration procedure, drinking solutions are prepared; the following preparations can be used:

Features of the use of these solutions:

1. It is usually recommended to give the child half or a whole teaspoon of the solution every 5 minutes.
2. During a mild form of the disease, you need to take about a ml of solution per 1 kilogram of weight per day.
3. In severe cases, it is recommended to take 70 ml per 1 kilogram of weight.
4. Replenishment of water-salt reserves is carried out within 2-3 days until all symptoms of intoxication completely disappear.

If salmonellosis is accompanied by frequent vomiting, which makes it impossible to drink these solutions, then in these cases rehydration is carried out intravenously. Glucose is used for intravenous administration.

Drug treatment

If the infection is severe, and if increased sensitivity of Salmonella to drugs is detected, then antibiotics for salmonellosis in children are the priority choice of therapy. Antibiotics of different groups are prescribed:

• penicillins - amoxiclav, ampicillin, flemoxin, etc.;
• cephalosporins – cefix, ceftriaxone;
• aminoglycosides – netilmicin;
• carbapenems – meropenem.

Additionally, the doctor may prescribe the use of enterosorbents - smecta, atoxil, polysorb.

Since antibiotics can cause various digestive disorders, prebiotics must be prescribed to normalize the state of the intestinal microflora. The most effective peribotics include Duphalac, Linex, and Bificol.

The treatment should be entrusted to the attending physician, who will select the optimal medications, including during the recovery period, and will also prescribe free medications for children.

Further observation

After the full course of treatment, the patient’s condition must be monitored for three months. Every month it is necessary to carry out bacterial culture. If a negative result for salmonella is detected, the child is removed from the register.

It is necessary to check people who have been in contact with the patient and monitor them for 7 days. A bacteriological analysis of stool is taken from people who have been in contact with the patient. If the results are negative, then the person is considered healthy.

How to treat at home

Treatment of salmonellosis in children at home is carried out only in cases where the disease is mild. But it is still recommended to consult a doctor first. How to treat salmonellosis at home? In addition to antibiotics and medications, you can use folk remedies at home.

An effective remedy is a tincture based on chamomile flowers, which is prepared according to the following scheme:

1. You need to pour 50 grams of dried chamomile flowers into the pan.
2. Pour a glass of hot water over chamomile.
3. Place on the fire, boil and boil for 5 minutes.
4. Then everything is infused for 4 hours.
5. After this, the broth is filtered.

The finished tincture should be given to the child 100 ml several times a day.

Prevention

Prevention of salmonellosis in children will help avoid the occurrence of this disease:

• All food must be thoroughly cooked during cooking, especially animal products.
• If there is a carrier of infection in the house, then separate hygiene products and utensils should be allocated for him.
• Under no circumstances should you allow your child to put dirty toys or objects from the floor into his mouth.
• All toys should be washed with soap.
• You should not swim in dirty waters.
• It is necessary to limit children's contact with poultry - chickens, ducks, geese.

If you follow all the recommendations, you can avoid contracting this infection. It is worth considering that salmonellosis is a dangerous infectious disease that can cause serious complications in children, so it is important to start treating this disease as early as possible.

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For medical assistance, we strongly recommend that you consult a doctor.

Salmonellosis in children: causes, symptoms, treatment and dangers of salmonella infection

Salmonellosis in children is a disease of the digestive system, the development of which is associated with infection of the body by Salmonella bacteria. The pathology occurs acutely with severe intoxication and dehydration. Cases of visiting a doctor with salmonellosis become more frequent during the warmer months of the year. They are explained by eating food that has expired. The most sensitive patients are children under 2 years of age.

Why does salmonellosis develop?

For salmonellosis to develop in the body, certain conditions must exist. These are:

• the child's tendency to allergies;
• frequent morbidity;
• weak immunity at an early age;
• damage to the gastrointestinal tract by microbes supplied with poor-quality food.

The causes of the disease are Salmonella - gram-negative, motile microbes that are resistant to various physicochemical factors. The strains tolerate frost and drought well and are preserved in dust and feces. They exist for a long time in soil and water bodies and take root in meat and dairy products.

Animals, waterfowl and sick people become sources of infection for a child. The pathogen is transmitted in several ways.

