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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Salmonella enteritidis</span> is considered the leading cause of foodborne illness by toxicoinfection in children in developed countries&#46; It usually causes mild and self-limiting disease&#46; However&#44; it may lead to complications and in rare cases to extraintestinal organ involvement&#46; In adults&#44; pancreatitis has been described as a potential complication of <span class="elsevierStyleItalic">Salmonella</span> infection&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a series of cases of acute pancreatitis in the context of infection by <span class="elsevierStyleItalic">Salmonella enteritidis</span> that occurred in the summer months of 2015&#46; This is the first published case series on this complication in the paediatric population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The series consists of four clinical cases of salmonellosis in children admitted to a tertiary care hospital due to moderate to severe dehydration&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the clinical features of the cases&#46; <span class="elsevierStyleItalic">Salmonella enteritidis</span> was isolated from stool cultures in all four cases&#46; There was evidence of pathological elevation of pancreatic enzymes in all patients&#44; but only three experienced an acute exacerbation of abdominal pain in the epigastric region that was poorly controlled with intravenous &#40;IV&#41; analgesia &#40;paracetamol and metamizole&#41; accompanied by oral feeding intolerance&#46; These three patients received antibiotic therapy with third-generation cephalosporins or ampicillin&#44; and pain management with IV meperidine and bowel rest&#46; The patient that had elevated pancreatic enzyme levels but had not experienced a worsening of symptoms or changes in abdominal pain was treated with IV fluids and did not receive antibiotics&#44; and oral feeding was reintroduced early on after IV rehydration&#46; None of the patients developed bacteraemia or any other severe extraintestinal complications&#44; except for prerenal acute kidney injury that resolved after improving hydration&#46; All patients had good outcomes&#44; with resolution of the gastrointestinal illness and a progressive decrease of pancreatic enzyme levels&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the current literature&#44; the diagnostic criteria for acute pancreatitis are clinical manifestations &#40;mainly epigastric pain and vomiting&#41; and laboratory abnormalities &#40;amylase and lipase levels at least 3-fold the normal value&#44; with a predictive positive value of 94&#37;&#41; compatible with the disease&#44; as pancreatic abnormalities were not detected by ultrasound imaging in most of the described cases&#46; Three of the patients in our series underwent an ultrasound examination&#44; which detected inflammation of the pancreatic parenchyma in only one&#46; The prognosis is good with appropriate antibiotic treatment and bowel rest&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although pancreatitis is a very rare complication of salmonellosis&#44; some studies have analysed the potential causal relationship between the two diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Some authors have described an increased risk of developing pancreatitis in association with right-sided colitis&#44; which could be considered a predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the most recent published studies &#40;in the last 15 years&#41; on this rare complication&#44; although only one case was described in the paediatric age group&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This disease may be underdiagnosed in everyday clinical practice&#44; since its symptoms &#40;abdominal pain and vomiting&#41; may overlap with those characteristic of enteritis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The studies currently available propose ruling out this complication in cases with worsening epigastric pain that cannot be explained by enteritis and elevated pancreatic enzyme levels&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Whether pancreatitis is part of the same gastrointestinal inflammatory process or should be considered an extraintestinal complication is currently under discussion&#46; Different experimental animal models<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> have demonstrated the association between gastroenteritis due to <span class="elsevierStyleItalic">Salmonella</span> and acute pancreatitis&#44; and the potential dissemination of the bacterium to the liver and spleen&#46; It is uncertain whether this is a true extraintestinal complication<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> or rather a nonspecific inflammation of no clinical relevance<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> in response to the underlying enteritis&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> which poses the dilemma of whether it should be treated or not&#46; The indications for antibiotic therapy in cases of salmonellosis in children include bacteraemia&#44; invasive extraintestinal forms of disease or the presence of risk factors &#40;infants aged less than 3 months&#44; asplenia&#44; neoplasias&#44; immunodeficiencies&#44; haemoglobinopathies or inflammatory intestinal diseases&#41;&#46; Under any other circumstances&#44; antibiotherapy is not recommended because it would prolong bacterial shedding and convalescent carriage&#46; In our series&#44; antibiotics were only prescribed to patients that met the clinical and laboratory criteria for acute pancreatitis&#44; fulfilling the definition of extraintestinal involvement established in current recommendations&#44; consistent with those of the authors in the literature review&#46; While we found no references in the literature describing an association of specific <span class="elsevierStyleItalic">Salmonella enteritidis</span> serotypes with pancreatitis&#44; serotype D9 was isolated in 75&#37; of the cases in this series&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Further research is needed to determine the true incidence of pancreatic involvement in children with salmonellosis and allow the individualised management of the disease&#46; 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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time elapsed since onset of AGE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of consumption of contaminated food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>Chicken&#47;mayonnaise&#47;omelette&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>Chicken&#47;mayonnaise&#47;omelette&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>Chicken&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>Omelette&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prerenal