Salmonella enterica serotypes may produce a syndrome characterized by prolonged fever and a positive blood culture (14). Although symptoms of gastroenteritis can precede bacteremia, they are usually lacking. In many instances the only manifestations are prolonged fever, which is usually spiking and accompanied by rigors, sweats, aching, anorexia, and weight loss. The characteristic symptoms of typhoid fever, which include rose spots, leukopenia, and sustained fever, are absent. Stool cultures are normally negative. In contrast to the constant bacteremia seen with typhoid fever, discharge of the organisms into the bloodstream is intermittent, and repeated blood cultures may be necessary to identify the causative organism. At some time during the course of the disease, localizing signs of the infection appear in about one quarter of the cases. Bacteremia caused by salmonellae can be a very puzzling disorder and should be considered in cases of fever of unknown origin.
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