1. Airborne dust – when inhaling contaminated dust.
2. Food, if the baby consumes milk, meat or eggs without proper heat treatment or raw water.
3. Contact and household. This type of infection often develops in infants when parents or medical staff care for them with unwashed hands. Germs can be on pacifiers, toys, and other items.
4. Transplacental. Infection of a child occurs in utero if a pregnant woman suffers from salmonellosis.

Clinical features of salmonellosis

Symptoms of salmonellosis in children do not immediately become pronounced. The incubation period is influenced by many factors, so parents may notice a significant deterioration in the baby’s health only after 3 days from the moment of infection. What signs the disease will manifest depends on the general condition of the child, his age and the stage of salmonellosis.

• Newborns. In the first month of life, there is no obvious evidence of gastrointestinal damage, temperature indicators remain normal. Mothers note that the baby refuses to eat and loses weight. The skin turns pale, the tummy swells, and belching comes out of the mouth. The baby is constantly worried.
• Infants. Early symptoms of salmonellosis infection in children under one year of age include vomiting and increased bowel movements up to 7 p.m. per day, poor appetite and a jump in temperature to high levels. If left untreated, diarrhea gets worse and causes dehydration.
• Preschoolers and older children. Salmonellosis develops acutely with a sharp increase in body temperature (38 – 38.5°C), abdominal pain, repeated vomiting and diarrhea. Children complain of decreased appetite and general weakness. Delayed or inadequate therapy leads to dehydration, acute renal failure and toxic shock.

The famous pediatrician Komarovsky draws the attention of parents to the external manifestations of salmonellosis. The condition of children deteriorates sharply; the body reacts to microbes with severe intoxication. If you suspect that your baby has become a victim of salmonella, immediately go to the clinic or call an ambulance.

Methods for diagnosing salmonellosis

The primary diagnosis after a general examination is acute intestinal infection. The final verdict is made by an infectious disease specialist or gastroenterologist based on the results of blood and urine tests and bacteriological culture of stool. The tasks of diagnostic measures include isolating the pathogen, determining its type and examining all persons in contact with the child.

An incorrect diagnosis and neglected condition of the child can lead to quite serious complications:

1. reactive arthritis;
2. convulsive syndrome;
3. renal failure;
4. infectious-toxic shock;
5. swelling of the lungs or brain.

How to treat children with salmonellosis

Drug treatment of salmonellosis in children is prescribed strictly individually and without the use of traditional methods. For moderate to severe illness, the patient is admitted to a hospital. In mild forms of salmonellosis, therapy is carried out at home.

In case of food infection, treatment begins with gastric lavage. A solution of sodium bicarbonate helps to partially remove toxins from the body and eliminate intoxication. A 2% concentrate of the substance is diluted with 2–3 liters of water at a temperature of 18–20°C. Hemosorption, or blood purification, is carried out using the drugs Sorbilact, Reosorbilact, Reopoliglyukin.

The state of dehydration is eliminated by using rehydration solutions:

The child is given solutions at the rate of 40–70 ml of product per kilogram of body weight. In case of severe intoxication without dehydration, the dose is reduced to 30–40 ml.

The use of antibiotics to treat children from salmonellosis is resorted to only in severe cases. First, the sensitivity of the detected salmonella is determined. Based on the data obtained, a suitable drug is selected. Usually this is a group of cephalosporins that stop repeated vomiting. Among intestinal antiseptics, small patients are prescribed Enterofuril or Ersefuril.

Salmonella carriers and older children are prescribed:

1. probiotics;
2. immune lactoglobulins;
3. bacteriophages are specific anti-Salmonella agents.

In case of salmonellosis, baby food should be gentle, protecting the intestinal mucosa from strong mechanical and chemical effects. The following should be completely excluded from the diet:

• whole milk;
• vegetables with coarse fiber;
• animal fats;
• marinades, spices, smoked meats, seasonings.

The following will be useful for a child affected by salmonella:

• cottage cheese;
• low-fat cheese;
• boiled fish;
• fruit jelly;
• steam cutlets and meatballs;
• oat and rice porridges with water and vegetable broths.

The diet must be followed for 4 weeks from the onset of the disease.

1. Remember that the consequences of salmonellosis undermine the immune system, attracting secondary infection or exacerbation of chronic pathologies. Salmonella remaining in the intestines spread throughout the body and form local foci of inflammation. A child who has recovered from the disease may subsequently suffer from sore throat, otitis media or pneumonia for a long time.
2. Observe personal hygiene rules and do not violate food preparation techniques. Subject animal products to high temperature processing. Do not give your child raw eggs, and wash the shells thoroughly before preparing omelettes and scrambled eggs.
3. To prevent salmonella infection, store meat in the freezer. Have a separate cutting board for cutting up game and chickens.

