Abstract
BackgroundInvasive non-typhoidal Salmonella (iNTS) disease is a well-described cause of mortality in children and human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. Additionally, there is an ill-defined burden of iNTS disease in Southeast Asia.MethodsAiming to investigate the causative serovars of non-invasive and iNTS disease and their associated antimicrobial susceptibility profiles in the Lao People’s Democratic Republic, we performed multilocus sequence typing and antimicrobial susceptibility profiling on 168 NTS (63 blood and 105 faecal) organisms isolated in Lao between 2000 and 2012.ResultsSix different serovars were isolated from blood; Salmonella enterica serovar Enteritidis (n=28), S. enterica serovar Typhimurium (n=19) and S. enterica serovar Choleraesuis (n=11) accounted for >90% (58/63) of the iNTS disease cases. In contrast, the isolates from diarrhoeal faeces were comprised of 18 different serovars, the mostly commonly identified being S. enterica Typhimurium (n=28), S. enterica Weltevreden (n=14) and S. enterica Stanley (n=15). S. enterica Enteritidis and S. enterica Choleraesuis were significantly more associated with systemic disease than diarrhoeal disease in this patient group (p<0.001).ConclusionsWe find a differing distribution of Salmonella sequence types/serovars between those causing iNTS disease and non-invasive disease in Lao. We conclude that there is a small but not insignificant burden of iNTS disease in Lao. Further clinical and epidemiological investigations are required to assess mortality and the role of comorbidities such as HIV.
Highlights
Gastroenteritis caused by non-typhoidal Salmonella (NTS) is of significant public health importance, resulting in an estimated 94 million cases and 155 000 deaths worldwide each year.[1]
It has been shown that a wide range of NTS serovars circulate on farms in Southeast Asia and much attention has been focused on sampling pigs and poultry in the region.[9]
Among the six different serovars isolates from the blood, S. enterica Enteritidis (Group D; n=28), S. enterica Typhimurium (Group B; n=19) and S. enterica Choleraesuis (Group C1; n=11) were the most common, accounting for >90% (58/63) of the Invasive non-typhoidal Salmonella (iNTS) disease cases
Summary
Gastroenteritis caused by non-typhoidal Salmonella (NTS) is of significant public health importance, resulting in an estimated 94 million cases and 155 000 deaths worldwide each year.[1] While NTS disease in humans is classically associated with self-limiting diarrhoea, these organisms may cause invasive disease (iNTS), in those who are immunocompromised due to extremes of age, malnutrition, human immunodeficiency virus (HIV) infection or malaria.[2,3,4] In individuals with these risk factors living in sub-Saharan Africa, iNTS disease is a significant problem, with associated mortality rates of 20–25%.5. The majority of serovars associated with NTS disease are classified within Salmonella enterica subspecies I, a broad species encompassing organisms such as Salmonella enterica serovar Typhimurium and S. enterica Enteritidis, which have the ability to colonize a wide range of animal hosts and cause human disease. Invasive non-typhoidal Salmonella (iNTS) disease is a well-described cause of mortality in children and human immunodeficiency virus (HIV)-infected adults in sub-Saharan Africa. There is an ill-defined burden of iNTS disease in Southeast Asia
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