Diversity among human non-typhoidal salmonellae isolates from Zimbabwe

Paglietti, Bianca; Falchi, Giovanni; Mason, Peter R.; Chitsatso, Owen; Nair, Satheesh; Gwanzura, Lovemore; Uzzau, Sergio; Cappuccinelli, Piero; Wain, John; Rubino, Salvatore

doi:10.1093/trstmh/trt046

Cited by 15 publications

(19 citation statements)

References 16 publications

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“…Salmonella enterica serovars Typhimurium and Enteritidis account for 65.2% and 33.1% of all invasive NTS infections, respectively [25], and similar observations have been made regarding the frequency with which these serovars occur in NTS meningitis [2]. In the past 30 years, the emergence of invasive Salmonella Typhimurium ST313, a sequence type associated with the African AIDS epidemic, has been highlighted [27, 28]. …”

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confidence: 77%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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Background The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. Methods From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. Results Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0–118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2–12 months (OR, 4.8; 95% CI, 1.1–21.1; P = .039). Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5–17.2; P < .001). Conclusions NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.

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mentioning

confidence: 77%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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“…However, asymptomatic carriage of nontyphoidal Salmonella appears to be relatively common (134,138). The contribution to asymptomatic carriage or diarrheal disease in Africa of Salmonella serovar Typhimurium ST313 is still unclear, although the diversity of nontyphoidal Salmonella strains from enteric samples is likely to be wide (139). Host risk and protective factors.…”

Section: Nontyphoidal Salmonellamentioning

confidence: 99%

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

et al. 2015

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SUMMARY Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica , initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.

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Section: Invasive Non-typhoidal Salmonella (Ints) Diseasementioning

confidence: 99%

“…NTS were not a common cause of moderate – severe diarrheal disease in the recent GEMS study in multiple African sites [29]. In contrast, asymptomatic carriage of NTS appears to be relatively common [4,29]. The contribution in Africa of S. Typhimurium ST313 or other invasive pathovars of NTS, to diarrhoeal illness or asymptomatic carriage is also still unclear, although there appears to be considerable diversity among NTS strains from enteric samples in Africa [30].…”

Section: Invasive Non-typhoidal Salmonella (Ints) Diseasementioning

confidence: 99%

Antimicrobial resistance and management of invasive Salmonella disease

Kariuki¹,

Gordon²,

Feasey³

et al. 2015

Vaccine

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Invasive Salmonella infections (typhoidal and non-typhoidal) cause a huge burden of illness estimated at nearly 3.4 million cases and over 600,000 deaths annually especially in resource-limited settings. Invasive non-typhoidal Salmonella (iNTS) infections are particularly important in immunosuppressed populations especially in sub-Saharan Africa, causing a mortality of 20–30% in vulnerable children below 5 years of age. In these settings, where routine surveillance for antimicrobial resistance is rare or non-existent, reports of 50–75% multidrug resistance (MDR) in NTS are common, including strains of NTS also resistant to flouroquinolones and 3rd generation cephalosporins. Typhoid (enteric) fever caused by Salmonella Typhi and Salmonella Paratyphi A remains a major public health problem in many parts of Asia and Africa. Currently over a third of isolates in many endemic areas are MDR, and diminished susceptibility or resistance to fluoroquinolones, the drugs of choice for MDR cases over the last decade is an increasing problem. The situation is particularly worrying in resource-limited settings where the few remaining effective antimicrobials are either unavailable or altogether too expensive to be afforded by either the general public or by public health services. Although the prudent use of effective antimicrobials, improved hygiene and sanitation and the discovery of new antimicrobial agents may offer hope for the management of invasive salmonella infections, it is essential to consider other interventions including the wider use of WHO recommended typhoid vaccines and the acceleration of trials for novel iNTS vaccines. The main objective of this review is to describe existing data on the prevalence and epidemiology of antimicrobial resistant invasive Salmonella infections and how this affects the management of these infections, especially in endemic developing countries.

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Diversity among human non-typhoidal salmonellae isolates from Zimbabwe

Cited by 15 publications

References 16 publications

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections

Antimicrobial resistance and management of invasive Salmonella disease

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