If you consult a doctor in a timely manner, the prognosis for treatment of salmonellosis is favorable. Therapy takes place within 5–10 days, but immunity against salmonella is not developed. Therefore, the child may get sick again.

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Salmonellosis is an infectious disease that is deadly for children. Without specific symptoms and manifestations, it can be confused with many other infections. Therefore, knowledge of the routes of transmission and clinical manifestations will help to suspect this infection in time and prevent the development of complications.

What is salmonellosis

Salmonellosis is an infectious disease that can occur either with severe symptoms of the disease or be asymptomatic (if carrier). The causative agent of this disease is the bacterium Salmonella.

Salmonella is a rod that has a flagellum (organelle of movement), with the help of which it moves. It is well preserved in the environment; oxygen is not necessary for its life. It can survive and reproduce in water and frozen meat for about six months, in sausages for up to 4 months, in milk for up to three weeks, in cheese for up to a year, in soil for a year and a half.

By multiplying in food (milk, meat), salmonella does not change the taste of the product. Smoking or salting does not have a detrimental effect on microorganisms, but freezing, on the contrary, increases their life expectancy.

Salmonella is a bacterium with flagella for movement

Once in a child’s body, salmonella attacks the intestinal wall, forming breeding sites in it. Endotoxins released by the pathogen cause fluid to leak out of the intestinal cells, causing diarrhea.

Loss of fluid leads to dehydration of the body, decreased blood pressure, which is dangerous due to hypovolemic shock and death of the patient. In addition, bacterial toxins enter the blood, leading to infectious-toxic shock (fever, weakness, loss of consciousness, infection).

Video by Dr. Komarovsky about the disease

Causes

The source of infection can be animals (cattle, pigs, horses, ducks, geese, chickens) and their products (milk, eggs, meat). A person becomes infected by consuming animal products or by handling infected animal carcasses.

Also, a person who is a carrier of salmonella can become a source of infection. Then this pathogen is transmitted through household contact through household items (towels, dishes, toys), hands, furniture. This happens especially often in children's groups (schools, kindergartens) when hygiene rules are not followed, or in medical institutions for the same reasons.

Raw eggs are one of the most common foods to contain salmonella.

The incubation period of the disease through foodborne transmission ranges from 6 hours to 3 days (on average 12–24 hours). With contact and household transmission, incubation is extended to 3–8 days.

Of the group of people who come into contact with the pathogen, not everyone will suffer a severe form of the disease. This depends on several factors:

• the number of bacteria entering the human body;
• pathogenicity of the pathogen (the strength of the pathogenic properties of the bacteria that cause the disease);
• a person’s immune status (the stronger the immunity, the less likely the occurrence of severe salmonellosis);
• age of the patient (newborns and premature infants are more sensitive to the causative agent of salmonellosis).

Symptoms of the disease in children

Clinical manifestations of salmonellosis vary depending on the form of the disease.

It is important to know that bacterial carriage does not manifest itself clinically at all; it can only be detected during a laboratory examination of the patient.

The course of the disease in newborns and infants manifests itself in a severe form of gastroenteritis with rapid dehydration and convulsions. Often salmonellosis is accompanied by another infection, a mixed infection develops, in most cases with a fatal outcome.

Diagnostics

When the first symptoms of the disease appear, you should contact your pediatrician or infectious disease doctor. Salmonellosis, due to its severe complications, is best treated in a hospital. To confirm the diagnosis, the following examinations are performed:

1. Clinical blood test. Salmonellosis does not have specific manifestations in a blood test. There may be an increase in the number of leukocytes, erythrocyte sedimentation rate (ESR), neutrophilosis (a large number of neutrophil granulocytes in the blood) - all these are signs of an inflammatory reaction in the body.
2. Culture of media for the presence of Salmonella. The media can be vomit, feces, urine, blood.
3. Serological blood tests. Aimed at identifying antibodies to the pathogen.

Treatment

Mild, so-called subclinical forms of the disease can be treated at home. Symptoms of gastroenteritis or generalized forms of the disease, especially in infants, are treated only in a hospital!