acute kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prerenal acute kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prerenal acute kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ions at admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 129<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 2&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 129<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 2&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 127<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 3&#46;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 129<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 2&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other laboratory abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metabolic acidosis<br>Hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hyperglycaemia<br>Hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mild hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Changes in abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No changes in abdominal pain &#40;periumbilical&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; nauseas&#44; vomiting&#44; abdominal distension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; nausea&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tachycardia&#44; hypotension&#44; fever&#44; dyspnoea&#44; shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperamylasaemia and day of admission&#46; Evolution of amylase levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">323<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 12&#46;<br><elsevierMultimedia ident="201610270016518701"></elsevierMultimedia><br>Peak&#58; day 9&#44; 446<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518702"></elsevierMultimedia><br>Peak&#58; day 5&#44; 123<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518703"></elsevierMultimedia><br>Peak&#58; day 5&#44; 169<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 2&#46;<br><elsevierMultimedia ident="201610270016518704"></elsevierMultimedia><br>Peak&#58; day 6&#44; 521<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperlipasaemia and day of admission&#46; Evolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">617<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 4&#46;<br><elsevierMultimedia ident="201610270016518705"></elsevierMultimedia><br>Peak&#58; day 9&#44; 570<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">207<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518706"></elsevierMultimedia><br>Peak&#58; day 5&#44; 207<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 2&#46;<br><elsevierMultimedia ident="201610270016518707"></elsevierMultimedia><br>Peak&#58; day 6&#44; 699<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammation of pancreatic parenchyma<br>Free intraperitoneal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal<br>Diffuse bowel wall thickening&#46; Free intraperitoneal fluid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; ciprofloxacin resistant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span><br>C7&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV cefotaxime&#44; 5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV ampicillin&#44; 7 days<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>oral amoxicillin&#44; 3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV cefotaxime&#44; 5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ABT&#44; antibiotherapy&#59; AGE&#44; acute gastroenteritis&#59; <span class="elsevierStyleItalic">N</span>&#44; sample size&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design&#46; <span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Objective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conclusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ABT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tossiti et al&#46; &#40;2001&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>507 adults with acute gastroenteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determine the incidence of hyperamylasaemia in AGE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Incidence of hyperamylasaemia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;2&#37;<br>&#8226; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#58; microorganism most frequently associated with hyperamylasaemia &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Significant enzyme level elevation<br>&#8226; Pancreatitis not diagnosed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moreno Cuerda et al&#46; &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical case<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;adolescent aged 16 years with AGE due to <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Case description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Elevated pancreatic enzyme levels with symptoms and sonographic signs consistent with pancreatitis in a patient with AGE due to <span class="elsevierStyleItalic">S&#46; enteritidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Case of pancreatitis secondary to salmonellosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pezzilli et al&#46; &#40;2003&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60 adults<br>&#8226; 30 cases of salmonellosis &#40;25&#58; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#44; 5&#58; <span class="elsevierStyleItalic">S&#46; typhimurium</span>&#41;<br>&#8226; 30 healthy controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determine the prevalence of hyperamylasaemia&#47;pancreatitis in adults with salmonellosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Prevalence of hyperamylasaemia &#40;6&#46;7&#37;&#41;<br>Increase not significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;2&#41;<br>&#8226; Prevalence of hyperlipasaemia &#40;16&#46;7&#37;&#41;<br>Significant increase &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>&#8226; No clinical or imaging correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Significant increase in lipase levels during the course of salmonellosis&#44; with no clinical impact&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Choung et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Descriptive<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1069 adults diagnosed with acute enteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Assess the prevalence and clinical significance of elevated pancreatic enzyme levels during acute enteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Prevalence