Invasive Non-Typhi Salmonella Disease in Africa
Identifieur interne : 003451 ( Istex/Corpus ); précédent : 003450; suivant : 003452Invasive Non-Typhi Salmonella Disease in Africa
Auteurs : Susan C. Morpeth ; Habib O. Ramadhani ; John A. CrumpSource :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2009-08-15.
Abstract
Invasive non-Typhi Salmonella is endemic to sub-Saharan Africa, where it is a leading cause of bloodstream infection. Some host risk factors have been established, but little is known about environmental reservoirs and predominant modes of transmission, so prevention strategies are underdeveloped. Although foodborne transmission from animals to humans predominates in high-income countries, it has been postulated that transmission between humans, both within and outside health care facilities, may be important in sub-Saharan Africa. Antimicrobial resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol is common among non-Typhi Salmonella strains; therefore, wider use of alternative agents may be warranted for empirical therapy. Development of vaccines targeting the leading invasive non-Typhi Salmonella serotypes Typhimurium and Enteritidis is warranted. The clinical presentation of non-Typhi Salmonella bacteremia is nonspecific and, in the absence of blood culture, may be confused with other febrile illnesses, such as malaria. Much work remains to be done to understand and control invasive non-Typhi Salmonella disease in sub-Saharan Africa.
Url:
DOI: 10.1086/603553
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ISTEX:A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747Le document en format XML
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Ramadhani</name><affiliation><mods:affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation><affiliation><mods:affiliation>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation></author><author><name sortKey="Crump, John A" sort="Crump, John A" uniqKey="Crump J" first="John A." last="Crump">John A. 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Morpeth</name><affiliation><mods:affiliation>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University, Durham, North Carolina</mods:affiliation></affiliation><affiliation><mods:affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation><affiliation><mods:affiliation>Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia</mods:affiliation></affiliation></author><author><name sortKey="Ramadhani, Habib O" sort="Ramadhani, Habib O" uniqKey="Ramadhani H" first="Habib O." last="Ramadhani">Habib O. Ramadhani</name><affiliation><mods:affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation><affiliation><mods:affiliation>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation></author><author><name sortKey="Crump, John A" sort="Crump, John A" uniqKey="Crump J" first="John A." last="Crump">John A. Crump</name><affiliation><mods:affiliation>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University, Durham, North Carolina</mods:affiliation></affiliation><affiliation><mods:affiliation>Duke Global Health Institute, Duke University, Durham, North Carolina</mods:affiliation></affiliation><affiliation><mods:affiliation>Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia</mods:affiliation></affiliation><affiliation><mods:affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation><affiliation><mods:affiliation>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: crump017@mc.duke.edu</mods:affiliation></affiliation><affiliation><mods:affiliation>Reprints or correspondence: Dr. John A. Crump, Div. of Infectious Diseases and International Health, Dept. of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: crump017@mc.duke.edu</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published" when="2009-08-15">2009-08-15</date><biblScope unit="volume">49</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="606">606</biblScope><biblScope unit="page" to="611">611</biblScope></imprint><idno type="ISSN">1058-4838</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Invasive non-Typhi Salmonella is endemic to sub-Saharan Africa, where it is a leading cause of bloodstream infection. Some host risk factors have been established, but little is known about environmental reservoirs and predominant modes of transmission, so prevention strategies are underdeveloped. Although foodborne transmission from animals to humans predominates in high-income countries, it has been postulated that transmission between humans, both within and outside health care facilities, may be important in sub-Saharan Africa. Antimicrobial resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol is common among non-Typhi Salmonella strains; therefore, wider use of alternative agents may be warranted for empirical therapy. Development of vaccines targeting the leading invasive non-Typhi Salmonella serotypes Typhimurium and Enteritidis is warranted. The clinical presentation of non-Typhi Salmonella bacteremia is nonspecific and, in the absence of blood culture, may be confused with other febrile illnesses, such as malaria. Much work remains to be done to understand and control invasive non-Typhi Salmonella disease in sub-Saharan Africa.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Susan C. Morpeth</name><affiliations><json:string>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University, Durham, North Carolina</json:string><json:string>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</json:string><json:string>Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia</json:string></affiliations></json:item><json:item><name>Habib O. Ramadhani</name><affiliations><json:string>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</json:string><json:string>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</json:string></affiliations></json:item><json:item><name>John A. 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Crump, Div. of Infectious Diseases and International Health, Dept. of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710</affiliation></author><idno type="istex">A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747</idno><idno type="ark">ark:/67375/HXZ-5ZKN3PGG-Z</idno><idno type="DOI">10.1086/603553</idno></analytic><monogr><title level="j">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="pISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><idno type="publisher-id">cid</idno><idno type="PublisherID-hwp">cid</idno><imprint><publisher>The University of Chicago Press</publisher><date type="published" when="2009-08-15"></date><biblScope unit="volume">49</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="606">606</biblScope><biblScope unit="page" to="611">611</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><abstract><p>Invasive non-Typhi Salmonella is endemic to sub-Saharan Africa, where it is a leading cause of bloodstream infection. Some host risk factors have been established, but little is known about environmental reservoirs and predominant modes of transmission, so prevention strategies are underdeveloped. Although foodborne transmission from animals to humans predominates in high-income countries, it has been postulated that transmission between humans, both within and outside health care facilities, may be important in sub-Saharan Africa. Antimicrobial resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol is common among non-Typhi Salmonella strains; therefore, wider use of alternative agents may be warranted for empirical therapy. Development of vaccines targeting the leading invasive non-Typhi Salmonella serotypes Typhimurium and Enteritidis is warranted. The clinical presentation of non-Typhi Salmonella bacteremia is nonspecific and, in the absence of blood culture, may be confused with other febrile illnesses, such as malaria. Much work remains to be done to understand and control invasive non-Typhi Salmonella disease in sub-Saharan Africa.</p></abstract></profileDesc><revisionDesc><change when="2009-08-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
<front>
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<journal-id journal-id-type="publisher-id">cid</journal-id>
<journal-title>Clinical Infectious Diseases</journal-title>
<abbrev-journal-title>Clinical Infectious Diseases</abbrev-journal-title>
<issn pub-type="ppub">1058-4838</issn>
<issn pub-type="epub">1537-6591</issn>
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<publisher-name>The University of Chicago Press</publisher-name>
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<article-meta>
<article-id pub-id-type="doi">10.1086/603553</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Invited Articles</subject>
<subj-group subj-group-type="heading">
<subject>Food Safety</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Invasive Non-Typhi <italic>Salmonella</italic> Disease in Africa</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Morpeth</surname>
<given-names>Susan C.</given-names>
</name>
<xref rid="aff1" ref-type="aff">1</xref>
<xref rid="aff4" ref-type="aff">4</xref>
