Abstract
SummaryInvasive strains of non-typhoidal salmonellae have emerged as a prominent cause of bloodstream infection in African adults and children, with an associated case fatality of 20–25%. The clinical presentation of invasive non-typhoidal salmonella disease in Africa is diverse: fever, hepatosplenomegaly, and respiratory symptoms are common, and features of enterocolitis are often absent. The most important risk factors are HIV infection in adults, and malaria, HIV, and malnutrition in children. A distinct genotype of Salmonella enterica var Typhimurium, ST313, has emerged as a new pathogenic clade in sub-Saharan Africa, and might have adapted to cause invasive disease in human beings. Multidrug-resistant ST313 has caused epidemics in several African countries, and has driven the use of expensive antimicrobial drugs in the poorest health services in the world. Studies of systemic cellular and humoral immune responses in adults infected with HIV have revealed key host immune defects contributing to invasive non-typhoidal salmonella disease. This emerging pathogen might therefore have adapted to occupy an ecological and immunological niche provided by HIV, malaria, and malnutrition in Africa. A good understanding of the epidemiology of this neglected disease will open new avenues for development and implementation of vaccine and public health strategies to prevent infections and interrupt transmission.
Highlights
The bacterial genus Salmonella causes a huge global burden of morbidity and mortality
Studies of bacteraemia have suggested that invasive nontyphoidal salmonellae are among the most common isolates from febrile presentations in adults and children across sub-Saharan Africa, especially where HIV prevalence is high.[3]
Cytokine responses are crucial for control of intracellular Salmonella infection,[108] and the dysregulation and attenuation reported in HIV infection probably explain intracellular persistence of the bacteria, failure of immunological control, and episodes of relapse of invasive non-typhoidal salmonella disease recorded in advanced HIV infection
Summary
The bacterial genus Salmonella causes a huge global burden of morbidity and mortality. Evidence from epidemiological studies; whole-genome sequencing of the pathogen; and discoveries about host immunity at the cellular, humoral, and mucosal level are helping to create a coherent picture of an emerging pathogen with a new pathogenesis. We will set these new findings in the context of what is known from other presentations of salmonella disease, and will discuss the similarities to and contrasts with typhoid fever
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