Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo

Abstract

Salmonella enterica is the leading cause of bloodstream infection in children in sub-Saharan Africa, but few data are available from Central-Africa. We documented during the period November 2011 to May 2012 an epidemic increase in invasive Salmonella bloodstream infections in HGR Bwamanda, a referral hospital in Equateur Province, DR Congo. Salmonella spp. represented 90.4 % (103 out of 114) of clinically significant blood culture isolates and comprised Salmonella Typhimurium (54.4 %, 56 out of 103), Salmonella Enteritidis (28.2 %, 29 out of 103) and Salmonella Typhi (17.5 %, 18 out of 103), with Salmonella Enteritidis accounting for most of the increase. Most (82 out of 103, 79.6 %) isolates were obtained from children < 5 years old. Median ages of patients infected with Salmonella Typhimurium and Salmonella Enteritidis were 14 months (14 days to 64 years) and 19 months (3 months to 8 years) respectively. Clinical presentation was non-specific; the in-hospital case fatality rate was 11.1 %. More than two thirds (69.7 %, 53 out of 76) of children < 5 years for whom laboratory data were available had Plasmodium falciparum infection. Most (83/85, 97.6 %) non-typhoid Salmonella isolates as well as 6/18 (33.3 %) Salmonella Typhi isolates were multidrug resistant (i.e. resistant to the first-line oral antibiotics amoxicillin, trimethoprim-sulfamethoxazole and chloramphenicol), one (1.0 %) Salmonella Typhimurium had decreased ciprofloxacin susceptibility owing to a point mutation in the gyrA gene (Gly81Cys). Multilocus variable-number tandem-repeat (MLVA) analysis of the Salmonella Enteritidis isolates revealed closely related patterns comprising three major and four minor profiles, with differences limited to one out of five loci. These data show an epidemic increase in clonally related multidrug-resistant Salmonella bloodstream infection in children in DR Congo.

A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal Salmonella (iNTS) Disease in Africa (1966 to 2014)

“…and ranged from 0% in individuals greater than or equal to 5 years old in Kenya [75] to 72.7% in another Kenyan study involving only HIV-infected patients [81]. The average CFR, derived from 8 studies [3,67,89,93,152,160,172,188] conducted among low risk populations (not HIV-infected, anaemic, malnourished, or having malaria), and with >90 iNTS cases isolated, is 19% (276 fatalities from 1427 cases).…”

An Appraisal of the Clinical Features of Pediatric Enteric Fever: Systematic Review and Meta-analysis of the Age-Stratified Disease Occurrence

“…Nevertheless, it is becoming increasingly evident that preschool children are also substantially affected, with a surveillance site in Bangladesh reporting an 8.9 times higher likelihood of preschool children acquiring enteric fever than older children and adults [34]. It should, however, be borne in mind that this discrepancy in disease burden may be due to the implementation of school-based vaccination programs in some areas, which is reflected in the lower disease burden among school-aged children in some reports [2].…”

Antimicrobial resistance in urinary isolates from inpatients and outpatients at a tertiary care hospital in South-Kivu Province (Democratic Republic of Congo)

“…Unfortunately, there are no data on rates of antibiotic resistance of uropathogens in DRC. In that respect, recent data on Salmonella isolates from blood cultures in DRC have shown high levels of antibiotic resistance [32-34]. …”