of elevated enzyme levels&#58; 2&#46;99&#37;<br>&#8226; Higher prevalence in cases with positive blood cultures<br>&#8226; Microorganism most frequently associated with elevated enzyme levels during enteritis&#58; <span class="elsevierStyleItalic">Salmonella</span> spp&#46;&#44; specially <span class="elsevierStyleItalic">S&#46; typhimurium</span> &#40;amylase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#59; lipase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;<br>&#8226; Increased prevalence of elevated enzymes in cases with right-side colitis &#40;amylase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#44; lipase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; The increase in levels of pancreatic enzymes in the course of enteritis was associated with right-sided colitis&#44; symptom severity and positive blood cultures&#44; and <span class="elsevierStyleItalic">Salmonella</span> was the microorganism isolated most frequently&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Del Giorno et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical trial<br>&#40;animal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Demonstrate the impact of <span class="elsevierStyleItalic">Salmonella</span> infection on the pancreas in vivo and in vitro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Colonisation of the pancreas by <span class="elsevierStyleItalic">S&#46; typhimurium</span> both in vivo and in vitro<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; The model demonstrated that <span class="elsevierStyleItalic">Salmonella</span> can cause pancreatic inflammation secondary to the enteric disease<br>&#8226; Persistent pancreatic infection carries an increased risk of future ductal adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mofredj et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Case series<br>&#40;adults&#41;<br>6 cases of pancreatitis due to <span class="elsevierStyleItalic">Salmonella</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Description of cases&#58; clinical manifestations&#44; abnormal laboratory results&#44; abnormal imaging&#44; treatment&#44; isolated serotype&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; 6 cases of pancreatitis secondary to enteritis due to <span class="elsevierStyleItalic">Salmonella</span>&#46; Serotypes&#58; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#47;<span class="elsevierStyleItalic">typhimurium</span>&#47;<span class="elsevierStyleItalic">typhi</span>&#47;<span class="elsevierStyleItalic">paratyphi</span><br>&#8226; Found abnormal laboratory results in association with clinical manifestations suggestive of pancreatitis<br>&#8226; Normal ultrasound in 4&#47;6 cases&#46; Abnormal CT in 5&#47;6 cases&#46;<br>&#8226; Good outcomes following antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Cases of pancreatitis secondary to enteritis due to <span class="elsevierStyleItalic">Salmonella</span>&#44; diagnosed based on clinical manifestations&#44; laboratory tests and imaging&#44; with good outcomes following antibiotic treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ceftriaxone&#47;<br>levofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Scientific Letter
Acute pancreatitis as a complication of Salmonella gastroenteritis, an unusual combination
Pancreatitis aguda como complicación de gastroenteritis por Salmonella, una asociación poco habitual
Jimena Pérez-Moreno
Corresponding author
, Lucía Carrascón González-Pinto, Felipe González Martínez, Blanca Toledo del Castillo, Rosa Rodríguez Fernández
Sección Pediatría Hospitalizados, Hospital Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Salmonella enteritidis</span> is considered the leading cause of foodborne illness by toxicoinfection in children in developed countries&#46; It usually causes mild and self-limiting disease&#46; However&#44; it may lead to complications and in rare cases to extraintestinal organ involvement&#46; In adults&#44; pancreatitis has been described as a potential complication of <span class="elsevierStyleItalic">Salmonella</span> infection&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a series of cases of acute pancreatitis in the context of infection by <span class="elsevierStyleItalic">Salmonella enteritidis</span> that occurred in the summer months of 2015&#46; This is the first published case series on this complication in the paediatric population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The series consists of four clinical cases of salmonellosis in children admitted to a tertiary care hospital due to moderate to severe dehydration&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the clinical features of the cases&#46; <span class="elsevierStyleItalic">Salmonella enteritidis</span> was isolated from stool cultures in all four cases&#46; There was evidence of pathological elevation of pancreatic enzymes in all patients&#44; but only three experienced an acute exacerbation of abdominal pain in the epigastric region that was poorly controlled with intravenous &#40;IV&#41; analgesia &#40;paracetamol and metamizole&#41; accompanied by oral feeding intolerance&#46; These three patients received antibiotic therapy with third-generation cephalosporins or ampicillin&#44; and pain management with IV meperidine and bowel rest&#46; The patient that had elevated pancreatic enzyme levels but had not experienced a worsening of symptoms or changes in abdominal pain was treated with IV fluids and did not receive antibiotics&#44; and oral feeding was reintroduced early on after IV rehydration&#46; None of the patients developed bacteraemia or any other severe extraintestinal complications&#44; except for prerenal acute kidney injury that resolved after improving hydration&#46; All patients had good outcomes&#44; with resolution of the gastrointestinal illness and a progressive decrease of pancreatic enzyme levels&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the current literature&#44; the diagnostic criteria for acute pancreatitis are clinical manifestations &#40;mainly epigastric pain and vomiting&#41; and laboratory abnormalities &#40;amylase and lipase levels at least 3-fold the normal value&#44; with a predictive positive value of 94&#37;&#41; compatible with the disease&#44; as pancreatic abnormalities were not detected by ultrasound imaging in most of the described cases&#46; Three of the patients in our series underwent an ultrasound examination&#44; which detected inflammation of the pancreatic parenchyma in only one&#46; The prognosis is good with appropriate antibiotic treatment and bowel rest&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although pancreatitis is a very rare complication of salmonellosis&#44; some