Gastroenteritis

1. Gastric lavage. It is carried out to remove contaminated food, toxins and bacteria from the stomach.
2. Antibacterial drugs are ineffective for this form of salmonellosis. Antimicrobial agents that do not have a systemic effect are used (medicines such as Nifuroxazide, Enterofuril). Drugs in this group are approved for children over 1 month of age.
3. Replenishing lost fluid and restoring water-salt balance. For this purpose, they drink oral rehydration medications. These include Regidron, Oralit, Biogaia ORS, Glucosolan. In severe cases of the disease, they resort to intravenous fluid replacement with solutions such as Trisol, Neogemodez, Reosorbilact, Reopoliglyukin.
4. Drugs that adsorb toxins. Used to reduce intoxication. This group includes Smecta, Enterosgel, Sorbex, Polyphepan.

Generalized forms

It is based on the same groups of drugs as for gastroenteritis, but in combination with antibiotics aimed at destroying salmonella directly.

For the period of intestinal symptoms (vomiting, diarrhea), diet No. 4 according to Pevzner is prescribed. Foods that can chemically or physically damage the wall of the gastrointestinal tract are excluded from the diet. You should not go hungry - this can weaken the body's defenses.

You should not eat foods that increase intestinal motility:

• raw vegetables;
• fruits;
• fermented milk products;
• black bread.

Products that enhance fermentation processes are prohibited:

• marinades;
• sauerkraut;
• fatty foods;
• sweets.

Prohibited products in the photo

Raw vegetables and fruits

Rice porridge, boiled lean fish, steamed lean meats, fruit juices or jelly, low-fat cottage cheese, and hard cheese are allowed.

Sample menu for the day:

1. Breakfast - manna and yogurt.
2. Second breakfast – low-fat cottage cheese.
3. Lunch – vegetable puree soup, beef meatballs, tea.
4. Afternoon snack – steamed omelette, jelly.
5. Dinner – rice pudding, tea.

After diarrhea stops, the patient is transferred to diet No. 13. This is a diet intended for patients with any infectious disease. Food is served crushed, in the form of puree. The list of permitted foods is expanding - you can eat vegetables, fruits, eggs, butter, meat, fish.

Possible menu for the day:

1. Breakfast – semolina porridge with milk, tea.
2. Second breakfast – boiled egg, rosehip compote.
3. Lunch – pureed vegetable soup, steamed meat balls, rice porridge, compote.
4. Afternoon snack – baked apple.
5. Dinner – boiled fish, mashed potatoes, tea.

This diet should be followed for no more than two weeks.

Possible complications

Incorrect or untimely treatment of salmonellosis leads to a relapse of the disease, as well as the development of such consequences as:

Among childhood infectious diseases, salmonellosis ranks second. This is an acute intestinal pathology that requires immediate treatment. There is a high probability of ending up in a hospital bed for a long time due to untimely provision of assistance, since not all parents can quickly recognize the symptoms of salmonellosis in children. In order to distinguish the disease from the same dysentery, which occurs no less often, it is necessary to know all the signs of its manifestation and, if suspected, seek qualified help.

There are many causative agents of intestinal infections in children. Often the cause of their occurrence is a gram-negative rod - salmonella. The diseases it causes have similar signs and symptoms. Therefore, when diagnosing this intestinal infection, it is customary to indicate only the form of its manifestation. The serotype of the isolated salmonella only indicates the source of infection.

Classification of salmonellosis according to the form of manifestation that can be diagnosed in children:

• Gastrointestinal. The most common form of acute gastrointestinal disorders.
• Typhoid-like. Roseola rash, severe fever, and enlarged liver and spleen are present. Exacerbations are wavy in nature, reminiscent of typhus.
• Septic. A severe form of the disease, the development of which is typical in people with immunosuppressive syndrome and children under one year of age. The deficiency of protective functions does not allow the infection to be localized only in the intestinal area. Often, infectious agents penetrate the medulla, provoking the development of meningeal syndrome.
• Erased. A mild form in which the child exhibits mild symptoms in the form of diarrhea.
• Subclinical. It is detected only by the results of tests for salmonellosis. No symptoms appear, and the person is considered only a carrier.

The incubation period for the development of the disease can range from 6 hours to 3 days, the average duration is 24 hours. The manifestation of salmonellosis in children is usually characterized by severe intoxication.

