The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa.
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Park Se Eun, Pak Gi Deok, Aaby Peter, Adu-Sarkodie Yaw, Ali Mohammad, Aseffa Abraham, Biggs Holly M, Bjerregaard-Andersen Morten, Breiman Robert F, Crump John A, Cruz Espinoza Ligia Maria, Eltayeb Muna Ahmed, Gasmelseed Nagla, Hertz Julian T, Im Justin, Jaeger Anna, Parfait Kabore Leon, von Kalckreuth Vera, Keddy Karen H, Konings Frank, Krumkamp Ralf, MacLennan Calman A, Meyer Christian G, Montgomery Joel M, Ahmet Niang Aissatou, Nichols Chelsea, Olack Beatrice, Panzner Ursula, Park Jin Kyung, Rabezanahary Henintsoa, Rakotozandrindrainy Raphaël, Sampo Emmanuel, Sarpong Nimako, Schütt-Gerowitt Heidi, Sooka Arvinda, Soura Abdramane Bassiahi, Sow Amy Gassama, Tall Adama, Teferi Mekonnen, Yeshitela Biruk, May Jürgen, Wierzba Thomas F, Clemens John D, Baker Stephen, Marks Florian
Аннотация
METHODS: Febrile patients received a blood culture and a malaria test. Isolated bacteria underwent antimicrobial susceptibility testing, and the association between iNTS disease and malaria was assessed.
RESULTS: A positive correlation between frequency proportions of malaria and iNTS was observed (P = .01; r = 0.70). Areas with higher burden of malaria exhibited higher odds of iNTS disease compared to other bacterial infections (odds ratio [OR], 4.89; 95% CI, 1.61-14.90; P = .005) than areas with lower malaria burden. Malaria parasite positivity was associated with iNTS disease (OR, 2.44; P = .031) and gram-positive bacteremias, particularly Staphylococcus aureus, exhibited a high proportion of coinfection with Plasmodium malaria. Salmonella Typhimurium and Salmonella Enteritidis were the predominant NTS serovars (53/73; 73%). Both moderate (OR, 6.05; P = .0001) and severe (OR, 14.62; P < .0001) anemia were associated with iNTS disease.
CONCLUSIONS: A positive correlation between iNTS disease and malaria endemicity, and the association between Plasmodium parasite positivity and iNTS disease across sub-Saharan Africa, indicates the necessity to consider iNTS as a major cause of febrile illness in malaria-holoendemic areas. Prevention of iNTS disease through iNTS vaccines for areas of high malaria endemicity, targeting high-risk groups for Plasmodium parasitic infection, should be considered.