From Gut to Bone

Anastassiades discusses nontyphoidal Salmonella infections, which cause the greatest percentage of hospitalizations and deaths due to foodborne pathogens. Salmonellosis can present with acute cholecystitis and may cause vertebral osteomyelitis. The presence of salmonella and other atypical organisms in the urine should never be treated in isolation, particularly in the context of other worrisome clinical features. Instead, it should be regarded as spillage of organisms into the urine and should always prompt an investigation for bacteremia, other deep tissue involvement, and the primary seeding source. Infectious or neoplastic processes must be considered in patients with low back pain and progressive neurological symptoms and signs, especially when initial therapy for simple discopathy has failed.