Routes of infection

Salmonella bacteria are most often transmitted through food. The source of infection is mainly animal products that can end up in children's diets - meat, milk, eggs obtained from livestock.

There are other ways salmonella can enter a child’s body:

• The infection is secreted by sick people or its carriers and, with poor hygiene, can be transmitted to children.
• Domestic animals such as cats and dogs that eat raw, previously infected meat can also spread salmonella.
• Bacteria enter the child’s body when drinking contaminated water, which often contains waste products of infected people and animals.
• Eating plant foods accidentally contaminated with salmonella. For example, in the summer, bacteria can multiply in rotting, infected meat, and insects transfer it to fruits or vegetables.

Favorable conditions promote the growth of salmonella bacteria in food products, while their appearance and quality do not change at all. A child may consume a contaminated product without knowing it.

Children under one year of age usually receive the infection from an infected mother or another family member directly involved in care. It should not be forgotten that carriage of salmonellosis in parents is also a serious danger for the child. When dealing with a newborn, hygiene should be a top priority.

Pathogenesis and signs

The development of infection usually occurs in the small intestine. There, bacteria colonize and invade nearby tissues. In children, this process provokes the occurrence of the most common type of salmonellosis - gastrointestinal.

Less commonly, proliferative or purulent foci are formed in places of Salmonella colonization, which lead to the development of typhus-like or septic symptoms.

The manifestation of the disease in a child is characterized by a wave-like aggravating nature. This is explained by the proliferation of bacteria, the intermittent nature of new colonies and the disintegration of old ones.

Newly appeared bacilli penetrate the blood and lymph, while in the mucous membrane of the small intestine the destruction of obsolete bacteria is observed, accompanied by the release of entero- and endotoxins. This process causes the child to develop a high fever and toxic shock.

Enterotoxins lead to an increase in the intracellular concentration of bioactive substances and disruption of the transport of sodium and chlorine ions through its membrane. As a result, they accumulate in the intestinal lumen, which causes the child to develop watery diarrhea, an imbalance of water-salt balance and hypovolemic shock.

Exposure to endotoxins affects blood clotting, decreased vascular tone and thermoregulation of the patient's body. The immune response is characterized by the production of antibodies of various classes and an increase in the phagocytic activity of macrophages.

Signs of salmonellosis in children cannot be manifested by the presence of such immunoglobulins, since their appearance is mainly the result of a secondary immune response in adults. The development of more complex forms of this bacteriosis is often explained by the development of immunotolerance to the antigens of these bacteria.

Symptoms in children

The manifestations of this infectious disease in children depend on the form of its development. The incubation period ends after a maximum of six days.

Almost all types of salmonellosis are characterized by:

• An acute period, accompanied by high fever and lasting from several days to several weeks.
• Frequent stools with a strong unpleasant odor.
• Dehydration.

In young children and infants, manifestations of salmonellosis are characterized not only by intestinal disorders. Symptoms are usually pronounced and have a severe clinical picture.

Salmonellosis in young children manifests itself:

• Severe intoxication of the body.
• Regurgitation.
• Bloating.
• Decreased appetite.
• Hypothermia of the extremities.
• Hypotrophy.
• Dry skin and mucous membranes.
• Worry.

Various forms of salmonellosis are manifested by the presence of other symptoms, which vary not only depending on its varieties, the severity of infection, but also on the age category of the child.

Gastrointestinal form

This variety is common mainly among the younger age group. Young children with weak immune systems and premature infants become easy prey for salmonella.

In children over 2 years of age, the infectious disease resembles gastritis or gastroenteritis with similar symptoms:

• Hyperthermia.
• Anxiety, weakness, general malaise.
• Pain in the epigastric region.
• Flatulence, nausea, vomiting.
• Frequent loose stools with inclusions of undigested food.
• Thick white or yellowish coating on the tongue.

Lack of personal hygiene skills and a constant desire to put various objects in their mouths place children under 2 years of age at risk.

The disease in this case develops in the form of enteritis, which is characterized by the following symptoms:

• Low-grade body temperature.
• Malaise and restlessness.
• Gas formation with characteristic rumbling.
• Flatulence.
• Periodic vomiting.
• Very frequent stools of a mushy consistency with greenish mucous impurities and a strong stench.