<xref rid="aff6" ref-type="aff">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ramadhani</surname>
<given-names>Habib O.</given-names>
</name>
<xref rid="aff4" ref-type="aff">4</xref>
<xref rid="aff5" ref-type="aff">5</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Crump</surname>
<given-names>John A.</given-names>
</name>
<xref rid="aff1" ref-type="aff">1</xref>
<xref rid="aff2" ref-type="aff">2</xref>
<xref rid="aff3" ref-type="aff">3</xref>
<xref rid="aff4" ref-type="aff">4</xref>
<xref rid="aff5" ref-type="aff">5</xref>
<xref rid="cor1" ref-type="corresp"></xref>
</contrib>
<aff id="aff1"><label>1</label><institution>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University</institution>, <addr-line>Durham, North Carolina</addr-line></aff>
<aff id="aff2"><label>2</label><institution>Duke Global Health Institute, Duke University</institution>, <addr-line>Durham, North Carolina</addr-line></aff>
<aff id="aff3"><label>3</label><institution>Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention</institution>, <addr-line>Atlanta, Georgia</addr-line></aff>
<aff id="aff4"><label>4</label><institution>Kilimanjaro Christian Medical Centre and Tumaini University</institution>, <addr-line>Moshi, Tanzania</addr-line></aff>
<aff id="aff5"><label>5</label><institution>Kilimanjaro Christian Medical College, Tumaini University</institution>, <addr-line>Moshi, Tanzania</addr-line></aff>
<aff id="aff6"><label>6</label><institution>Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital</institution>, <addr-line>Brisbane, Queensland, Australia</addr-line></aff>
</contrib-group>
<author-notes>
<corresp id="cor1">Reprints or correspondence: Dr. John A. Crump, Div. of Infectious Diseases and International Health, Dept. of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710 (<email>crump017@mc.duke.edu</email>).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>15</day>
<month>8</month>
<year>2009</year>
</pub-date>
<volume>49</volume>
<issue>4</issue>
<fpage>606</fpage>
<lpage>611</lpage>
<history>
<date date-type="received">
<day>17</day>
<month>2</month>
<year>2009</year>
</date>
<date date-type="accepted">
<day>13</day>
<month>4</month>
<year>2009</year>
</date>
</history>
<copyright-statement>© 2009 by the Infectious Diseases Society of America</copyright-statement>
<copyright-year>2009</copyright-year>
<abstract>
<p>Invasive non-Typhi <italic>Salmonella</italic> is endemic to sub-Saharan Africa, where it is a leading cause of bloodstream infection. Some host risk factors have been established, but little is known about environmental reservoirs and predominant modes of transmission, so prevention strategies are underdeveloped. Although foodborne transmission from animals to humans predominates in high-income countries, it has been postulated that transmission between humans, both within and outside health care facilities, may be important in sub-Saharan Africa. Antimicrobial resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol is common among non-Typhi <italic>Salmonella</italic> strains; therefore, wider use of alternative agents may be warranted for empirical therapy. Development of vaccines targeting the leading invasive non-Typhi <italic>Salmonella</italic> serotypes Typhimurium and Enteritidis is warranted. The clinical presentation of non-Typhi <italic>Salmonella</italic> bacteremia is nonspecific and, in the absence of blood culture, may be confused with other febrile illnesses, such as malaria. Much work remains to be done to understand and control invasive non-Typhi <italic>Salmonella</italic> disease in sub-Saharan Africa.</p>
</abstract>
</article-meta>
</front>
<body>
<p><italic>Salmonella enterica</italic> subspecies <italic>enterica</italic> includes >2400 serotypes found in humans and other warm-blooded animals. Non-Typhi <italic>S. enterica</italic> serotypes are abbreviated using their serotype name—for example, <italic>Salmonella</italic> Typhimurium [<xref rid="ref1" ref-type="bibr">1</xref>].</p>
<p>Non-Typhi <italic>Salmonella</italic> (NTS) is among the 3 most common pathogens causing bacterial bloodstream infections in adults and children in sub-Saharan Africa [<xref rid="ref2" ref-type="bibr">2</xref>, <xref rid="ref3" ref-type="bibr">3</xref>]. Children <3 years old and human immunodeficiency virus (HIV)-infected adults carry most of the burden of invasive disease, and mortality among these groups is high. This contrasts with developed countries, where NTS disease is usually a self-limited diarrhea, and mortality is lower.</p>
<sec id="sec1">
<title>Burden of Disease</title>
<p>Invasive NTS disease is endemic to rural and urban sub-Saharan Africa. The burden of mortality due to childhood invasive bacterial disease may be greater than that due to childhood malaria in some African communities [<xref rid="ref4" ref-type="bibr">4</xref>]. In rural Kenya, the estimated minimum incidence of bacteremia was 505 cases per 100,000 person-years in the age group of <5 years old, of which 88 cases per 100,000 person-years were NTS bacteremia. In rural Mozambique, the incidence of childhood bacteremia was 425 cases per 100,000 person-years among children aged <15 years, and within this category, NTS incidence accounted for 120 cases per 100,000 person-years [<xref rid="ref3" ref-type="bibr">3</xref>]. The true incidence of bacteremia is likely to be 2–3 times this figure, because the incidence of bacteremia among children who die before reaching the district hospital was unable to be ascertained in either study [<xref rid="ref3" ref-type="bibr">3</xref>, <xref rid="ref4" ref-type="bibr">4</xref>]. In an evaluation of the impact of pneumococcal conjugate vaccine in the Gambia, an incidence of NTS bacteremia of 262 cases per 100,000 person-years among children aged ⩽29 months was demonstrated [<xref rid="ref5" ref-type="bibr">5</xref>]. In Uganda, NTS bacteremia was reported to be rare among adults with CD4<sup>+</sup>T-lymphocyte counts (CD4 cell counts) >500 cells/mm<sup>3</sup>, but the incidence was 500 cases per 100,000 person-years among adults with CD4 cell counts of 200–500 cells/mm<sup>3</sup>and was 7500 cases per 100,000 person-years among adults with CD4 cell counts <200 cells/mm<sup>3</sup>[<xref rid="ref6" ref-type="bibr">6</xref>].</p>
<p>Case-fatality estimates for invasive NTS disease among hospitalized patients in Africa have been in the range 4.4%-27% for children [<xref rid="ref5" ref-type="bibr">5</xref>, <xref rid="ref7" ref-type="bibr">7</xref>-<xref rid="ref9" ref-type="bibr">9</xref>] and 22%-47% for adults [<xref rid="ref10" ref-type="bibr">10</xref>, <xref rid="ref11" ref-type="bibr">11</xref>]. Meningitis case-fatality rates may be higher for NTS than for any other common cause of bacterial meningitis. For example, in Malawi, 64% of neonates with NTS meningitis died, compared with 26% of neonates with group B <italic>Streptococcus</italic> meningitis [<xref rid="ref12" ref-type="bibr">12</xref>].</p>
<p>Although these studies provide some insight into the burden of invasive NTS disease in Africa, most studies have focused on high-risk groups, such as young children and HIV-infected adults. The actual incidence is likely to vary by population prevalence of HIV infection, local conditions, and age distribution. The incidence of invasive NTS disease in sub-Saharan Africa is likely to be higher than the incidence of typhoid fever, which has been estimated to be 50 cases per 100,000 person-years in Africa [<xref rid="ref13" ref-type="bibr">13</xref>]. Furthermore, hospital-based studies suggest that typhoid fever may be considerably less common than is invasive NTS in sub-Saharan Africa [<xref rid="ref14" ref-type="bibr">14</xref>].</p>
<p>Data on the frequency of complications of NTS bacteremia in Africa are limited. Meningitis, septic arthritis, and osteomyelitis have been described [<xref rid="ref7" ref-type="bibr">7</xref>, <xref rid="ref15" ref-type="bibr">15</xref>-<xref rid="ref17" ref-type="bibr">17</xref>], especially among children, for whom NTS may be a more common cause of septic arthritis than <italic>Staphylococcus aureus</italic> [<xref rid="ref18" ref-type="bibr">18</xref>]. Gordon et al [<xref rid="ref11" ref-type="bibr">11</xref>] investigated 100 Malawian adults with NTS bacteremia for focal suppurative disease and did not identify any localized NTS infections at initial presentation.</p>
<p>Of 2517 children with NTS bacteremia in Malawi during 1998–2004, 85% were aged <36 months and an estimated 19%-35% were HIV infected [<xref rid="ref10" ref-type="bibr">10</xref>]. During the same period, 2439 adults with NTS bacteremia were identified, and an estimated 95%-98% were HIV infected. A South African autopsy study of 50 patients who died and had a premortem clinical diagnosis of tuberculosis revealed that 94% were HIV infected and 23% of HIV-infected patients were harboring splenic NTS [<xref rid="ref19" ref-type="bibr">19</xref>].</p>
</sec>
<sec id="sec2">
<title>Risk Factors and Prevention Strategies</title>
