There are two Salmonella species: Salmonella enterica (S. enterica) and Salmonella bongori (S. bongori). S. bongori strains predominantly colonize cold-blooded reptiles, whereas S. enterica strains are capable of infecting both humans and mammals.[1] Based on factors such as morphology, structure, mode of reproduction, and other criteria, the two species are further classified into subgroups called serotypes or serovars. More than 2,600 serotypes have been described for Salmonella, and they are characterized by the type(s) of animal they are found in or by the clinical symptoms they cause.[2] Of these, less than 100 are responsible for most human Salmonella infections.[3]

Where Does Salmonella Come From?
Salmonellae are widely distributed in nature and are found in the intestinal tract of wild and domesticated animals and in humans. Salmonella poisoning can occur when a person ingests contaminated fecal particles transmitted by another infected human or animal.[4]
Salmonella enterica serotypes Typhi, Sendai, and Paratyphi A, B, or C are found exclusively in humans. These serotypes, collectively referred to as typhoidal Salmonella, cause enteric fever (also known as typhoid or paratyphoid fever if caused by serotypes Typhi or Paratyphi, respectively).[5] Most often, enteric fever is acquired through ingestion of food or water contaminated with human feces. Most U.S. residents who are diagnosed with typhoidal Salmonella are infected while traveling abroad in areas where typhoid fever and paratyphoid fever are common. Three types of vaccines against S. Typhi are commercially available, although there is still not a single licensed vaccine available against S. Paratyphi A.[6] Persons planning to travel outside of the United States are advised to find out if a vaccine for typhoid fever is recommended (see www.cdc.gov/travel).
Most Salmonella infections are caused by eating contaminated food. One study found that 87% of all confirmed cases of Salmonella are foodborne. Foods of animal origin, including meat, poultry, eggs, or dairy products can become contaminated with Salmonella. Eating uncooked or inadequately cooked food—or food cross contaminated with uncooked or undercooked products—can lead to human infections. As explained in a comprehensive report issued by the U.S. Department of Agriculture’s Economic Research Service:
Salmonella contamination occurs in a wide range of animal and plant products. Poultry products and eggs are frequently contaminated with S. Enteritidis, while beef products are commonly contaminated with S.Typhimurium. Other food sources of Salmonella may include raw milk or other dairy products and pork.
In the past two decades, consumption of produce, especially sprouts, tomatoes, fruits, leafy greens, nuts, and nut butters, has been associated with Salmonella illnesses.[7] The surface of fruits and vegetables may be contaminated by human or animal feces. Changes in food consumption and production, as well as the rapid growth of international trade in agricultural products, have facilitated the transmission of Salmonella associated with fresh fruits and vegetables.
In the United States, Salmonella is the second most commonly isolated bacterial pathogen when laboratory diagnosis of diarrhea is sought.[8] However, passive laboratory surveillance, which uses voluntary reporting by health care providers and facilities, captures only a fraction of illnesses that actually occur. Furthermore, only a small proportion of illnesses are confirmed by laboratory testing and reported to public health agencies. Thus, researchers rely on quantitative statistical modeling to estimate the incidence of foodborne illness. These estimates are used to direct policy and interventions. The CDC currently estimates that Salmonella causes about 1.35 million illnesses, 26,500 hospitalizations, and 420 deaths in the United States each year—making nontyphoidal Salmonella the leading bacterial cause of foodborne hospitalizations and deaths (CDC).
What are the Symptoms of Salmonellosis?