In addition, gastrointestinal manifestations of salmonellosis in children can occur in the form of colitis. The main symptoms of this type include:

• Acute initial period with severe intoxication.
• Pain in the colon.
• Frequent loose stools mixed with blood and mucus.
• Fecal matter resembles swamp slurry with a foul odor.

The gastrointestinal form very often causes in a child a decrease in the production of secretory fluids of the digestive system and a violation of their outflow, absorption decreases, and dysbacteriosis appears.

Some children develop chronic pancreatitis. This age is characterized by reactive arthritis affecting the knee or elbow joints.

Typhoid-like form

This type of salmonellosis has similar symptoms to paratyphoid fever. Although there is no typhoid status, all the main signs of this disease in a child are usually visible on the face.

Common picture of typhoid-like salmonellosis:

• Gastrointestinal dysfunction accompanied by fever.
• Intoxication, accompanied by malaise, lethargy and anxiety.
• Normalization of intestinal functions occurs approximately on the 2nd day.
• Then a sharp hyperthermia of the body occurs.
• Deterioration in general health.
• There is apathy, lethargy, pallor, and a rash appears mainly in the abdominal area.
• On the 6th day, cardiac auscultation becomes dull, and dry wheezing appears in the lungs.
• The spleen and liver enlarge, the stomach swells.

Fever in a child with typhoid-like salmonellosis can be constant or periodic in nature and last up to 3 weeks.

Septic form

The already severe course of salmonellosis with this variety in children develops into a more dangerous variant. But it is worth noting that special conditions are required for the septic form of the disease to occur. The main one is a deficiency of immune defense. More often, the disease develops in weakened or premature children, as well as in bottle-fed infants.

Symptoms and manifestations of the septic form of salmonellosis:

• The disease begins to develop acutely, accompanied by high fever from the first days.
• Diarrhea at the initial stage can be mild or moderate.
• The child develops severe sweating and tachycardia.
• Jaundice and hepatosplenomegaly appear.
• The condition is getting worse every day, and inflammatory processes in the internal organs are developing.
• Often the pathogenesis progresses to the stage of meningitis, pneumonia, otitis, pyelonephritis, osteomyelitis.

In some children, after treatment for septic salmonellosis, bacteria are released for some time, which can be found both in feces and in sputum, urine, and cerebrospinal fluid. If after 3 months this process does not stop, the child is diagnosed with the chronic stage.

Erased and subclinical forms, bacterial carriage

These varieties have a milder course of salmonellosis. Basically, in such cases, the child’s defense system functions perfectly and is able to cope with the infection on its own.

The erased form of salmonellosis develops with the penetration of a small amount of infectious agents and occurs with minor symptoms in the form of diarrhea and mild malaise. All symptoms disappear after about 2 days, which is typical for complete recovery.

The subclinical variety of salmonellosis occurs in a latent form, and the child does not show any symptoms of the disease. The presence of infection is detected randomly, for example, during a routine medical examination. Typically, the bacteria present do not cause any harm, and the person is considered merely a carrier of the bacteria.

The danger is that in the absence of symptoms in a child, it is difficult to suspect the presence of an infection in the body, and the biological material released by the bacteria can harm a healthy person.

Identified bacterial carriage must also be treated, and people caring for such children must comply with sanitary and hygienic standards.

Types of treatment in children

The age group under 1 year falls under mandatory hospitalization and full medical supervision, regardless of what form of salmonellosis develops in the child. For older children, this infectious disease can be treated on an outpatient basis only if it is mild.

Therapy for salmonellosis of more complex forms, other than mild forms, is divided into several stages:

• Diet therapy.
• Drug treatment.
• Rehydration therapy.
• Symptomatic treatment.
• Detoxification of the body.
• Rehabilitation therapy.

Diet therapy

The development of complex and severe forms of salmonellosis provokes a malfunction of the body’s digestive system. A lack of enzymes leads to poor breakdown and digestion of food, and malabsorption leads to incomplete absorption.

To minimize irritation of the gastrointestinal tract, a ban on certain products is introduced:

• Animal foods rich in fat.
• Whole milk.
• Plant foods rich in coarse fiber.

In addition, therapy for patients with salmonellosis begins with the appointment of a special diet, namely table No. 4, where the following are used:

• Water-based porridge made from oatmeal or rice.
• Boiled or steamed fish dishes.
• Steamed cutlets.
• Boiled low-fat meatballs.
• Low-fat cottage cheese.
• Low-fat cheeses.
• Fruit jelly.

Dietary nutrition is observed for a month. It begins with a water-tea break in the first 6 hours after the onset of symptoms of salmonellosis. The child is first given water, and then light food is gradually introduced into the diet.

Drug treatment

Antibacterial therapy is typical for salmonellosis of severe and generalized forms. In these cases, children are prescribed Amikacin, Rifampicillin, Nevigramon, Levomecitin, Doxycycline. For mild forms, antibiotics are contraindicated.

One of the specific drugs for the treatment of salmonellosis in children are bacteriophages. In addition, in complex therapy of severe cases, intramuscular injections of polyoxidonium are sometimes prescribed.

Rehydration

Correction of dehydration in children diagnosed with salmonellosis is carried out in two ways - intravenous administration of special drugs or oral administration of medications.

To restore the water-salt balance, use:

• Intravenously – saline solution and glucose preparation 5%. It is used when it is not possible to give the child medicine.
• Oral – Regidron, Glucosolan, Oralit. The dosage is prescribed according to the child’s weight and degree of dehydration. On average, it is 40-70 ml per 1 kg of weight.

The solutions used are given to small children in fractional portions, 1 teaspoon every 5 minutes.

Detoxification

Cleansing the body of toxins is carried out by rinsing the stomach with clean water or sodium bicarbonate solution. The procedure is applicable for older children.

For infants, the drugs Reosorbilact, Sorbilact, Reopoliglyukin are used. They are administered by intravenous drip.

Detoxification of the body from salmonella toxins is carried out only after dehydration has been eliminated.

Recovery

With salmonellosis in children, as a rule, severe diarrhea develops, which washes away the beneficial intestinal microflora. In addition, during drug treatment, broad-spectrum drugs are used that also destroy beneficial bacteria.

To normalize the microflora in the child’s body, after treatment for salmonellosis, probiotics and prebiotics are prescribed - Bifidumbacterin, Bifikol. Restoration of digestive function is carried out by taking enzyme preparations - for children it is permissible to use Festal or Enzistal.

To improve the child's protective functions, immunomodulatory drugs are used.

Salmonella is also the cause of typhoid fever, paratyphoid A, B, C.

Salmonellosis is a fairly common disease in children, as is carriage of the pathogen itself. In terms of prevalence, it ranks second after shigellosis. Infection is most common in preschool children (65%).

Food

The food route of infection includes the consumption of unwashed vegetables and fruits that contain the infection, as well as foods that are not sufficiently thermally processed. Bacteria are stable in the external environment; low temperatures are not particularly dangerous for them. But high temperatures kill salmonella perfectly.

Salmonellosis bacteria multiply very quickly in food products - meat, milk, eggs. They are most active at the end of spring and summer, when there are problems with food preservation.

Animal

Pets are the main source of food-borne salmonellosis in children. Their feces, urine, saliva, and nasal mucus may contain large amounts of salmonella. As a result of infection from animals, both salmonellosis itself and carriage of the infection can occur.

Contact and household

Salmonellosis is also transmitted to children through simple household contact: through the unwashed hands of parents or nannies caring for children, through the common use of children's potties, toys in kindergarten.

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Symptoms

The first symptoms in children appear quite quickly after infection, since the children's immune system has not yet strengthened. It is especially difficult for children under one year old. The incubation period lasts at least several hours, maximum 3-4 days.

Typical forms

Gastrointestinal

Gastrointestinal is the most well-known form of salmonellosis in children aged one year and above. The harmful bacterium is transmitted from a source and affects different parts of the gastrointestinal tract. The reason is infection from food; The incubation period is less than a day.

Gastrointestinal salmonellosis in children manifests itself externally through the following signs or symptoms:

• pain in the epigastric region;
• vomiting with repetition;
• increase in temperature;
• weakness throughout the body;
• the presence of a thick coating on the tongue;
• bloating;
• diarrhea (with gastritis);
• loose greenish stool 3-5 times a day (large, with parts of undigested food).

Typhoid-like

Symptoms of the typhus-like form are as follows:

• confusion;
• rave;
• coating on the tongue;
• bloated stomach;
• temperature rise to 39-40 degrees;
• headache;
• vomit;
• decreased appetite;
• decline in activity;
• stunned.

Typhoid-like salmonellosis in children has additional symptoms - enlargement of the spleen, as well as the child’s liver. A rare roseola rash may also appear. Signs of an intestinal disorder may be absent, but more often the disorder appears from the very beginning of the disease.