studies have analysed the potential causal relationship between the two diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Some authors have described an increased risk of developing pancreatitis in association with right-sided colitis&#44; which could be considered a predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the most recent published studies &#40;in the last 15 years&#41; on this rare complication&#44; although only one case was described in the paediatric age group&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This disease may be underdiagnosed in everyday clinical practice&#44; since its symptoms &#40;abdominal pain and vomiting&#41; may overlap with those characteristic of enteritis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The studies currently available propose ruling out this complication in cases with worsening epigastric pain that cannot be explained by enteritis and elevated pancreatic enzyme levels&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Whether pancreatitis is part of the same gastrointestinal inflammatory process or should be considered an extraintestinal complication is currently under discussion&#46; Different experimental animal models<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> have demonstrated the association between gastroenteritis due to <span class="elsevierStyleItalic">Salmonella</span> and acute pancreatitis&#44; and the potential dissemination of the bacterium to the liver and spleen&#46; It is uncertain whether this is a true extraintestinal complication<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> or rather a nonspecific inflammation of no clinical relevance<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> in response to the underlying enteritis&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> which poses the dilemma of whether it should be treated or not&#46; The indications for antibiotic therapy in cases of salmonellosis in children include bacteraemia&#44; invasive extraintestinal forms of disease or the presence of risk factors &#40;infants aged less than 3 months&#44; asplenia&#44; neoplasias&#44; immunodeficiencies&#44; haemoglobinopathies or inflammatory intestinal diseases&#41;&#46; Under any other circumstances&#44; antibiotherapy is not recommended because it would prolong bacterial shedding and convalescent carriage&#46; In our series&#44; antibiotics were only prescribed to patients that met the clinical and laboratory criteria for acute pancreatitis&#44; fulfilling the definition of extraintestinal involvement established in current recommendations&#44; consistent with those of the authors in the literature review&#46; While we found no references in the literature describing an association of specific <span class="elsevierStyleItalic">Salmonella enteritidis</span> serotypes with pancreatitis&#44; serotype D9 was isolated in 75&#37; of the cases in this series&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Further research is needed to determine the true incidence of pancreatic involvement in children with salmonellosis and allow the individualised management of the disease&#46; A potential pancreatic complication should be suspected in patients that develop vomiting associated with an acute epigastric pain that cannot be accounted for by the existing enteritis&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prerenal acute kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prerenal acute kidney failure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 129<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 2&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 127<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 3&#46;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Na&#43; 129<span class="elsevierStyleHsp" style=""></span>mmol&#47;L<br>K&#43; 2&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other laboratory abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metabolic acidosis<br>Hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hyperglycaemia<br>Hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mild hypoalbuminaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Changes in abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No changes in abdominal pain &#40;periumbilical&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epigastric&#44; non-radiating pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; nauseas&#44; vomiting&#44; abdominal distension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anorexia&#44; nausea&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tachycardia&#44; hypotension&#44; fever&#44; dyspnoea&#44; shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperamylasaemia and day of admission&#46; Evolution of amylase levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">323<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 12&#46;<br><elsevierMultimedia ident="201610270016518701"></elsevierMultimedia><br>Peak&#58; day 9&#44; 446<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518702"></elsevierMultimedia><br>Peak&#58; day 5&#44; 123<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518703"></elsevierMultimedia><br>Peak&#58; day 5&#44; 169<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 2&#46;<br><elsevierMultimedia ident="201610270016518704"></elsevierMultimedia><br>Peak&#58; day 6&#44; 521<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperlipasaemia and day of admission&#46; Evolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">617<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 4&#46;<br><elsevierMultimedia ident="201610270016518705"></elsevierMultimedia><br>Peak&#58; day 9&#44; 570<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">207<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 5&#46;<br><elsevierMultimedia ident="201610270016518706"></elsevierMultimedia><br>Peak&#58; day 5&#44; 207<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228<span class="elsevierStyleHsp" style=""></span>U&#47;L on day 2&#46;<br><elsevierMultimedia ident="201610270016518707"></elsevierMultimedia><br>Peak&#58; day 6&#44; 699<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammation of pancreatic parenchyma<br>Free intraperitoneal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal<br>Diffuse bowel wall thickening&#46; Free intraperitoneal fluid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span> D9&#44; ciprofloxacin resistant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Salmonella enteritidis</span><br>C7&#44; sensitive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV cefotaxime&#44; 5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV ampicillin&#44; 7 days<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>oral