The expanding spectrum of disease due to salmonella: an international perspective.

Human disease due to Salmonella infections appears to be on the rise worldwide. Despite the availability of vaccines and generally effective antibiotic therapy, salmonellosis, in the forms of gastroenteritis and enteric fever, remains a major cause of morbidity and mortality in many developing countries, especially in young children and immunocompromised hosts. In certain highly endemic areas of South and Southeast Asia, the emergence of quinolone-resistant and multidrug-resistant strains of Salmonella contribute to the magnitude of the problem. In the United States and Europe, a low but consistent rate of disease appears to be primarily related to ingestion of contaminated poultry, lapses in sanitary agricultural practices, and importation of tainted vegetable products. An improved understanding of the molecular basis of bacterial resistance and improved design and expanded use of vaccines provide hope for containing the spread and reducing morbidity of the international spectrum of disease due to Salmonella pathogens.