Salmonella infections can produce a broad range of disease, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms commonly include diarrhea and abdominal cramps, often accompanied by fever of 100°F to 102°F (38°C to 39°C). More serious infections may also involve bloody diarrhea, vomiting, headache, and body aches.[9]
The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours; however, there is evidence that in some situations the incubation can be longer than 10 days. People with salmonellosis usually recover without treatment within three to seven days. Nonetheless, Salmonella bacteria can persist in the intestinal tract and stool for many weeks after the resolution of symptoms—on average, one month in adults and longer in children.[10]
Treatment of Salmonellosis
S. Typhi and S. Paratyphi are capable of causing systemic illness if they invade the bloodstream (termed “bacteremia”). “Septicemia” or “sepsis” (bloodstream infection or “blood poisoning”) occurs if the bacteria multiply in the blood and cause the immune system to respond by activating inflammatory mechanisms. This may result in the development of “systemic inflammatory response syndrome,” or “SIRS.” By definition, SIRS includes tachycardia, tachypnea, fever, and abnormal white blood cell count. When the bacteria involved are S. Typhi or S. Paratyphi, this serious illness is called enteric typhoid, or paratyphoid fever. Symptoms may start gradually and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present seemingly innocuously as a non-specific fever. The incubation period for S. Typhi is usually 8 to 14 days, but it can range from three to 60 days. For S. Paratyphi infections, the incubation period is similar to that of nontyphoidal Salmonella—one to 10 days.[11]
Medical treatment is acutely important, though, if the patient becomes severely dehydrated or if the infection spreads from the intestines. Persons with severe diarrhea often require re-hydration, usually with intravenous (IV) fluids. But antibiotics are not necessary or indicated unless the infection spreads from the intestines, at which time the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, though, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals. Multidrug-resistant strains are an increasing concern: a multidrug-resistant strain of Salmonella Newport—linked to beef and to soft cheese and travel associated with Mexico—has in recent years spread to all 50 states and caused multiple outbreaks (CDC).[12]
Complications of Salmonellosis
Although most people who become ill with salmonellosis recover completely within a week, a subset of patients—particularly infants and young children, adults over 65, pregnant women, and persons with weakened immune systems—go on to develop serious or long-term complications.[13] For these vulnerable groups, what begins as acute gastroenteritis can progress to severe, and occasionally fatal, disease.
In approximately five percent of nontyphoidal Salmonella infections, the bacteria invade the bloodstream, a condition known as bacteremia. Once in the blood, Salmonella can travel to and establish focal infections at distant sites in the body, including abscesses, septic arthritis, osteomyelitis (infection of the bone), endocarditis (infection of the inner lining of the heart), and meningitis. The bacteria have a particular affinity for damaged or abnormal vascular tissue, so persons with atherosclerosis, aneurysms, or vascular grafts face a heightened risk of life-threatening infection of the blood vessels.[14]
A small number of persons develop a complication known as reactive arthritis, formerly called Reiter’s syndrome—a term that has now largely fallen into disfavor. Estimates of the proportion of Salmonella patients who develop reactive arthritis vary widely, ranging from roughly two to fifteen percent.[15] Reactive arthritis is characterized by inflammation of the joints—most often the knees, ankles, feet, and heels—and may be accompanied by irritation of the eyes (conjunctivitis or iritis) and pain during urination. It is most common in persons between 15 and 35 years of age. Although symptoms frequently resolve within months, in some patients—especially those who carry the HLA-B27 genetic marker—the condition can persist for years and develop into chronic arthritis or spondyloarthropathy.
There is also evidence that Salmonella infection increases the long-term risk of chronic digestive disorders, including post-infectious irritable bowel syndrome (IBS), gastroesophageal reflux disease, and inflammatory bowel conditions such as ulcerative colitis.[16]
Prevention of Salmonella Infection
Because food contaminated with Salmonella usually looks, smells, and tastes completely normal, prevention depends on safe food handling rather than on detecting spoilage. Public health authorities organize these practices around four basic steps: clean, separate, cook, and chill.[17]
Thorough handwashing is one of the most effective safeguards. Hands should be washed with soap and running water for at least 20 seconds before, during, and after preparing food; before eating; after using the bathroom; and after handling raw meat, poultry, seafood, or eggs. Kitchen utensils, cutting boards, and countertops should be washed with hot, soapy water after contact with raw foods, and fresh fruits and vegetables should be rinsed under running water before they are eaten or prepared.
Raw meat, poultry, seafood, and eggs should be kept separate from ready-to-eat foods throughout shopping, storage, and preparation. Using separate cutting boards and keeping the juices of raw animal products away from produce and other foods helps prevent cross-contamination, one of the most common routes of Salmonella transmission in the home.
Cooking food to a safe internal temperature reliably kills Salmonella, and the only way to verify that temperature is with a food thermometer—color and texture are not reliable indicators. Poultry (including ground chicken and turkey), stuffing, and casseroles should reach 165°F; ground meats and egg dishes should reach 160°F; and whole cuts of beef, pork, veal, and lamb should reach 145°F, followed by a three-minute rest.[18]
Salmonella multiplies rapidly at temperatures between 40°F and 140°F—the so-called “danger zone.” Refrigerators should be kept at 40°F or below, and perishable foods should never be left at room temperature for more than two hours (or one hour if the surrounding temperature exceeds 90°F). Consumers should also avoid unpasteurized (raw) milk and dairy products, raw or undercooked eggs, and raw or undercooked meat and poultry.
Finally, many healthy-appearing animals—including reptiles and amphibians such as turtles, snakes, and lizards, as well as backyard poultry—carry Salmonella in their intestinal tracts and shed the bacteria into their surroundings. Hands should always be washed after contact with these animals or their environment, and reptiles and amphibians should not be kept in households with young children or immunocompromised persons.[19] When traveling to regions with lower food and water safety standards, the CDC advises a simple rule: “Boil it, cook it, peel it, or forget it.”
[1] Hernandez, A. K. C. Salmonella bongori. Poultry and Avian Diseases. Encyclopedia of Agriculture and Food Systems. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/salmonella-bongori.
[2] Boore AL, et al. (2015). Salmonella enterica Infections in the United States and Assessment of Coefficients of Variation: A Novel Approach to Identify Epidemiologic Characteristics of Individual Serotypes, 1996–2011. PloS One. 10(12): e0145416
[3] Besser JM. (2018). Salmonella epidemiology: a whirlwind of change. Food Microbiol. 71:55-9.
[4] Chiu, C.-H. (2019). Salmonella, Non-Typhoidal Species (S. Choleraesuis, S. Enteritidis, S. Hadar, S. Typhimurium). http://www.antimicrobe.org/b258.asp.
[5] Ohad eGal-Mor, Erin C Boyle, & Guntram A. Grassl. (2014). Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ. Frontiers in Microbiology, 5. https://doi.org/10.3389/fmicb.2014.00391
[6] Id.
[7] National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2015.” Centers for Disease Control and Prevention, 6 Nov. 2018. Available at: https://www.cdc.gov/typhoid-fever/reports/annual-report-2015.html.
[8] “National Enteric Disease Surveillance: Salmonella Annual Report, 2016.” Centers for Disease Control and Prevention, 28 Feb. 2018. Available at: https://www.cdc.gov/nationalsurveillance/pdfs/2016-Salmonella-report-508.pdf.
[9] “Salmonella.” Centers for Disease Control and Prevention, 24 Jun. 2020. Available at: https://www.cdc.gov/salmonella/.
[10] Id.
[11] Miller, S. and Pegues, D. “Salmonella Species, Including Salmonella Typhi” in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Sixth Edition, Chap. 220, pp. 2636-50 (2005).
[12] Medalla, F., Gu, W., Mahon, B. E., Judd, M., Folster, J., Griffin, P. M., & Hoekstra, R. M. (2016). Estimated Incidence of Antimicrobial Drug-Resistant Nontyphoidal Salmonella Infections, United States, 2004-2012. Emerging infectious diseases, 23(1), 29–37. https://doi.org/10.3201/eid2301.160771
[13] “Symptoms of Salmonella Infection.” Centers for Disease Control and Prevention. Available at https://www.cdc.gov/salmonella/signs-symptoms/index.html.
[14] “Salmonella Infection – Symptoms & Causes.” Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329. See also Chen, P.-L., et al. (2007). Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia: predisposing factors and clinical outcome. Journal of Internal Medicine, 261, 91–100.
[15] “Clinical Overview of Salmonellosis.” Centers for Disease Control and Prevention. Available at https://www.cdc.gov/salmonella/hcp/clinical-overview/index.html. On the chronicity of reactive arthritis and its association with HLA-B27, see also “Short- and Long-term Effects of Bacterial Gastrointestinal Infections.” Emerging Infectious Diseases, 14(1) (Jan. 2008), available at https://wwwnc.cdc.gov/eid/article/14/1/07-0524_article.
[16] “Short- and Long-term Effects of Bacterial Gastrointestinal Infections.” Emerging Infectious Diseases, 14(1) (Jan. 2008). Available at https://wwwnc.cdc.gov/eid/article/14/1/07-0524_article.
[17] “Preventing Salmonella Infection.” Centers for Disease Control and Prevention. Available at https://www.cdc.gov/salmonella/prevention/index.html.
[18] “Preventing Food Poisoning.” Centers for Disease Control and Prevention. Available at https://www.cdc.gov/food-safety/prevention/index.html; see also “Safe Food Handling,” U.S. Department of Agriculture, Food Safety and Inspection Service, available at https://www.fsis.usda.gov.
[19] “Preventing Salmonella Infection.” Centers for Disease Control and Prevention. Available at https://www.cdc.gov/salmonella/prevention/index.html.

