amoxicillin&#44; 3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IV cefotaxime&#44; 5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ABT&#44; antibiotherapy&#59; AGE&#44; acute gastroenteritis&#59; <span class="elsevierStyleItalic">N</span>&#44; sample size&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study design&#46; <span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Objective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Conclusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ABT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tossiti et al&#46; &#40;2001&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>507 adults with acute gastroenteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determine the incidence of hyperamylasaemia in AGE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Incidence of hyperamylasaemia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;2&#37;<br>&#8226; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#58; microorganism most frequently associated with hyperamylasaemia &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Significant enzyme level elevation<br>&#8226; Pancreatitis not diagnosed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moreno Cuerda et al&#46; &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical case<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;adolescent aged 16 years with AGE due to <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Case description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Elevated pancreatic enzyme levels with symptoms and sonographic signs consistent with pancreatitis in a patient with AGE due to <span class="elsevierStyleItalic">S&#46; enteritidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Case of pancreatitis secondary to salmonellosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pezzilli et al&#46; &#40;2003&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospective<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60 adults<br>&#8226; 30 cases of salmonellosis &#40;25&#58; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#44; 5&#58; <span class="elsevierStyleItalic">S&#46; typhimurium</span>&#41;<br>&#8226; 30 healthy controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determine the prevalence of hyperamylasaemia&#47;pancreatitis in adults with salmonellosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Prevalence of hyperamylasaemia &#40;6&#46;7&#37;&#41;<br>Increase not significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;2&#41;<br>&#8226; Prevalence of hyperlipasaemia &#40;16&#46;7&#37;&#41;<br>Significant increase &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>&#8226; No clinical or imaging correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Significant increase in lipase levels during the course of salmonellosis&#44; with no clinical impact&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Choung et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Descriptive<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1069 adults diagnosed with acute enteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Assess the prevalence and clinical significance of elevated pancreatic enzyme levels during acute enteritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Prevalence of elevated enzyme levels&#58; 2&#46;99&#37;<br>&#8226; Higher prevalence in cases with positive blood cultures<br>&#8226; Microorganism most frequently associated with elevated enzyme levels during enteritis&#58; <span class="elsevierStyleItalic">Salmonella</span> spp&#46;&#44; specially <span class="elsevierStyleItalic">S&#46; typhimurium</span> &#40;amylase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#59; lipase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&#41;<br>&#8226; Increased prevalence of elevated enzymes in cases with right-side colitis &#40;amylase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#44; lipase <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;029&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; The increase in levels of pancreatic enzymes in the course of enteritis was associated with right-sided colitis&#44; symptom severity and positive blood cultures&#44; and <span class="elsevierStyleItalic">Salmonella</span> was the microorganism isolated most frequently&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Del Giorno et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical trial<br>&#40;animal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Demonstrate the impact of <span class="elsevierStyleItalic">Salmonella</span> infection on the pancreas in vivo and in vitro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Colonisation of the pancreas by <span class="elsevierStyleItalic">S&#46; typhimurium</span> both in vivo and in vitro<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; The model demonstrated that <span class="elsevierStyleItalic">Salmonella</span> can cause pancreatic inflammation secondary to the enteric disease<br>&#8226; Persistent pancreatic infection carries an increased risk of future ductal adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mofredj et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Case series<br>&#40;adults&#41;<br>6 cases of pancreatitis due to <span class="elsevierStyleItalic">Salmonella</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Description of cases&#58; clinical manifestations&#44; abnormal laboratory results&#44; abnormal imaging&#44; treatment&#44; isolated serotype&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; 6 cases of pancreatitis secondary to enteritis due to <span class="elsevierStyleItalic">Salmonella</span>&#46; Serotypes&#58; <span class="elsevierStyleItalic">S&#46; enteritidis</span>&#47;<span class="elsevierStyleItalic">typhimurium</span>&#47;<span class="elsevierStyleItalic">typhi</span>&#47;<span class="elsevierStyleItalic">paratyphi</span><br>&#8226; Found abnormal laboratory results in association with clinical manifestations suggestive of pancreatitis<br>&#8226; Normal ultrasound in 4&#47;6 cases&#46; Abnormal CT in 5&#47;6 cases&#46;<br>&#8226; Good outcomes following antibiotic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226; Cases of pancreatitis secondary to enteritis due to <span class="elsevierStyleItalic">Salmonella</span>&#44; diagnosed based on clinical manifestations&#44; laboratory tests and imaging&#44; with good outcomes following antibiotic treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ceftriaxone&#47;<br>levofloxacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 23412879
Original language: English
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