<p>Risk factors for NTS infection in Africa (<xref rid="tab1" ref-type="fig">Table 1</xref>) have not been well characterized; consequently, evidence-based prevention interventions are limited. Small African studies and evidence-based prevention studies of NTS in more-developed countries may provide clues until more data from Africa are available.</p>
<p>Prospective studies of enteric NTS infection that investigate risk factors for development of bacteremia are limited. A North American study noted a bacteremia incidence of 6% among infants with NTS diarrhea, but modifiable risk factors were not identified [<xref rid="ref21" ref-type="bibr">21</xref>].</p>
<sec id="sec3">
<title>Environmental Risk Factors</title>
<p><bold><italic>Food and water</italic></bold>. Seasonal peaks of NTS disease occur with the rainy season among both adults and children [<xref rid="ref7" ref-type="bibr">7</xref>, <xref rid="ref10" ref-type="bibr">10</xref>, <xref rid="ref12" ref-type="bibr">12</xref>, <xref rid="ref22" ref-type="bibr">22</xref>], suggesting that environmental risk factors are important. Fecal organisms are found at the highest concentrations in drinking water sources in Africa at the onset of the wet season [<xref rid="ref23" ref-type="bibr">23</xref>], and this may correspond to increased risk of waterborne NTS. Protection of source water; increased access to centrally treated safe water; strategies such as the use of narrow-mouthed, spigoted containers for water storage [<xref rid="ref24" ref-type="bibr">24</xref>]; and treatment of water at home by chlorination, solar disinfection, filtration, flocculation, or a combination of measures may reduce the risk of diarrhea [<xref rid="ref25" ref-type="bibr">25</xref>].</p>
<p>Numerous outbreaks of foodborne illness due to NTS have been studied in industrialized countries and also have been described in Africa. Meat, eggs, produce, and dairy products have all been implicated as vehicles for transmission. NTS infect or colonize most mammalian species. Food animals, such as chickens, have been a focus of efforts to reduce transmission of NTS to humans in developed countries [<xref rid="ref26" ref-type="bibr">26</xref>]. NTS has also been isolated from cattle, goats, sheep, and pigs in African slaughterhouses. Identification and management of hazards, facilitated by microbiological sampling at critical control points from farm to fork, have been used in both developing and industrialized countries to improve food safety and to control NTS disease [<xref rid="ref27" ref-type="bibr">27</xref>].</p>
<p><bold><italic>Zoonotic transmission and transmission between humans</italic></bold>. Animal contact, particularly handling of young chickens by children, is a well-established risk factor for acquisition of NTS disease in industrialized countries [<xref rid="ref28" ref-type="bibr">28</xref>]. Although not often considered a common risk factor for NTS infection in studies of developed countries, apparent transmission between humans has been suggested to be relatively more important in Africa [<xref rid="ref22" ref-type="bibr">22</xref>, <xref rid="ref29" ref-type="bibr">29</xref>]. Kariuki et al [<xref rid="ref22" ref-type="bibr">22</xref>] demonstrated carriage of identical strains of NTS in the stool of human household contacts of children with invasive disease and a lack of such strains in environmental and domestic animal sampling from the households, although a common source from food or water could not be ruled out. Asymptomatic carriers of NTS have been described in Africa [<xref rid="ref30" ref-type="bibr">30</xref>]. A Kenyan study of NTS carriage at admission to the hospital found that 20 (3.6%) of 556 children but none of 111 adults carried NTS [<xref rid="ref31" ref-type="bibr">31</xref>]. In developed countries, it is known that children are likely to excrete NTS in their stool for several weeks after recovering from enteric infection.</p>
<p><bold><italic>Hospital-acquired infection</italic></bold>. Outbreaks of NTS disease have been reported in hospitals in many parts of the world, occurring among patients who are admitted with a different diagnosis. Outbreaks of hospital-acquired NTS can be particularly severe on pediatric wards in developing countries, where children may be malnourished and have other host risk factors. In African hospitals, food is often provided by a patient's family. Although few studies have examined risk factors for infection in hospital outbreaks, contaminated food and person-to-person transmission have been considered. High death rates are frequently observed, especially when outbreaks are caused by strains of NTS resistant to the local empirical therapy [<xref rid="ref17" ref-type="bibr">17</xref>]. Of 360 adult and pediatric patients with hospital-acquired diarrhea in a Kenyan hospital in 1988, 10% of cases were due to <italic>Salmonella</italic> species and 2.5% to <italic>Shigella</italic> species. Among children aged 6 months to 6 years, recent antimicrobial use and crowded living conditions at home were associated with hospital-acquired diarrhea due to <italic>Salmonella</italic> or <italic>Shigella</italic> species. Among adults, sharing a hospital room with somebody who has diarrhea and a history of previous hospitalization were associated with hospital-acquired <italic>Salmonella</italic> or <italic>Shigella</italic> diarrhea [<xref rid="ref31" ref-type="bibr">31</xref>]. Prevention strategies could include patient and visitor education regarding personal hygiene and food preparation and storage, provision of safe drinking water, hand washing before and after patient contact by health care workers, thorough cleaning of the hospital environment, reduction in crowding, avoidance of sharing beds, increasing the number of health care workers, adequate disinfection of reusable equipment, surveillance of NTS infection, and isolation of identified cases [<xref rid="ref17" ref-type="bibr">17</xref>, <xref rid="ref32" ref-type="bibr">32</xref>].</p>
</sec>
<sec id="sec4">
<title>Host Risk Factors</title>
<p><bold><italic>Age</italic></bold>. Children and infants <3 years old are particularly at risk for invasive NTS disease [<xref rid="ref3" ref-type="bibr">3</xref>-<xref rid="ref5" ref-type="bibr">5</xref>, <xref rid="ref7" ref-type="bibr">7</xref>-<xref rid="ref10" ref-type="bibr">10</xref>]. Endovascular infections with NTS have been described in adults aged >50 years in industrialized countries. Older age may also be a risk factor in African populations but is dominated by HIV-associated NTS disease among younger adults.</p>
<p><bold><italic>Exposure to antimicrobial agents</italic></bold>. Recent use of antimicrobial agents is an established risk factor for development of NTS diarrhea [<xref rid="ref31" ref-type="bibr">31</xref>, <xref rid="ref33" ref-type="bibr">33</xref>]. Prior antimicrobial use and malnutrition contribute to abnormal gastrointestinal flora with possible loss of mucosal integrity.</p>
<p><bold><italic>Malaria and anemia</italic></bold>. Malaria has long been suspected to increase the risk of invasive NTS infection and might contribute to the seasonality of NTS disease. Although the mechanism underlying the association between malaria and NTS is only partially understood, malarial hemolysis may lead to impaired macrophage and neutrophil function due to the accumulation of malarial pigment by phagocytic cells, saturation of iron-binding proteins, and increased iron availability to NTS, a siderophilic organism. Although some studies have shown an association between malaria and NTS bacteremia [<xref rid="ref5" ref-type="bibr">5</xref>], others have demonstrated an association between recent malaria or malarial anemia and NTS, compared with other causes of bacteremia [<xref rid="ref7" ref-type="bibr">7</xref>, <xref rid="ref15" ref-type="bibr">15</xref>, <xref rid="ref34" ref-type="bibr">34</xref>]. Thus, measures directed at malaria control may have the potential to lead to reduction in the incidence of invasive NTS disease in tropical Africa.</p>
<p><bold><italic>Malnutrition</italic></bold>. Malnutrition was associated with NTS bacteremia among children in Kilifi, Kenya [<xref rid="ref4" ref-type="bibr">4</xref>, <xref rid="ref7" ref-type="bibr">7</xref>]. Malnutrition, measles, and diarrheal disease were common reasons for admission to the hospital among children who subsequently developed hospital-acquired NTS disease in Rwanda [<xref rid="ref17" ref-type="bibr">17</xref>]. Although children aged <3 years are at greater risk for NTS disease, those aged <4 months appear to be relatively protected, perhaps both by maternal antibodies [<xref rid="ref35" ref-type="bibr">35</xref>] and by exclusive breast-feeding, which provides colostrum and limits exposure to unsafe water and food.</p>
