Invasive<i>Salmonella</i>Infections at Multiple Surveillance Sites in the Democratic Republic of the Congo, 2011–2014

Kalonji, Lisette Mbuyi; Post, Annelies; Phoba, Marie-France; Falay, Dadi; Ngbonda, Dauly; Muyembe, Jean‐Jacques; Bertrand, Sophie; Ceyssens, Pieter‐Jan; Mattheus, Wesley; Verhaegen, Jan; Barbé, Barbara; Kuijpers, Laura Maria Francisca; Geet, Chris Van; Lunguya, Octavie; Jan, Jacobs

doi:10.1093/cid/civ713

Cited by 66 publications

(108 citation statements)

References 12 publications

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“…[18] In the Democratic Republic of the Congo, MDR occurs in >80% of these 2 serotypes. [19] Interestingly, MDR was low in Salmonella Dublin in Mali, [4] similar to our findings. The predominance of Salmonella Typhimurium and Salmonella Enteritidis in Africa has highlighted these pathogens as primary serotypes for Salmonella vaccine development.…”

Section: Discussionsupporting

confidence: 88%

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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Section: Discussionsupporting

confidence: 88%

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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“…However, in the present study, 31(5.5%) isolates were found to be resistant to azithromycin. Previously, Salmonella strains resistant to azithromycin have also been found in other countries (Sjolund-Karlsson et al, 2011; Kalonji et al, 2015). The plasmid-borne mphA gene was reported as one of the reasons of azithromycin-resistance (Glynn et al, 1998).…”

Section: Discussionmentioning

confidence: 94%

Antimicrobial Resistance of Salmonella enterica Serovar Typhimurium in Shanghai, China

Wang

et al. 2017

Front. Microbiol.

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We aimed to analyze the antimicrobial resistance phenotypes and to elucidate the molecular mechanisms underlying resistance to cephalosporins, ciprofloxacin, and azithromycin in Salmonella enterica serovar Typhimurium isolates identified from patients with diarrhea in Shanghai. The isolates showed high rates of resistance to traditional antimicrobials, and 20.6, 12.7, and 5.5% of them exhibited decreased susceptibility to cephalosporins, ciprofloxacin, and azithromycin, respectively. Notably, 473 (84.6%) isolates exhibited multidrug resistance (MDR), including 161 (28.8%) isolates that showed an ACSSuT profile. Twenty-two MDR isolates concurrently exhibited decreased susceptibility to cephalosporins and ciprofloxacin, and six of them were co-resistant to azithromycin. Of all the 71 isolates with decreased susceptibility to ciprofloxacin, 65 showed at least one mutation (D87Y, D87N, or D87G) in gyrA, among which seven isolates simultaneously had mutations of parC (S80R) (n = 6) or parC (T57S/S80R) (n = 1), while 49 isolates with either zero or one mutation in gyrA contained plasmid-mediated quinolone resistance (PMQR) genes including qnrB, qnrS, and aac(6′)-Ib-cr. Among the 115 cephalosporin-resistant isolates, the most common ESBL gene was blaCTX-M, followed by blaTEM-1, blaOXA-1, and blaSHV -12. Eight subtypes of blaCTX-M were identified and blaCTX-M-14 (n = 22) and blaCTX-M-55 (n = 31) were found to be dominant. To the best of our knowledge, this is the first report of the presence of blaCTX-M-123 and blaCTX-M-125 in S. Typhimurium. Besides, mphA gene was identified in 15 of the 31 azithromycin-resistant isolates. Among the 22 isolates with reduced susceptibility to cephalosporins and ciprofloxacin, 15 contained ESBL and PMQR genes. Coexistence of these genes lead to the emergence of MDR and the transmission of them will pose great difficulties in S. Typhimurium treatments. Therefore, surveillance for these MDR isolates should be enhanced.

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“…Given their association with multidrug resistance and case fatality [3, 40, 41], and the fact that their reservoir and transmission are still poorly understood, iNTS are urgent candidates for vaccine development [42]. Proof-of-principle studies from animal models are available for vaccine prototypes targeting O-antigens, flagellin proteins, and other outer membrane proteins of the Typhimurium and Enteritidis serotypes.…”

Section: Discussionmentioning

confidence: 99%

Population-based incidence, seasonality and serotype distribution of invasive salmonellosis among children in Nanoro, rural Burkina Faso

et al. 2017

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BackgroundBloodstream infections (BSI) caused by Salmonella Typhi and invasive non-Typhoidal Salmonella (iNTS) frequently affect children living in rural sub-Saharan Africa but data about incidence and serotype distribution are rare.ObjectiveThe present study assessed the population-based incidence of Salmonella BSI and severe malaria in a Health and Demographic Surveillance System in a rural area with seasonal malaria transmission in Nanoro, Burkina Faso.MethodsChildren between 2 months—15 years old with severe febrile illness were enrolled during a one-year surveillance period (May 2013—May 2014). Thick blood films and blood cultures were sampled and processed upon admission. Population-based incidences were corrected for non-referral, health seeking behavior, non-inclusion and blood culture sensitivity. Adjusted incidence rates were expressed per 100,000 person-years of observations (PYO).ResultsAmong children < 5 years old, incidence rates for iNTS, Salmonella Typhi and severe malaria per 100,000 PYO were 4,138 (95% Confidence Interval (CI): 3,740–4,572), 224 (95% CI: 138–340) and 2,866 (95% CI: 2,538–3,233) respectively. Among those aged 5–15 years, corresponding incidence rates were 25 (95% CI: 8–60), 273 (95% CI: 203–355) and 135 (95% CI: 87–195) respectively. Most iNTS occurred during the peak of the rainy season and in parallel with the increase of Plasmodium falciparum malaria; for Salmonella Typhi no clear seasonal pattern was observed. Salmonella Typhi and iNTS accounted for 13.3% and 55.8% of all 118 BSI episodes; 71.6% of iNTS (48/67) isolates were Salmonella enterica serovar Typhimurium and 25.4% (17/67) Salmonella enterica serovar Enteritidis; there was no apparent geographical clustering.ConclusionThe present findings from rural West-Africa confirm high incidences of Salmonella Typhi and iNTS, the latter with a seasonal and Plasmodium falciparum-related pattern. It urges prioritization of the development and implementation of Salmonella Typhi as well as iNTS vaccines in this setting.

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InvasiveSalmonellaInfections at Multiple Surveillance Sites in the Democratic Republic of the Congo, 2011–2014

Abstract: Salmonella Typhi and NTS are major causes of BSI in DRC; their antimicrobial resistance is increasing.

Cited by 66 publications

References 12 publications

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

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

Antimicrobial Resistance of Salmonella enterica Serovar Typhimurium in Shanghai, China

Population-based incidence, seasonality and serotype distribution of invasive salmonellosis among children in Nanoro, rural Burkina Faso

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