49 - Nontyphoid Salmonella Disease

Abstract

Nontyphoidal Salmonella (NTS) typically causes self-limiting enterocolitis in high-income settings. In sub-Saharan Africa (SSA), however, NTS is a major cause of bloodstream infections, termed invasive nontyphoidal Salmonella (iNTS) disease, causing an estimated 1.9 million cases and 388,000 deaths annually. In SSA, specific clades of Salmonella Typhimurium and Salmonella Enteritidis associated with genomic degradation and multi-drug resistance have emerged. iNTS disease disproportionately affects adults with advanced HIV infection and young children with immature immunity, HIV, and malaria. Children in SSA bear two-thirds of the burden of disease. The non-specific nature of iNTS disease makes it difficult to differentiate from other causes of non-focal febrile illness, and the widespread emergence of multi-drug resistance and emerging cephalosporin resistance presents increasing treatment challenges. iNTS disease causes a large burden of morbidity and mortality in SSA, and there is much that is still unknown about environmental and host reservoirs and transmission of the pathogen and about optimal therapy for this condition. iNTS is also a problem in other resource-limited areas among individuals with HIV, malaria, and compromised or immature immune systems, although SSA accounts for the largest global burden. Vaccine acceleration is a high priority.