If the baby gets sick with typhoid-like salmonellosis, a complication may be added: pneumonia or otitis media.

Septic

Septic salmonellosis occurs in newborns, infants, children under one year old, premature babies, in children on artificial nutrition and with a weak immune system. Symptoms of the septic form:

• increased temperature retention for 21 to 28 days with strong fluctuations;
• the appearance of purulent foci with the prospect of developing purulent meningitis;
• pneumonia;
• otitis;

Treatment

It is strictly forbidden to treat children yourself, especially under one year of age. After all, if the wrong treatment is chosen, salmonellosis can lead to death. To cure your child, you must show him to an infectious disease specialist or gastroenterologist. He will examine, examine him, and based on the results of laboratory tests, prescribe the necessary treatment, including proper nutrition.

To accurately make a diagnosis after establishing all the symptoms, bacteriological and serological testing is used. Feces, vomit, urine, blood are studied. It may be necessary to resort to intensive care to quickly cure the child.

Treatment includes:

• strict diet;
• taking medications (antibiotics and intestinal antiseptics).

Having identified signs of salmonellosis in children, the doctor prescribes treatment based on the child’s age, level of severity of the condition, taking into account the absence of pathological consequences.

If a child under three years of age is infected with a bacterium, he should definitely be hospitalized.

Treatment and recovery period depend on the severity of the disease. In severe cases, treatment involves bed rest for a period of about 3 weeks, in mild cases - 1-2 weeks until it gets better. When temperature and stool normalize, the diet can be slightly softened, nutrition gradually expanded to a level close to normal. The treatment itself should continue as prescribed by the doctor.

Diet

The diet during treatment should contain:

• additional drinks, fermented milk mixtures;
• porridge (wheat, buckwheat);
• vegetable puree;
• light soups.

The main thing is that the food is varied, rich in vitamins and microelements. A strict diet implies a complete absence from the diet for a long time:

• acute;
• fried;
• spicy dishes.

Vaccine

Taking medications, antibiotics or intestinal antiseptics, not only diet, can eliminate salmonellosis, its signs and symptoms. In severe cases, “heavy artillery” is used - antibiotics, in mild cases - antiseptics. Medicines are taken as prescribed by a doctor; you should also first read the manufacturer’s instructions regarding age-specific dosages. A diet will only eliminate additional stress on a weakened body.

If the baby is a carrier of the bacterium and there are no visible signs and symptoms of the pathological disease salmonellosis, then salmonellosis should be treated with bacteriophages that destroy harmful bacteria, immune lactoglobulins and various biological products that correct the intestinal microflora.

If salmonellosis is accompanied by severe toxicosis and dehydration in children, a glucose solution or saline preparations are administered through a vein. Due to vomiting and diarrhea, you should not allow more fluid to leave the body than enters. Fluid balance needs to be replenished regularly.

At home

Treatment of salmonellosis at home is acceptable if, in the opinion of the doctor, such a situation is acceptable. Children are treated for salmonellosis, in addition to the medications prescribed by the doctor, with folk remedies.

A proven method of folk treatment is as follows:

• Pour 50 grams of chamomile flowers into a glass of boiling water and boil for 5 minutes. After this, leave for four hours, strain and give the infusion to the baby 100 grams several times a day.

Consequences

The consequences of salmonellosis in schoolchildren make themselves felt by stomach and intestinal inflammation. Then a balanced diet and nutrition should be continued. If, after a course of treatment, a sample was taken for laboratory testing, the result contained signs of the presence of salmonellosis in the body, then treatment should be continued, especially if individual symptoms of the disease are clearly visible.

If the child's laboratory test for salmonellosis is negative, the special diet prescribed by the doctor must be followed for at least another 90 days.

After treatment with antibiotics, there may be consequences such as dysbiosis, contributing to constipation or weak stool.

Prevention

Prevention is needed to exclude carriage of the pathogen and prevent infection of family members with salmonellosis. To prevent children and their parents from getting sick, the necessary prevention is as follows:

• If you have pets, take them to the veterinarian regularly.
• Thoroughly wash and heat-treat food products that are planned to be used in cooking.
• Maintain high sanitary standards in the house, and be sure to teach children to do this.
• Teach your children to always wash their hands with soap, preferably household soap, after contact with animals.