title: Salmonella bacteremia in Kenyan children.
abstract: BACKGROUND
  Nontyphoidal Salmonella spp. are among the leading causes of childhood bacteremia in sub-Saharan Africa, yet there are few published clinical series, and the risk factors for acquiring infection are not fully understood.
  
  
  METHODS
  We examined data from 166 cases of nontyphoidal Salmonella bacteremia identified during a large prospective study of bacteremia among all children admitted to a district hospital in Kenya. We also investigated the importance of comorbidities, including current malaria parasitemia, recent malaria (detectable Plasmodium falciparum histidine rich protein 2 in the absence of parasitemia), sickle cell disease, malnutrition and human immunodeficiency virus (HIV) infection.
  
  
  RESULTS
  Nontyphoidal Salmonella bacteremia was associated with severe malnutrition (33% cases), HIV infection (18% cases), a history of illness >7 days, recent hospital admission, splenomegaly, anemia and recent (but not current) malaria but was not associated with diarrhea. Seventy-seven (46%) children with nontyphoidal Salmonella bacteremia fulfilled World Health Organization clinical criteria for a diagnosis of pneumonia. Independent risk factors for death were diarrhea, tachypnea, HIV infection, severe malnutrition, meningitis and young age.
  
  
  CONCLUSIONS
  Clinical diagnosis of invasive nontyphoidal Salmonella infection in African children is difficult without microbiology facilities because clinical features overlap with other conditions. The common risk factors for nontyphoidal Salmonella infection differ from developed countries, with high a prevalence of malnutrition, HIV, malaria and anemia. Children with nontyphoidal Salmonella infection who fulfill World Health Organization clinical criteria for severe pneumonia may receive ineffective therapy in the form of penicillin.
authors.affiliation: Wellcome Trust/KEMRI Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. andrew_brent@doctors.org.uk
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Brent
authors.forename: Joe O
authors.initials: JO
authors.lastname: Oundo
authors.forename: Isaiah
authors.initials: I
authors.lastname: Mwangi
authors.forename: Lucy
authors.initials: L
authors.lastname: Ochola
authors.forename: Brett
authors.initials: B
authors.lastname: Lowe
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
mesh_terms: D000740:Anemia / Q000150:complications; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications; D008297:Male; D044342:Malnutrition / Q000150:complications; D012307:Risk Factors; D012475:Salmonella / Q000145:classification / Q000302:isolation & purification; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality