Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003–2013

Details

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

  More +
• Source:
  Clin Infect Dis. 61(0 4):S272-S282.
• 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
• Name as Subject:
  United States. President's Emergency Plan For AIDS Relief (PEPFAR)
• Place as Subject:
  South Africa
• Volume:
  61
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:1e73cfcc27bb9358c4cde929fc58aa2731871a943116fd4aa62332068d1368629e026996e2db5722197d644824477e84e0f799acf4f4d8798d581c405e4edfe2
• Download URL:
  https://stacks.cdc.gov/view/cdc/36798/cdc_36798_DS1.pdf
• File Type:
  [PDF - 552.16 KB ]