Abstract
IntroductionAlthough non-typhoidal Salmonella (NTS) infection usually causes self-limited enterocolitis, several risk factors have been found to predispose individuals to more severe NTS infections. However, few studies have discussed the association between NTS infection and pediatric thalassemia populations.Material and methodsA nationwide population-based retrospective cohort study was conducted using medical records of the selected children from the Taiwan National Health Insurance Research Database. Immunocompromised individuals or patients with a history of transfusion or splenectomy were excluded. One thalassemia patient was matched with four non-thalassemia patients based on their year of birth, sex, and urbanization level.ResultsIn this cohort, 912 patients with thalassemia and 3648 comparison cohort were analyzed. The mean age of NTS hospitalization was 2.0 ± 1.4 in thalassemia cohort and 2.6 ± 2.4 in non-thalassemia cohort. Transfusion-naïve thalassemia children were proved to have a higher rate of NTS hospitalization (6.90 vs 4.11 per 1000 person-year; p = 0.0004) than the non-thalassemia cohort, with an adjusted hazard ratio (HR) of 1.68 (95% confidence interval [CI] = 1.26–2.24).ConclusionOur research shows that transfusion-naïve thalassemia is associated with an increased risk of NTS hospitalization. Further prospective study comparing the incidence and severity of NTS infection among children with and without thalassemia is needed.ImpactPediatric transfusion-naïve thalassemia patients have an 1.68-fold increased risk for hospitalization due to non-typhoidal Salmonella (NTS) infection.This is the first nationwide population-based cohort study based on an extremely large database that shows pediatric transfusion-naïve thalassemia patients have an increased risk for NTS hospitalizations.Besides the previously known risk factors such as extremes of age, sickle cell disease, or immunosuppressing conditions, clinicians must also take thalassemia as a possible risk factor for more severe NTS disease.
Highlights
Non-typhoidal Salmonella (NTS) infection usually causes self-limited enterocolitis, several risk factors have been found to predispose individuals to more severe NTS infections
NTS infection frequently shows as a primary bacteremia in adults, while it often remains secondary to gastroenteritis in children.[13,14,15]
Most NTS bacteremia in immunocompetent children is readily manageable with adequate antibiotic treatments, the economic burden is much heavier compared to self-limited NTS enterocolitis.[14,20]
Summary
Non-typhoidal Salmonella (NTS) infection usually causes self-limited enterocolitis, several risk factors have been found to predispose individuals to more severe NTS infections. Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, there were an estimated 95.1 million cases,[1] and 535,000 invasive NTS infections globally in 2017.2 NTS are usually caused by contacting animals, drinking contaminated water, or consuming contaminated food products, especially poultry and eggs.[3,4,5,6,7] Despite the significant improvement in public health in Taiwan, NTS infection has remained as the most common cause of bacterial enterocolitis among children requiring hospitalization.[8]. Children with NTS bacteremia are less often
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