Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study.
Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine...
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ftdoajarticles:oai:doaj.org/article:6f29344ab784467dbeb8a0ec2323dd6c 2023-05-15T15:14:42+02:00 Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. Calman A MacLennan Chisomo L Msefula Esther N Gondwe James J Gilchrist Paul Pensulo Wilson L Mandala Grace Mwimaniwa Meraby Banda Julia Kenny Lorna K Wilson Amos Phiri Jenny M MacLennan Elizabeth M Molyneux Malcolm E Molyneux Stephen M Graham 2017-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0006027 https://doaj.org/article/6f29344ab784467dbeb8a0ec2323dd6c EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5745124?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006027 https://doaj.org/article/6f29344ab784467dbeb8a0ec2323dd6c PLoS Neglected Tropical Diseases, Vol 11, Iss 12, p e0006027 (2017) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2017 ftdoajarticles https://doi.org/10.1371/journal.pntd.0006027 2022-12-31T11:44:55Z Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8-35.1), dyspnea (OR 4.2; 95%CI 1.5-12.0) and HIV infection (OR 3.3; 95%CI 1.1-10.2) were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 11 12 e0006027 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Calman A MacLennan Chisomo L Msefula Esther N Gondwe James J Gilchrist Paul Pensulo Wilson L Mandala Grace Mwimaniwa Meraby Banda Julia Kenny Lorna K Wilson Amos Phiri Jenny M MacLennan Elizabeth M Molyneux Malcolm E Molyneux Stephen M Graham Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8-35.1), dyspnea (OR 4.2; 95%CI 1.5-12.0) and HIV infection (OR 3.3; 95%CI 1.1-10.2) were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children. |
format |
Article in Journal/Newspaper |
author |
Calman A MacLennan Chisomo L Msefula Esther N Gondwe James J Gilchrist Paul Pensulo Wilson L Mandala Grace Mwimaniwa Meraby Banda Julia Kenny Lorna K Wilson Amos Phiri Jenny M MacLennan Elizabeth M Molyneux Malcolm E Molyneux Stephen M Graham |
author_facet |
Calman A MacLennan Chisomo L Msefula Esther N Gondwe James J Gilchrist Paul Pensulo Wilson L Mandala Grace Mwimaniwa Meraby Banda Julia Kenny Lorna K Wilson Amos Phiri Jenny M MacLennan Elizabeth M Molyneux Malcolm E Molyneux Stephen M Graham |
author_sort |
Calman A MacLennan |
title |
Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
title_short |
Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
title_full |
Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
title_fullStr |
Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
title_full_unstemmed |
Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study. |
title_sort |
presentation of life-threatening invasive nontyphoidal salmonella disease in malawian children: a prospective observational study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2017 |
url |
https://doi.org/10.1371/journal.pntd.0006027 https://doaj.org/article/6f29344ab784467dbeb8a0ec2323dd6c |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 11, Iss 12, p e0006027 (2017) |
op_relation |
http://europepmc.org/articles/PMC5745124?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006027 https://doaj.org/article/6f29344ab784467dbeb8a0ec2323dd6c |
op_doi |
https://doi.org/10.1371/journal.pntd.0006027 |
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PLOS Neglected Tropical Diseases |
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11 |
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12 |
container_start_page |
e0006027 |
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