Epidemics of InvasiveSalmonella entericaSerovar Enteritidis andS. entericaSerovar Typhimurium Infection Associated with Multidrug Resistance among Adults and Children in Malawi

Abstract

These data have important implications for the treatment of severe febrile illness in adults and children in tropical Africa. Further understanding of the molecular basis of these epidemics of multidrug-resistant NTS infection, including ongoing whole-genome sequencing of multidrug-resistant isolates, will yield important tools for the study of NTS pathogenesis, transmission, epidemiology, and prevention.

Non-Typhoidal Salmonella Gastroenteritis at a Diarrheal Hospital in Dhaka, Bangladesh, 1996–2011

“…Studies from developed countries have shown that the elderly with NTS infections have higher hospitalization and mortality rates. 23,24 As opposed to reports of increasing resistance to traditional first-line agents in both Asia and Africa and increasing rates of multidrug resistance, 13 we found a marked decrease in MDR and decreasing resistance to the traditional first-line agents ampicillin, chloramphenicol, and TMP/SMX but an increasing resistance to ciprofloxacin. This result may be because of a decreasing use of non-fluoroquinolone agents in favor of fluoroquinolones for the treatment of both gastroenteritis and undefined febrile illnesses.…”

“…This seasonal peak during the summer months corresponds to reports from other Asian countries. [10][11][12] Similarly, studies in Malawi 13 and Kenya 14,15 describe peaks of NTS disease associated with the rainy season, which may reflect, in part, the seasonal pattern of malaria in those areas, unlikely to be a factor at our site, as well as flooding. Although our data suggest that rainfall-associated contamination of water may be associated with disease transmission, it is likely that both environmental and host behavioral factors play a role in the seasonal variation of NTS, as they do for other enteric infections in Bangladesh.…”

Importance of antibody and complement for oxidative burst and killing of invasive nontyphoidalSalmonellaby blood cells in Africans

“…bacteremia | bactericidal antibody | immunity | opsonic activity | vaccines I nfection with nontyphoidal strains of Salmonella (NTS), in particular Salmonella enterica serovar Typhimurium (S. Typhimurium) are a major cause of invasive bacterial disease, which typically manifest as bacteremia and meningitis, among African children (1)(2)(3). In some African countries such as Malawi, NTS is the commonest cause of bacteremia (1).…”

“…In some African countries such as Malawi, NTS is the commonest cause of bacteremia (1). Among children younger than 5 y of age in Kenya, the estimated minimum incidence of NTS bacteremia is 175 per 100,000 (2).…”

“…Case-fatality rates exceed 20% and 50% for NTS bacteremia (3) and meningitis (4), respectively. Antibiotic resistance is an increasing problem (1) and currently no vaccine is available. There are well recognized clinical associations with young age, malaria, anemia, malnutrition, and HIV infection (1)(2)(3).…”