Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Keddy, Karen H. ; Sooka, Arvinda ; Musekiwa, Alfred ; Smith, Anthony M. ; Ismail, Husna ; ... More +
Keddy, Karen H. ; Sooka, Arvinda ; Musekiwa, Alfred ; Smith, Anthony M. ; Ismail, Husna ; Tau, Nomsa P. ; Crowther-Gibson, Penny ; Angulo, Frederick J. ; Klugman, Keith P. Less -
Description:
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.


Subjects:
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Adolescent Adult Article Child Child, Preschool Drug Resistance, Multiple, Bacterial Epidemiological Monitoring Female Glasgow Coma Scale HIV HIV Infections Humans Infant Infant, Newborn Male Meningitis Meningitis, Bacterial Middle Aged Multilocus Sequence Typing Salmonella Salmonella Infections Salmonella Typhimurium Salmonella Typhimurium ST313 Serogroup Young Adult
Source:
Clin Infect Dis. 61(0 4):S272-S282.
Series:
PEPFAR
Pubmed ID:
26449942
Pubmed Central ID:
PMC4675618
Document Type:
Journal Article
Funding:
5U2GPS001328/PHS HHS/United States ; U2G PS001328/PS/NCHHSTP CDC HHS/United States ; CC999999/Intramural CDC HHS/United States ; U62/PSO022901/PHS HHS/United States ; PEPFAR/United States
5U2GPS001328/PHS HHS/United States ; U2G PS001328/PS/NCHHSTP CDC HHS/United States ; CC999999/Intramural CDC HHS/United States ; U62/PSO022901/PHS HHS/United States ; PEPFAR/United States Less -
Place as Subject:
South Africa
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:84b433a0221d96a93c0d74435dd63c2164f912eee3e4d450f3aff0ffe8bcf9a3
Download URL:
https://stacks.cdc.gov/view/cdc/36798/cdc_36798_DS1.pdf
File Type:

Supporting Files

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