Abstract

BackgroundClinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa.MethodsFrom November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA).ResultsA total of 1,108 participants were included (median age 15 years (IQR: 7–36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2–54.1) and 3.4% (95% CI: 2.5–4.7) respectively, with 2.2% (95% CI: 1.5–3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates.ConclusionSalmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation.

Highlights

  • In sub-Saharan Africa, Salmonella is among the most frequent bacteria causing invasive infections in humans [1,2]

  • The overall prevalence of Schistosoma mansoni infection and nontyphoidal Salmonella carriage was 51.2% and 3.4%

  • Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection

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Summary

Introduction

In sub-Saharan Africa, Salmonella is among the most frequent bacteria causing invasive infections in humans [1,2]. Invasive Salmonella infections comprise the human-restricted typhoid fever (caused by Salmonella enterica subspecies enterica serotypes Typhi and Paratyphi) as well as the non-typhoidal Salmonella (NTS) infections. In 2010, 11.9 million typhoid fever cases were reported worldwide causing 129,000 deaths [3,4]. Typhoid fever incidence in sub-Saharan Africa is more than 100 cases per 100,000 person-years [3,4]. Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection.

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