<p><bold><italic>HIV infection</italic></bold>. NTS bacteremia is more common among HIV-infected individuals [<xref rid="ref2" ref-type="bibr">2</xref>, <xref rid="ref29" ref-type="bibr">29</xref>], and the association with HIV infection is strongest among adults. Recurrent NTS bacteremia is a World Health Organization (WHO) stage 4 defining condition. Prophylactic therapy with trimethoprim-sulfamethoxazole is recommended to prevent the occurrence of opportunistic infections among HIV-infected patients [<xref rid="ref36" ref-type="bibr">36</xref>]. This strategy appears to remain effective even in areas with high levels of resistance to trimethoprim-sulfamethoxazole among pathogens such as NTS [<xref rid="ref37" ref-type="bibr">37</xref>]. Combination antiretroviral therapy has been associated with dramatic reductions in the incidence of NTS diarrhea and NTS bacteremia among HIV-infected persons in developed countries [<xref rid="ref38" ref-type="bibr">38</xref>]. HIV infection is also a risk factor for bacteremia among children, including NTS bacteremia. HIV was associated with any bacteremia among children in Kilifi, Kenya (odds ratio, 3.22; 95% confidence interval, 2.34–4.44) and with NTS bacteremia (odds ratio, 3.21; 95% confidence interval, 1.95–5.28) [<xref rid="ref4" ref-type="bibr">4</xref>].</p>
<p><bold><italic>Gastric acid suppression</italic></bold>. Use of medications that reduce gastric acidity is associated with an increased risk of gastrointestinal infection [<xref rid="ref39" ref-type="bibr">39</xref>]. Infants have relative gastric achlorhydria, compared with adults, which may contribute to their risk of NTS disease.</p>
<p><bold><italic>Sickle cell disease</italic></bold>. Persons homozygous for sickle cell disease are at particular risk for bacterial sepsis, including NTS bacteremia. Of 78 consecutive cases of acute osteomyelitis complicating sickle cell disease in Nigeria involving patients with a mean age of 12 years (range, 9 months-50 years), 32 were able to have culture of blood or pus performed and one-half of the cases were due to <italic>Salmonella</italic> species [<xref rid="ref16" ref-type="bibr">16</xref>].</p>
<p><bold><italic>Schistosomiasis</italic></bold>. Intestinal schistosomiasis may be a risk factor for invasive NTS disease among children in areas of endemicity [<xref rid="ref40" ref-type="bibr">40</xref>]. However, among HIV-infected adults in Malawi, the presence of intestinal helminths was not shown to be associated with NTS bacteremia [<xref rid="ref41" ref-type="bibr">41</xref>].</p>
</sec>
</sec>
<sec id="sec5">
<title>Clinical Presentation and Diagnosis</title>
<p>Fever or sweats were noted among 95% and splenomegaly among 38% of 100 Malawian adults at initial presentation with NTS bacteremia, features that are also seen in malaria. The median hemoglobin level in this group, 99% of whom were HIV infected, was 6.8 g/dL (range, 2.5–11.7 g/dL) [<xref rid="ref11" ref-type="bibr">11</xref>]. Fever and splenomegaly predicted NTS bacteremia among hospitalized adults in Malawi [<xref rid="ref42" ref-type="bibr">42</xref>]. In Tanzania, patients admitted to the hospital for antimalarial treatment were more likely to die when the results of a malaria slide test were negative than when the results were positive [<xref rid="ref43" ref-type="bibr">43</xref>], which suggests that a lack of capacity to diagnose and treat nonmalarial infections, such as bacterial sepsis, may contribute to outcome. Among 166 children with NTS bacteremia in Kenya, splenomegaly was present in 44% and fever in 94% [<xref rid="ref7" ref-type="bibr">7</xref>]. In the same rural district, 26% of all inpatient childhood deaths were associated with bacteremia, whereas 22% of such deaths were associated with malaria. Of children with malaria who died, 21% also had bacteremia [<xref rid="ref4" ref-type="bibr">4</xref>].</p>
<p>NTS bacteremia frequently occurs without gastrointestinal symptoms in adults [<xref rid="ref11" ref-type="bibr">11</xref>] and children [<xref rid="ref7" ref-type="bibr">7</xref>]. Peters et al [<xref rid="ref42" ref-type="bibr">42</xref>] have noted that, although pneumococcal or mycobacterial sepsis in adult patients could often be diagnosed clinically before blood culture results became available, NTS sepsis was much more difficult to diagnose on clinical grounds, because of nonspecific symptoms and signs. The syndrome of childhood pneumonia overlaps with both malaria and NTS sepsis [<xref rid="ref7" ref-type="bibr">7</xref>, <xref rid="ref15" ref-type="bibr">15</xref>, <xref rid="ref17" ref-type="bibr">17</xref>]. Because clinical diagnosis of NTS bacteremia is difficult, blood culture facilities are needed to diagnose it and to conduct accurate surveillance to guide public health policy. Unfortunately, adequate clinical laboratory infrastructure is frequently lacking in resource-poor countries in Africa [<xref rid="ref44" ref-type="bibr">44</xref>].</p>
<p>Outcomes were studied among 100 Malawian adults with NTS bacteremia, 99% of whom were HIV infected; 47% died within 1 month and 77% died within 1 year after the index presentation, and 43% of the initial survivors experienced at least 1 recurrence of NTS bacteremia. Molecular testing revealed that recurrence was due to recrudescence, rather than reinfection, in most instances [<xref rid="ref11" ref-type="bibr">11</xref>]. Recrudescence probably occurs because of persistence of NTS intracellularly in the reticuloendothelial system.</p>
</sec>
<sec id="sec6">
<title>Clinical Management</title>
<p>Empirical treatment of childhood sepsis in accordance with WHO guidelines [<xref rid="ref45" ref-type="bibr">45</xref>], with penicillin and chloramphenicol or ampicillin and gentamicin, may not provide adequate coverage for NTS disease that is resistant to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Gentamicin has limited activity against intracellular pathogens, so although isolates may appear susceptible in vitro, gentamicin cannot be relied on in vivo. WHO guidelines advise that, when there is known substantial antimicrobial resistance to traditional first-line antimicrobial agents, use of a third-generation cephalosporin may be appropriate [<xref rid="ref45" ref-type="bibr">45</xref>]. The cerebrospinal fluid penetration of ceftriaxone makes it a good choice for treatment of meningitis. A recent report on pediatric NTS meningitis from Malawi during 1997–2006 demonstrated a static case-fatality rate of ∼50% but a decrease in permanent sequelae over time, possibly associated with a change in duration of therapy from 2 to 4 weeks [<xref rid="ref46" ref-type="bibr">46</xref>]. The Centers for Disease Control and Prevention rec ommends ciprofloxacin for the treatment of NTS bacteremia in HIV-infected adults, given for 4–6 weeks if the CD4 cell count is <200 cells/mm<sup>3</sup>, followed by long-term secondary prophylaxis [<xref rid="ref47" ref-type="bibr">47</xref>]. Data to guide duration of therapy or secondary prophylaxis for neonates, patients with meningitis, and HIV-infected persons in Africa are lacking. <italic>Salmonella</italic> serotype Typhi with decreased ciprofloxacin susceptibility, often associated with nalidixic acid resistance, may not respond adequately to ciprofloxacin therapy. It is not known whether this is also true for NTS [<xref rid="ref48" ref-type="bibr">48</xref>]. When patients with NTS bacteremia do not respond to appropriate antimicrobial therapy, a search for focal disease and for schistosomiasis coinfection is warranted.</p>
</sec>
<sec id="sec7">
<title>Microbiology</title>
<p><italic>S</italic>. Typhimurium and <italic>Salmonella</italic> Enteritidis are the most common serotypes of NTS causing human disease in sub-Saharan Africa [<xref rid="ref7" ref-type="bibr">7</xref>, <xref rid="ref9" ref-type="bibr">9</xref>, <xref rid="ref10" ref-type="bibr">10</xref>, <xref rid="ref29" ref-type="bibr">29</xref>, <xref rid="ref35" ref-type="bibr">35</xref>, <xref rid="ref49" ref-type="bibr">49</xref>]. The acquisition of a plasmid conveying a multidrug-resistant phenotype may be associated with successful spread and has been observed with <italic>S</italic>. Typhimurium in Malawi [<xref rid="ref10" ref-type="bibr">10</xref>]. <italic>Salmonella</italic> Isangi was a rare serotype in South Africa until 2002, when it expanded to account for 20% of NTS isolates in a national surveillance program and was found to produce an extended-spectrum β-lactamase [<xref rid="ref50" ref-type="bibr">50</xref>]. Antimicrobial resistance of NTS to trimethoprim-sulfamethoxazole, ampicillin, and chloramphenicol has become common in sub-Saharan Africa, which limits the value of these agents for management of invasive NTS [<xref rid="ref5" ref-type="bibr">5</xref>, <xref rid="ref10" ref-type="bibr">10</xref>, <xref rid="ref12" ref-type="bibr">12</xref>, <xref rid="ref17" ref-type="bibr">17</xref>].</p>
</sec>
<sec id="sec8">
<title>NTS Vaccine Prospects</title>
