Wilson disease + treating salmonella

[coffeesnob]

Pathoma, Robbins and RR Path contradict each other on how to diagnose Wilson disease. What that all agree on is that decreased serum ceruloplasmin is diagnostic of WD.

But they don't agree with each other on how to interpret serum copper levels. RR path says dx is supported by increased serum and urine free copper, and decreased total serum copper. But Robbins says, "serum copper levels are of no diagnosis value." Help a little here please.

Also, do you treat typhoid salmonella? In lectures, we were taught that we should not treat with antibiotics. RR path says "treat if symptomatic."

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[Apoplexy__]

It's a subtle difference:
-Serum total Cu = Useless
-Serum ceruloplasmin = Decreased
-Serum free Cu = Increased (less bound, due to lower carrier protein)
-Urine free Cu = Increased

My understanding of Salmonella:
-Treating asymptomatic infections --> Increased risk of carrier state in biliary system
-Treating Typhoid Fever = Necessary because it is a life-threatening illness

 

[mcloaf]

My understanding of Salmonella:
-Treating asymptomatic infections --> Increased risk of carrier state in biliary system
-Treating Typhoid Fever = Necessary because it is a life-threatening illness

^^^This is what I was taught as well.

 

[coffeesnob]

Coolio. Thanks! @kirbymiester and @mcloaf

 

[dyspareunia]

What we learned.

Non-typhoidal Salmonella (as in gastroenteritis) = self limiting. Don't give antibiotic.
Non-typhoidal Salmonella bacteremia = give antibiotic.
Salmonella typhi = give antibiotic.

This is all pretty fresh for me since I'm in micro right now, but I like to remember the treatment like this:

Always treat salmonella typhi just like you always treat shigella. Both salmonella typhi and shigella have human hosts only (other salmonella are zoonotic too). I'm hoping this sticks with me through step 1.

 

[coffeesnob]

Yup. According to CMMRS, it's actually UNTREATED typhoid fever that can increase the likelihood of carrier states. RR path incorrectly says treating typhoid fever with antibiotics "may increase frequency of carrier states." This necessitates a correction on RR path page 442. I don't trust RR path anymore.

 

[tantacles]

What we learned.

Non-typhoidal Salmonella (as in gastroenteritis) = self limiting. Don't give antibiotic.
Non-typhoidal Salmonella bacteremia = give antibiotic.
Salmonella typhi = give antibiotic.

This is all pretty fresh for me since I'm in micro right now, but I like to remember the treatment like this:

Always treat salmonella typhi just like you always treat shigella. Both salmonella typhi and shigella have human hosts only (other salmonella are zoonotic too). I'm hoping this sticks with me through step 1.

I want to point out in addition that giving an antibiotic to gastroenteritis caused by Salmonella may also lead to a longer course of disease. I don't know what the exact mechanism is.

My assumption is that since the antibiotic doesn't do much, it might cause more harm than good by depleting normal gut flora that could possibly help with recovery. But I have no evidence of this, and I'm too lazy to google.