Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013

• Type of Material: Article
• Authors: Karen H. Keddy, National Institute for Communicable Diseases, South Africa; Arvinda Sooka, National Institute for Communicable Diseases, South Africa; Alfred Musekiwa, Centers for Disease Control and Prevention; Anthony M. Smith, National Institute for Communicable Diseases, South Africa; Husna Ismail, National Institute for Communicable Diseases, South Africa; Nomsa P. Tau, National Institute for Communicable Diseases, South Africa; Penny Crowther-Gibson, National Institute for Communicable Diseases, South Africa; Frederick J. Angulo, Centers for Disease Control and Prevention; Keith Klugman, Emory University
• Language: English
• Date: 2015-11-01
• Publisher: Oxford University Press (OUP): Policy A1 - Oxford Open Option C
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/civ685
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 61
• Start Page: S272
• End Page: S282
• Grant/Funding Information: For 2007–2009, it was supported by the CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Global AIDS Program Cooperative Agreement (U62/PSO022901).; This research has been supported by the NICD/NHLS and the President's Emergency Plan for AIDS Relief through the CDC (5U2GPS001328) and, in part, for 2003–2006 by funds from the US Agency for International Development Antimicrobial Resistance Initiative, transferred via a cooperative agreement (number U60/CCU022088) from the CDC.; This publication was made possible by a grant from the Bill & Melinda Gates Foundation (OPP1125993).
• Keywords: Salmonella Typhimurium ST313; Immunology; HIV; ENTERICA SEROVAR TYPHIMURIUM; OPPORTUNISTIC INFECTIONS; HUMAN-IMMUNODEFICIENCY-VIRUS; Life Sciences & Biomedicine; NEONATAL MENINGITIS; ANTIRETROVIRAL THERAPY; Salmonella; meningitis; SYSTEMIC-LUPUS-ERYTHEMATOSUS; Science & Technology; BACTERIAL-MENINGITIS; MALAWIAN CHILDREN; Infectious Diseases; NORTH-AMERICA; Microbiology
• Research Categories: Biology, Microbiology; Health Sciences, Public Health; Health Sciences, Immunology

Abstract

Background. The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. Methods. From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. Results. Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P =. 002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P =. 039). Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P =. 03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P <. 001). Conclusions. NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.