<p>The virulence of NTS is dependent on its ability to grow within macrophages of the reticuloendothelial system [<xref rid="ref51" ref-type="bibr">51</xref>]. Extracellular replication and bacteremic dissemination also occur. Resistance to complement killing, by way of long-chain lipopolysaccharide, is an important virulence trait. Both complement and specific antibodies together are required to kill <italic>Salmonella</italic> species in vitro. Although serum samples from healthy African adults were able to kill NTS, serum samples from children aged <16 months often did not contain specific antibody titers sufficient to kill effectively [<xref rid="ref35" ref-type="bibr">35</xref>]. This probably explains the predisposition of young children to invasive NTS disease and may go some way toward helping us understand a mechanism by which the immune dysregulation of HIV infection contributes to NTS disease risk. Such immunological clues suggest that vaccine development directed toward the common invasive serotypes could be a useful approach to prevent invasive NTS disease.</p>
</sec>
<sec id="sec9">
<title>Conclusions and Future Directions</title>
<p>As invasive diseases caused by <italic>Streptococcus pneumoniae</italic> and <italic>Haemophilus influenzae</italic> are controlled by vaccine strategies, invasive non-Typhi <italic>Salmonella</italic> disease may consolidate its position as a leading cause of community-acquired bloodstream infection in sub-Saharan Africa.</p>
<p>Despite the substantial burden of illness and death caused by invasive NTS disease, much remains to be done to understand and control invasive NTS disease in sub-Saharan Africa. A clearer understanding of the incidence, complications, and case-fatality rates at the population level would be valuable in deciding how to prioritize health care resources. A scale-up of access to blood culture or to improved alternative diagnostic methods is needed to support such studies, to improve patient care, and to inform policy. Research to determine the major environmental sources and modes of transmission and to characterize risk factors for mucosal colonization or infection and for invasive disease is urgently needed. It would be useful to understand more about the syndrome of invasive NTS in sub-Saharan Africa, including the proportion of persons with NTS diarrhea or NTS carriage who also develop invasive disease, the pathogenesis, the prevalence of carriage and chronic shedding, and the risk of NTS bacteremia attributable to comorbid conditions, such as malnutrition, malaria, and HIV infection. Algorithms for the management of febrile illness need to be continually reevaluated to address the relative importance of malaria versus invasive bacterial infections such as NTS. Clinical effectiveness studies and surveillance of antimicrobial resistance and serotype distribution are needed to inform clinical management strategies, to detect changes in patterns of disease, and to assist in vaccine development.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p><bold><italic>Financial support</italic></bold>. US National Institutes of Health awards: AIDS International Training and Research Program, Fogarty International Center (D43 PA-03-018 to H.O.R. and J.A.C.), International Studies of AIDS-associated Co-infections (AI062563 to H.O.R. and J.A.C.), the Duke University Center for AIDS Research (AI64518 to H.O.R. and J.A.C.), and the Duke Clinical Trials Unit and Clinical Research Sites (AI069484-01 to J.A.C.); the Hubert-Yeargan Center for Global Health and a Duke Clinical Research Institute Synderman Award, Duke University Medical Center (to S.C.M.).</p>
<p><bold><italic>Potential conflicts of interest</italic></bold>. All authors: no conflicts.</p>
</ack>
<ref-list>
<title>References</title>
<ref id="ref1">
<label>1</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brenner</surname>
<given-names>FW</given-names>
</name>
<name>
<surname>Villar</surname>
<given-names>RG</given-names>
</name>
<name>
<surname>Angulo</surname>
<given-names>FJ</given-names>
</name>
<name>
<surname>Tauxe</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Swaminathan</surname>
<given-names>B</given-names>
</name>
</person-group>
<article-title><italic>Salmonella</italic> nomenclature</article-title>
<source>J Clin Microbiol</source>
<year>2000</year>
<volume>38</volume>
<fpage>2465</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="ref2">
<label>2</label>
<nlm-citation citation-type="confproc">
<person-group person-group-type="author">
<name>
<surname>Shaw</surname>
<given-names>AV</given-names>
</name>
<name>
<surname>Reddy</surname>
<given-names>EA</given-names>
</name>
<name>
<surname>Crump</surname>
<given-names>JA</given-names>
</name>
</person-group>
<article-title>Etiology of community-acquired bloodstream infections in Africa [abstract L-620]</article-title>
<source>Program and abstracts of the 46th Annual Meeting of the Infectious Diseases Society of America (Washington, DC)</source>
<year>2008</year>
<publisher-loc>Alexandria, VA</publisher-loc>
<publisher-name>Infectious Diseases Society of America</publisher-name>
</nlm-citation>
</ref>
<ref id="ref3">
<label>3</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sigauque</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Roca</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Mandomando</surname>
<given-names>I</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Community-acquired bacteremia among children admitted to a rural hospital in Mozambique</article-title>
<source>Pediatr Infect Dis J</source>
<year>2009</year>
<volume>28</volume>
<fpage>108</fpage>
<lpage>13</lpage>
</nlm-citation>
</ref>
<ref id="ref4">
<label>4</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Berkley</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Lowe</surname>
<given-names>BS</given-names>
</name>
<name>
<surname>Mwangi</surname>
<given-names>I</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Bacteremia among children admitted to a rural hospital in Kenya</article-title>
<source>N Engl J Med</source>
<year>2005</year>
<volume>352</volume>
<fpage>39</fpage>
<lpage>47</lpage>
</nlm-citation>
</ref>
<ref id="ref5">
<label>5</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Enwere</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Biney</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Cheung</surname>
<given-names>YB</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Epidemiologic and clinical characteristics of community-acquired invasive bacterial infections in children aged 2–29 months in the Gambia</article-title>
<source>Pediatr Infect Dis J</source>
<year>2006</year>
<volume>25</volume>
<fpage>700</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="ref6">
<label>6</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gilks</surname>
<given-names>CF</given-names>
</name>
</person-group>
<article-title>Acute bacterial infections and HIV disease</article-title>
<source>Br Med Bull</source>
<year>1998</year>
<volume>54</volume>
<fpage>383</fpage>
<lpage>93</lpage>
</nlm-citation>
</ref>
<ref id="ref7">
<label>7</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brent</surname>
<given-names>AJ</given-names>
</name>
<name>
<surname>Oundo</surname>
<given-names>JO</given-names>
</name>
<name>
<surname>Mwangi</surname>
<given-names>I</given-names>
</name>
<name>
<surname>Ochola</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Lowe</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Berkley</surname>
<given-names>JA</given-names>
</name>
</person-group>
<article-title><italic>Salmonella</italic> bacteremia in Kenyan children</article-title>
<source>Pediatr Infect Dis J</source>
<year>2006</year>
<volume>25</volume>
<fpage>230</fpage>
<lpage>6</lpage>
</nlm-citation>
</ref>
<ref id="ref8">
<label>8</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Walsh</surname>
<given-names>AL</given-names>
</name>
<name>
<surname>Phiri</surname>
<given-names>AJ</given-names>
</name>
<name>
<surname>Graham</surname>
<given-names>SM</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>EM</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>ME</given-names>
</name>
</person-group>
<article-title>Bacteremia in febrile Malawian children: clinical and microbiologic features</article-title>
<source>Pediatr Infect Dis J</source>
<year>2000</year>
<volume>19</volume>
<fpage>312</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="ref9">
<label>9</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Graham</surname>
<given-names>SM</given-names>
</name>
<name>
<surname>Walsh</surname>
<given-names>AL</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>EM</given-names>
</name>
<name>
<surname>Phiri</surname>
<given-names>AJ</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>ME</given-names>
</name>
</person-group>
<article-title>Clinical presentation of non-typhoidal <italic>Salmonella</italic> bacteraemia in Malawian children</article-title>
<source>Trans R Soc Trop Med Hyg</source>
<year>2000</year>
<volume>94</volume>
<fpage>310</fpage>
<lpage>4</lpage>
</nlm-citation>
</ref>
<ref id="ref10">
<label>10</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gordon</surname>
<given-names>MA</given-names>
</name>
<name>
<surname>Graham</surname>
<given-names>SM</given-names>
</name>
<name>
<surname>Walsh</surname>
