May 22, 2015
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Invasive nontyphoidal salmonella major cause of global illness, death

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Invasive nontyphoidal salmonella disease is a significant contributor to global illness and mortality, particularly in Africa, according to recent findings.

Nontyphoidal Salmonella is a major cause of bloodstream infections worldwide, and HIV-infected persons and malaria-infected and malnourished children are at increased risk for the disease,” researchers wrote in Emerging Infectious Diseases.

In a systematic literature review, the researchers searched several databases for incidence data on invasive nontyphoidal salmonella disease (iNTS) for the period between January 1990 and December 2012. Population-based incidence studies and surveillance systems, along with national surveillance data, were included in the analysis. Ten studies were selected for review.

Significant geographic disparities in age-specific iNTS incidence were observed. In general, Kenya and Malawi had a higher incidence of disease across all age groups than other countries, with children aged younger than 5 years and adults aged 30 to 35 years being heavily affected. Moreover, among children aged younger than 5 years, disease rates in Kenya and Malawi were more than threefold that of other countries.

An estimated 3.4 million cases of iNTS disease were seen annually at an overall incidence of 49 cases per 100,000 population.

The highest incidence of iNTS was in Africa (227 cases per 100,000 population), which also had the largest number of cases (1.9 million).

The review revealed a range of potential case-fatality ratios (CFRs) — from 3% to 47%. An expert opinion consensus determined a likely CFR of 20%. Using this CFR, the researchers estimated that 681,316 deaths would result from the annual number of cases.

“iNTS is a leading cause of invasive bacterial disease in Africa,” the researchers wrote. “It is vital that recommendations for empiric management of sepsis incorporate antimicrobial agents suitable for the management of iNTS.”

Disclosure: The researchers report no relevant financial disclosures.