Invasive<i>Salmonella</i>Infections Among Children From Rural Mozambique, 2001–2014

Mandomando, Inácio; Bassat, Quique; Sigaùque, Betuel; Massora, Sérgio; Quintó, Llorenç; Acácio, Sozinho; Nhampossa, Tacilta; Vubil, Delfino; Garrine, Marcelino; Macete, Eusébio; Aíde, Pedro; Sacoor, Charfudin; Herrera-León, Silvia; Ruiz, Joaquı́m; Tennant, Sharon M.; Menéndez, Clara; Alonso, Pedro L.

doi:10.1093/cid/civ712

Cited by 38 publications

(41 citation statements)

References 34 publications

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“…African centers reporting longitudinal surveillance (9,11,13,14,44,45) have found a decline in pediatric iNTS disease incidence (Fig. 2).…”

Section: Changing Rates Of Ints Disease Over Timementioning

confidence: 99%

“…iNTS disease in African populations primarily affects HIV-infected adults and young children. In the limited number of African studies with defined denominator populations (9)(10)(11)(12)(13)(14)(15), the median estimated incidence of iNTS disease in children is 195 cases (range 26 to 1,870) per 100,000 person-years of observation (Table 1). Among African adults, population-based surveillance data estimated the incidence of iNTS disease to be between 0 and 54 cases per 100,000 person-years of observation in 13 surveillance sites across sub-Saharan Africa (16).…”

Section: Epidemiology Of Ints Disease In Africa Burden Of Ints Diseasementioning

confidence: 99%

“…Provision of ART treatment programs in Malawi resulted in the NTS-associated case fatality rate in Malawian adults declining to 11% (20). In studies reporting case fatality rates in African children (Table 2), the median case fatality is 12% (range 3 to 24%) (9,12,13,15,21). However, adopting a consensus case fatality rate of 20% for iNTS disease, global iNTS disease-related mortality was estimated at 680,000 deaths in 2010, of which 390,000 occurred in Africa (8).…”

Section: Mortality Secondary To Ints Diseasementioning

confidence: 99%

“…Disease is predominantly seen in Figure 2 Variation in invasive nontyphoidal Salmonella disease incidence in Africa over time. Variation in iNTS disease incidence in African children at seven sites between 2008 and 2014 (9,11,13,14,44,45). Incidence per 100,000 person-years observation in children under 5 years.…”

Section: Clinical Aspects Of Ints Disease Clinical Presentationmentioning

confidence: 99%

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Invasive Nontyphoidal Salmonella Disease in Africa

Gilchrist

MacLennan²

2019

EcoSal Plus

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Nontyphoidal salmonellae (NTS) are a major cause of invasive (iNTS) disease in sub-Saharan Africa, manifesting as bacteremia and meningitis. Available epidemiological data indicate that iNTS disease is endemic in much of the region. Antimicrobial resistance is common and case fatality rates are high. There are well-characterized clinical associations with iNTS disease, including young age, HIV infection, malaria, malnutrition, anemia, and sickle cell disease. However, the clinical presentation of iNTS disease is often with fever alone, so clinical diagnosis is impossible without blood culture confirmation. No vaccine is currently available, making this a priority area for global health research. Over the past ten years, it has emerged that iNTS disease in Africa is caused by distinct pathovars of Salmonella Typhimurium, belonging to sequence type ST313, and Salmonella Enteritidis. These are characterized by genome degradation and appear to be adapting to an invasive lifestyle. Investigation of rare patients with primary immunodeficiencies has suggested a key role for interferon gamma–mediated immunity in host defense against NTS. This concept has been supported by recent population-based host genetic studies in African children. In contrast, immunoepidemiological studies from Africa indicate an important role for antibody for protective immunity, supporting the development of antibody-inducing vaccines against iNTS disease. With candidate O-antigen–based vaccines due to enter clinical trials in the near future, research efforts should focus on understanding the relative contributions of antibody and cell-mediated immunity to protection against iNTS disease in humans.