<given-names>AL</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Epidemics of invasive <italic>Salmonella enterica</italic> serovar Enteritidis and <italic>S. enterica</italic> serovar Typhimurium infection associated with multidrug resistance among adults and children in Malawi</article-title>
<source>Clin Infect Dis</source>
<year>2008</year>
<volume>46</volume>
<fpage>963</fpage>
<lpage>9</lpage>
</nlm-citation>
</ref>
<ref id="ref11">
<label>11</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gordon</surname>
<given-names>MA</given-names>
</name>
<name>
<surname>Banda</surname>
<given-names>HT</given-names>
</name>
<name>
<surname>Gondwe</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Non-typhoidal <italic>Salmonella</italic> bacteraemia among HIV-infected Malawian adults: high mortality and frequent recrudescence</article-title>
<source>AIDS</source>
<year>2002</year>
<volume>16</volume>
<fpage>1633</fpage>
<lpage>41</lpage>
</nlm-citation>
</ref>
<ref id="ref12">
<label>12</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Milledge</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Calis</surname>
<given-names>JC</given-names>
</name>
<name>
<surname>Graham</surname>
<given-names>SM</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Aetiology of neonatal sepsis in Blantyre, Malawi: 1996–2001</article-title>
<source>Ann Trop Paediatr</source>
<year>2005</year>
<volume>25</volume>
<fpage>101</fpage>
<lpage>10</lpage>
</nlm-citation>
</ref>
<ref id="ref13">
<label>13</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crump</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Luby</surname>
<given-names>SP</given-names>
</name>
<name>
<surname>Mintz</surname>
<given-names>ED</given-names>
</name>
</person-group>
<article-title>The global burden of typhoid fever</article-title>
<source>Bull World Health Organ</source>
<year>2004</year>
<volume>82</volume>
<fpage>346</fpage>
<lpage>53</lpage>
</nlm-citation>
</ref>
<ref id="ref14">
<label>14</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mweu</surname>
<given-names>E</given-names>
</name>
<name>
<surname>English</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Typhoid fever in children in Africa</article-title>
<source>Trop Med Int Health</source>
<year>2008</year>
<volume>13</volume>
<fpage>532</fpage>
<lpage>40</lpage>
</nlm-citation>
</ref>
<ref id="ref15">
<label>15</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Graham</surname>
<given-names>SM</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>EM</given-names>
</name>
<name>
<surname>Walsh</surname>
<given-names>AL</given-names>
</name>
<name>
<surname>Cheesbrough</surname>
<given-names>JS</given-names>
</name>
<name>
<surname>Molyneux</surname>
<given-names>ME</given-names>
</name>
<name>
<surname>Hart</surname>
<given-names>CA</given-names>
</name>
</person-group>
<article-title>Nontyphoidal <italic>Salmonella</italic> infections of children in tropical Africa</article-title>
<source>Pediatr Infect Dis J</source>
<year>2000</year>
<volume>19</volume>
<fpage>1189</fpage>
<lpage>96</lpage>
</nlm-citation>
</ref>
<ref id="ref16">
<label>16</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ebong</surname>
<given-names>WW</given-names>
</name>
</person-group>
<article-title>Acute osteomyelitis in Nigerians with sickle cell disease</article-title>
<source>Ann Rheum Dis</source>
<year>1986</year>
<volume>45</volume>
<fpage>911</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="ref17">
<label>17</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lepage</surname>
<given-names>P</given-names>
</name>
<name>
<surname>Bogaerts</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Van Goethem</surname>
<given-names>C</given-names>
</name>
<name>
<surname>Hitimana</surname>
<given-names>DG</given-names>
</name>
<name>
<surname>Nsengumuremyi</surname>
<given-names>F</given-names>
</name>
</person-group>
<article-title>Multiresistant <italic>Salmonella</italic> Typhimurium systemic infection in Rwanda: clinical features and treatment with cefotaxime</article-title>
<source>J Antimicrob Chemother</source>
<year>1990</year>
<volume>26</volume>
<issue>Suppl A</issue>
<fpage>53</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="ref18">
<label>18</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lavy</surname>
<given-names>CB</given-names>
</name>
<name>
<surname>Thyoka</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Pitani</surname>
<given-names>AD</given-names>
</name>
</person-group>
<article-title>Clinical features and microbiology in 204 cases of septic arthritis in Malawian children</article-title>
<source>J Bone Joint Surg Br</source>
<year>2005</year>
<volume>87</volume>
<fpage>1545</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="ref19">
<label>19</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Martinson</surname>
<given-names>NA</given-names>
</name>
<name>
<surname>Karstaedt</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Venter</surname>
<given-names>WD</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study</article-title>
<source>AIDS</source>
<year>2007</year>
<volume>21</volume>
<fpage>2043</fpage>
<lpage>50</lpage>
</nlm-citation>
</ref>
<ref id="ref20">
<label>20</label>
<nlm-citation citation-type="other">
<collab>Oxford Centre for Evidence-based Medicine</collab>
<comment>Levels of evidence. Available at: http://www.cebm.net/index.aspx?.o=1025. Accessed 26 March 2009</comment>
</nlm-citation>
</ref>
<ref id="ref21">
<label>21</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Torrey</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Fleisher</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Jaffe</surname>
<given-names>D</given-names>
</name>
</person-group>
<article-title>Incidence of <italic>Salmonella</italic> bacteremia in infants with <italic>Salmonella</italic> gastroenteritis</article-title>
<source>J Pediatr</source>
<year>1986</year>
<volume>108</volume>
<fpage>718</fpage>
<lpage>21</lpage>
</nlm-citation>
</ref>
<ref id="ref22">
<label>22</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kariuki</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Revathi</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Kariuki</surname>
<given-names>N</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Invasive multidrug-resistant non-typhoidal <italic>Salmonella</italic> infections in Africa: zoonotic or anthroponotic transmission?</article-title>
<source>J Med Microbiol</source>
<year>2006</year>
<volume>55</volume>
<fpage>585</fpage>
<lpage>91</lpage>
</nlm-citation>
</ref>
<ref id="ref23">
<label>23</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wright</surname>
<given-names>RC</given-names>
</name>
</person-group>
<article-title>The seasonality of bacterial quality of water in a tropical developing country (Sierra Leone)</article-title>
<source>J Hyg (Lond)</source>
<year>1986</year>
<volume>96</volume>
<fpage>75</fpage>
<lpage>82</lpage>
</nlm-citation>
</ref>
<ref id="ref24">
<label>24</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mintz</surname>
<given-names>ED</given-names>
</name>
<name>
<surname>Reiff</surname>
<given-names>FM</given-names>
</name>
<name>
<surname>Tauxe</surname>
<given-names>RV</given-names>
</name>
</person-group>
<article-title>Safe water treatment and storage in the home: a practical new strategy to prevent waterborne disease</article-title>
<source>JAMA</source>
<year>1995</year>
<volume>273</volume>
<fpage>948</fpage>
<lpage>53</lpage>
</nlm-citation>
</ref>
<ref id="ref25">
<label>25</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Clasen</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Schmidt</surname>
<given-names>WP</given-names>
</name>
<name>
<surname>Rabie</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Roberts</surname>
<given-names>I</given-names>
</name>
<name>
<surname>Cairncross</surname>
<given-names>S</given-names>
</name>
</person-group>
<article-title>Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis</article-title>
<source>BMJ</source>
<year>2007</year>
<volume>334</volume>
<fpage>782</fpage>
</nlm-citation>
</ref>
<ref id="ref26">
<label>26</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crump</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Griffin</surname>
<given-names>PM</given-names>
</name>
<name>
<surname>Angulo</surname>
<given-names>FJ</given-names>
</name>
</person-group>
<article-title>Bacterial contamination of animal feed and its relationship to human foodborne illness</article-title>
<source>Clin Infect Dis</source>
<year>2002</year>
<volume>35</volume>
<fpage>859</fpage>
<lpage>65</lpage>
</nlm-citation>
</ref>
<ref id="ref27">
<label>27</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schlundt</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Toyofuku</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Jansen</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Herbst</surname>
<given-names>SA</given-names>
</name>
</person-group>
<article-title>Emerging food-borne zoonoses</article-title>
<source>Rev Sci Tech</source>
<year>2004</year>
<volume>23</volume>
<fpage>513</fpage>
<lpage>33</lpage>
</nlm-citation>
</ref>
<ref id="ref28">
<label>28</label>
<nlm-citation citation-type="journal">
<collab>Centers for Disease Control and Prevention</collab>
<article-title>Three outbreaks of salmonellosis associated with baby poultry from three hatcheries—United States, 2006</article-title>
<source>MMWR Morb Mortal Wkly Rep</source>
<year>2007</year>
<volume>56</volume>
<fpage>273</fpage>
<lpage>6</lpage>
</nlm-citation>
</ref>
<ref id="ref29">
<label>29</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gordon</surname>
<given-names>MA</given-names>
</name>
</person-group>
<article-title><italic>Salmonella</italic> infections in immunocompromised adults</article-title>
<source>J Infect</source>
<year>2008</year>
<volume>56</volume>
<fpage>413</fpage>
<lpage>22</lpage>
</nlm-citation>
</ref>
<ref id="ref30">
<label>30</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nkuo-Akenji</surname>
<given-names>TK</given-names>
</name>
<name>
<surname>Ntemgwa</surname>
<given-names>ML</given-names>
</name>
<name>
<surname>Ndip</surname>
<given-names>RN</given-names>
</name>
</person-group>
<article-title>Asymptomatic salmonellosis and drug susceptibility in the Buea District, Cameroon</article-title>
<source>Cent Afr J Med</source>
<year>2001</year>
<volume>47</volume>
<fpage>254</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="ref31">
<label>31</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Paton</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Nicolle</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Mwongera</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title><italic>Salmonella</italic> and <italic>Shigella</italic> gastroenteritis at a public teaching hospital in Nairobi, Kenya</article-title>
<source>Infect Control Hosp Epidemiol</source>
<year>1991</year>
<volume>12</volume>
<fpage>710</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="ref32">
<label>32</label>
<nlm-citation citation-type="book">
<collab>World Health Organization, Department of Communicable Disease, Surveillance and Response</collab>
<source>Prevention of hospital-acquired infections: a practical guide 2nd ed</source>
<year>2002</year>
<publisher-loc>Geneva</publisher-loc>
<publisher-name>World Health Organization</publisher-name>
<comment>Available at: http://www.who.int/csr/resources/publications/drugresist/WHO_CDS_CSR_EPH_2002_12/en/. Accessed 4 January 2009</comment>
</nlm-citation>
</ref>
<ref id="ref33">
<label>33</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pavia</surname>
<given-names>AT</given-names>
</name>
<name>
<surname>Shipman</surname>
<given-names>LD</given-names>
</name>
<name>
<surname>Wells</surname>
<given-names>JG</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Epidemiologic evidence that prior antimicrobial exposure decreases resistance to infection by antimicrobial-sensitive <italic>Salmonella</italic></article-title>
<source>J Infect Dis</source>
<year>1990</year>
<volume>161</volume>
<fpage>255</fpage>
<lpage>60</lpage>
</nlm-citation>
</ref>
<ref id="ref34">
<label>34</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mabey</surname>
<given-names>DC</given-names>
</name>
<name>
<surname>Brown</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Greenwood</surname>
<given-names>BM</given-names>
</name>
</person-group>
<article-title><italic>Plasmodium falciparum</italic> malaria and <italic>Salmonella</italic> infections in Gambian children</article-title>
<source>J Infect Dis</source>
<year>1987</year>
<volume>155</volume>
<fpage>1319</fpage>
<lpage>21</lpage>
</nlm-citation>
</ref>
<ref id="ref35">
<label>35</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>MacLennan</surname>
<given-names>CA</given-names>
</name>
<name>
<surname>Gondwe</surname>
<given-names>EN</given-names>
</name>
<name>
<surname>Msefula</surname>
<given-names>CL</given-names>
</name>
<etal></etal>
</person-group>
<article-title>The neglected role of antibody in protection against bacteremia caused by nontyphoidal strains of <italic>Salmonella</italic> in African children</article-title>
<source>J Clin Invest</source>
<year>2008</year>
<volume>118</volume>
<fpage>1553</fpage>
<lpage>62</lpage>
</nlm-citation>
</ref>
<ref id="ref36">
<label>36</label>
<nlm-citation citation-type="journal">
<article-title>Provisional WHO/UNAIDS recommendations on the use of cotrimoxazole prophylaxis in adults and children living with HIV/AIDS in Africa</article-title>
<source>Afr Health Sci</source>
<year>2001</year>
<volume>1</volume>
<fpage>30</fpage>
<lpage>1</lpage>
</nlm-citation>
</ref>
<ref id="ref37">
<label>37</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Watera</surname>
<given-names>C</given-names>
</name>
<name>
<surname>Todd</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Muwonge</surname>
<given-names>R</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda</article-title>
<source>J Acquir Immune Defic Syndr</source>
<year>2006</year>
<volume>42</volume>
<fpage>373</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="ref38">
<label>38</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hung</surname>
<given-names>CC</given-names>
</name>
<name>
<surname>Hung</surname>
<given-names>MN</given-names>
</name>
<name>
<surname>Hsueh</surname>
<given-names>PR</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Risk of recurrent nontyphoid <italic>Salmonella</italic> bacteremia in HIV-infected patients in the era of highly active antiretroviral therapy and an increasing trend of fluoroquinolone resistance</article-title>
<source>Clin Infect Dis</source>
<year>2007</year>
<volume>45</volume>
<fpage>e60</fpage>
<lpage>7</lpage>
</nlm-citation>
</ref>
<ref id="ref39">
<label>39</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Leonard</surname>
<given-names>J</given-names>
</name>
<name>
<surname>Marshall</surname>
<given-names>JK</given-names>
</name>
<name>
<surname>Moayyedi</surname>
<given-names>P</given-names>
</name>
</person-group>
<article-title>Systematic review of the risk of enteric infection in patients taking acid suppression</article-title>
<source>Am J Gastroenterol</source>
<year>2007</year>
<volume>102</volume>
<fpage>2047</fpage>
<lpage>56</lpage>
</nlm-citation>
</ref>
<ref id="ref40">
<label>40</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gendrel</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Kombila</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Beaudoin-Leblevec</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Richard-Lenoble</surname>
<given-names>D</given-names>
</name>
</person-group>
<article-title>Nontyphoidal salmonellal septicemia in Gabonese children infected with <italic>Schistosoma intercalatum</italic></article-title>
<source>Clin Infect Dis</source>
<year>1994</year>
<volume>18</volume>
<fpage>103</fpage>
<lpage>5</lpage>
</nlm-citation>
</ref>
<ref id="ref41">
<label>41</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dowling</surname>
<given-names>JJ</given-names>
</name>
<name>
<surname>Whitty</surname>
<given-names>CJ</given-names>
</name>
<name>
<surname>Chaponda</surname>
<given-names>M</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Are intestinal helminths a risk factor for non-typhoidal <italic>Salmonella</italic> bacteraemia in adults in Africa who are seropositive for HIV?. A case-control study</article-title>
<source>Ann Trop Med Parasitol</source>
<year>2002</year>
<volume>96</volume>
<fpage>203</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="ref42">
<label>42</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Peters</surname>
<given-names>RP</given-names>
</name>
<name>
<surname>Zijlstra</surname>
<given-names>EE</given-names>
</name>
<name>
<surname>Schijffelen</surname>
<given-names>MJ</given-names>
</name>
<etal></etal>
</person-group>
<article-title>A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management</article-title>
<source>Trop Med Int Health</source>
<year>2004</year>
<volume>9</volume>
<fpage>928</fpage>
<lpage>34</lpage>
</nlm-citation>
</ref>
<ref id="ref43">
<label>43</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Reyburn</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Mbatia</surname>
<given-names>R</given-names>
</name>
<name>
<surname>Drakeley</surname>
<given-names>C</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study</article-title>
<source>BMJ</source>
<year>2004</year>
<volume>329</volume>
<fpage>1212</fpage>
</nlm-citation>
</ref>
<ref id="ref44">
<label>44</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Petti</surname>
<given-names>CA</given-names>
</name>
<name>
<surname>Polage</surname>
<given-names>CR</given-names>
</name>
<name>
<surname>Quinn</surname>
<given-names>TC</given-names>
</name>
<name>
<surname>Ronald</surname>
<given-names>AR</given-names>
</name>
<name>
<surname>Sande</surname>
<given-names>MA</given-names>
</name>
</person-group>
<article-title>Laboratory medicine in Africa: a barrier to effective health care</article-title>
<source>Clin Infect Dis</source>
<year>2006</year>
<volume>42</volume>
<fpage>377</fpage>
<lpage>82</lpage>