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“…African centers reporting longitudinal surveillance (9,11,13,14,44,45) have found a decline in pediatric iNTS disease incidence (Fig. 2).…”

Section: Changing Rates Of Ints Disease Over Timementioning

confidence: 99%

Section: Epidemiology Of Ints Disease In Africa Burden Of Ints Diseasementioning

confidence: 99%

Section: Mortality Secondary To Ints Diseasementioning

confidence: 99%

Section: Clinical Aspects Of Ints Disease Clinical Presentationmentioning

confidence: 99%

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Invasive Nontyphoidal Salmonella Disease in Africa

Gilchrist

MacLennan²

2019

EcoSal Plus

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“…[6] A number of studies have highlighted the high health burden of iNTS in children, frequently associated with malaria and malnutrition. [3,5] Much work has also focused on microbiological aspects of iNTS, including serotype and multidrug resistance (MDR), [4,5] or iNTS disease burden. [7] Several have called for development of nontyphoidal Salmonella vaccines.…”

Section: Introductionmentioning

confidence: 99%

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Keddy

Musekiwa²,

Sooka

et al. 2017

Medicine

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The aim of this study was to define factors associated with HIV-infected versus uninfected patients with invasive nontyphoidal Salmonella (iNTS) and factors associated with mortality, which are inadequately described in Africa.Laboratory-based surveillance for iNTS was undertaken. At selected sentinel sites, clinical data (age, sex, HIV status, severity of illness, and outcome) were collected.Surveillance was conducted in Gauteng, South Africa, from 2003 to 2013. Clinical and microbiological differences between HIV-infected and uninfected patients were defined and risk factors for mortality established.Of 4886 iNTS infections in Gauteng from 2003 to 2013, 3106 (63.5%) were diagnosed at sentinel sites. Among persons with iNTS infections, more HIV-infected persons were aged ≥5 years (χ2 = 417.6; P < 0.001) and more HIV-infected children were malnourished (χ2 = 5.8; P = 0.02). Although 760 (30.6%) patients died, mortality decreased between 2003 [97/263 (36.9%)] and 2013 [926/120 (21.7%)]. On univariate analysis, mortality was associated with patients aged 25 to 49 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.7–2.7; P < 0.001 and ≥50 years (OR = 3.0; 95% CI = 2.2–4.1; P < 0.001) compared with children < 5 years, HIV-infected patients (OR = 2.4; 95% CI = 1.7–3.4; P < 0.001), and severe illness (OR = 5.4; 95% CI = 3.6–8.1; P < 0.001). On multivariate analysis, mortality was associated with patients aged ≥50 years [adjusted OR (AOR) = 3.6, 95% CI = 2.1–6.1, P < 0.001] and severe illness (AOR = 6.3; 95% CI = 3.8–10.5; P < 0.001).Mortality due to iNTS in Gauteng remains high primarily due to disease severity. Interventions must be aimed at predisposing conditions, including HIV, other immune-suppressive conditions, and malignancy.

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Epidemiology and clinical presentation of community-acquired Staphylococcus aureus bacteraemia in children under 5 years of age admitted to the Manhiça District Hospital, Mozambique, 2001–2019

Garrine

Quintò

Costa

et al. 2023

Eur J Clin Microbiol Infect Dis

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Staphylococcus aureus bacteraemia (SAB) is one of the most common bloodstream infections globally. Data on the burden and epidemiology of community-acquired SAB in low-income countries are scarce but needed to define preventive and management strategies. Blood samples were collected from children < 5 years of age with fever or severe disease admitted to the Manhiça District Hospital for bacterial isolation, including S. aureus. Between 2001 and 2019, 7.6% (3,197/41,891) of children had bacteraemia, of which 12.3% corresponded to SAB. The overall incidence of SAB was 56.1 episodes/100,000 children-years at risk (CYAR), being highest among neonates (589.8 episodes/100,000 CYAR). SAB declined significantly between 2001 and 2019 (322.1 to 12.5 episodes/100,000 CYAR). In-hospital mortality by SAB was 9.3% (31/332), and significantly associated with infections by multidrug-resistant (MDR) strains (14.7%, 11/75 vs. 6.9%, 14/204 among non-MDR, p = 0.043) and methicillin-resistant S. aureus (33.3%, 5/15 vs. 7.6%, 20/264 among methicillin-susceptible S. aureus, p = 0.006). Despite the declining rates of SAB, this disease remains an important cause of death among children admitted to MDH, possibly in relation to the resistance to the first line of empirical treatment in use in our setting, suggesting an urgent need to review current policy recommendations.

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InvasiveSalmonellaInfections Among Children From Rural Mozambique, 2001–2014

Abstract: The decreasing but still high incidence of iNTS, its high associated case fatality ratio, and the common detection of multidrug-resistant strains call for a need to improve treatment and prevention strategies for iNTS.

Cited by 38 publications

References 34 publications

Invasive Nontyphoidal Salmonella Disease in Africa

Invasive Nontyphoidal Salmonella Disease in Africa

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Epidemiology and clinical presentation of community-acquired Staphylococcus aureus bacteraemia in children under 5 years of age admitted to the Manhiça District Hospital, Mozambique, 2001–2019

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