</nlm-citation>
</ref>
<ref id="ref45">
<label>45</label>
<nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source>Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources</source>
<year>2005</year>
<publisher-loc>Geneva</publisher-loc>
<publisher-name>World Health Organization</publisher-name>
<comment>Available at: http://www.helid.desastres.net/?.e=d-000who-000-1-0-010-4-0-0-10l-11en- 5000-50-about-0-01131-001-110utfZz-8-0-0&a=d&c=who&cl=CL4&d=Js13431e.10.5. Accessed 4 January 2009</comment>
</nlm-citation>
</ref>
<ref id="ref46">
<label>46</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Molyneux</surname>
<given-names>EM</given-names>
</name>
<name>
<surname>Mankhambo</surname>
<given-names>LA</given-names>
</name>
<name>
<surname>Phiri</surname>
<given-names>A</given-names>
</name>
<etal></etal>
</person-group>
<article-title>The outcome of non-typhoidal <italic>Salmonella</italic> meningitis in Malawian children, 1997–2006</article-title>
<source>Ann Trop Paediatr</source>
<year>2009</year>
<volume>29</volume>
<fpage>13</fpage>
<lpage>22</lpage>
</nlm-citation>
</ref>
<ref id="ref47">
<label>47</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Benson</surname>
<given-names>CA</given-names>
</name>
<name>
<surname>Kaplan</surname>
<given-names>JE</given-names>
</name>
<name>
<surname>Masur</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Pau</surname>
<given-names>A</given-names>
</name>
<name>
<surname>Holmes</surname>
<given-names>KK</given-names>
</name>
</person-group>
<article-title>Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America</article-title>
<source>MMWR Recomm Rep</source>
<year>2004</year>
<volume>53</volume>
<fpage>1</fpage>
<lpage>112</lpage>
</nlm-citation>
</ref>
<ref id="ref48">
<label>48</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Crump</surname>
<given-names>JA</given-names>
</name>
<name>
<surname>Barrett</surname>
<given-names>TJ</given-names>
</name>
<name>
<surname>Nelson</surname>
<given-names>JT</given-names>
</name>
<name>
<surname>Angulo</surname>
<given-names>FJ</given-names>
</name>
</person-group>
<article-title>Reevaluating fluoroquinolone breakpoints for <italic>Salmonella enterica</italic> serotype Typhi and for non-Typhi salmonellae</article-title>
<source>Clin Infect Dis</source>
<year>2003</year>
<volume>37</volume>
<fpage>75</fpage>
<lpage>81</lpage>
</nlm-citation>
</ref>
<ref id="ref49">
<label>49</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Galanis</surname>
<given-names>E</given-names>
</name>
<name>
<surname>Lo Fo Wong</surname>
<given-names>DM</given-names>
</name>
<name>
<surname>Patrick</surname>
<given-names>ME</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Web-based surveillance and global <italic>Salmonella</italic> distribution, 2000–2002</article-title>
<source>Emerg Infect Dis</source>
<year>2006</year>
<volume>12</volume>
<fpage>381</fpage>
<lpage>8</lpage>
</nlm-citation>
</ref>
<ref id="ref50">
<label>50</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kruger</surname>
<given-names>T</given-names>
</name>
<name>
<surname>Szabo</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Keddy</surname>
<given-names>KH</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Infections with nontyphoidal <italic>Salmonella</italic> species producing TEM-63 or a novel TEM enzyme, TEM-131, in South Africa</article-title>
<source>Antimicrob Agents Chemother</source>
<year>2004</year>
<volume>48</volume>
<fpage>4263</fpage>
<lpage>70</lpage>
</nlm-citation>
</ref>
<ref id="ref51">
<label>51</label>
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fields</surname>
<given-names>PI</given-names>
</name>
<name>
<surname>Swanson</surname>
<given-names>RV</given-names>
</name>
<name>
<surname>Haidaris</surname>
<given-names>CG</given-names>
</name>
<name>
<surname>Heffron</surname>
<given-names>F</given-names>
</name>
</person-group>
<article-title>Mutants of <italic>Salmonella</italic> Typhimurium that cannot survive within the macrophage are avirulent</article-title>
<source>Proc Natl Acad Sci U S A</source>
<year>1986</year>
<volume>83</volume>
<fpage>5189</fpage>
<lpage>93</lpage>
</nlm-citation>
</ref>
</ref-list>
<sec sec-type="display-objects">
<title>Figures and Tables</title>
<fig position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Risk Factors for Non-Typhi <italic>Salmonella</italic> Bacteremia in Africa</p>
</caption>
<graphic mimetype="image" xlink:href="49-4-606-tbl001.tif"></graphic>
</fig>
</sec>
</back>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Invasive Non-Typhi Salmonella Disease in Africa</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Invasive Non-Typhi Salmonella Disease in Africa</title></titleInfo><name type="personal"><namePart type="given">Susan C.</namePart><namePart type="family">Morpeth</namePart><affiliation>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University, Durham, North Carolina</affiliation><affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</affiliation><affiliation>Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Habib O.</namePart><namePart type="family">Ramadhani</namePart><affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</affiliation><affiliation>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">John A.</namePart><namePart type="family">Crump</namePart><affiliation>Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, and Duke University, Durham, North Carolina</affiliation><affiliation>Duke Global Health Institute, Duke University, Durham, North Carolina</affiliation><affiliation>Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia</affiliation><affiliation>Kilimanjaro Christian Medical Centre and Tumaini University, Moshi, Tanzania</affiliation><affiliation>Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania</affiliation><affiliation>E-mail: crump017@mc.duke.edu</affiliation><affiliation>Reprints or correspondence: Dr. John A. Crump, Div. of Infectious Diseases and International Health, Dept. of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710</affiliation><affiliation>E-mail: crump017@mc.duke.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>The University of Chicago Press</publisher><dateIssued encoding="w3cdtf">2009-08-15</dateIssued><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><abstract>Invasive non-Typhi Salmonella is endemic to sub-Saharan Africa, where it is a leading cause of bloodstream infection. Some host risk factors have been established, but little is known about environmental reservoirs and predominant modes of transmission, so prevention strategies are underdeveloped. Although foodborne transmission from animals to humans predominates in high-income countries, it has been postulated that transmission between humans, both within and outside health care facilities, may be important in sub-Saharan Africa. Antimicrobial resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol is common among non-Typhi Salmonella strains; therefore, wider use of alternative agents may be warranted for empirical therapy. Development of vaccines targeting the leading invasive non-Typhi Salmonella serotypes Typhimurium and Enteritidis is warranted. The clinical presentation of non-Typhi Salmonella bacteremia is nonspecific and, in the absence of blood culture, may be confused with other febrile illnesses, such as malaria. Much work remains to be done to understand and control invasive non-Typhi Salmonella disease in sub-Saharan Africa.</abstract><relatedItem type="host"><titleInfo><title>Clinical Infectious Diseases</title></titleInfo><titleInfo type="abbreviated"><title>Clinical Infectious Diseases</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">1058-4838</identifier><identifier type="eISSN">1537-6591</identifier><identifier type="PublisherID">cid</identifier><identifier type="PublisherID-hwp">cid</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>49</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>606</start><end>611</end></extent></part></relatedItem><identifier type="istex">A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747</identifier><identifier type="DOI">10.1086/603553</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2009 by the Infectious Diseases Society of America</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>© 2009 by the Infectious Diseases Society of America</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/metadata/json</uri></json:item></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/covers/tiff</uri></json:item><json:item><extension>html</extension><original>true</original><mimetype>text/html</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/covers/html</uri></json:item></covers><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/annexes/jpeg</uri></json:item><json:item><extension>gif</extension><original>true</original><mimetype>image/gif</mimetype><uri>https://api.istex.fr/document/A037AC0EEF9DA9C1215E8CA667A570A6CB3DB747/annexes/gif</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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