Invasive salmonellosis among children admitted to a rural Tanzanian hospital and a comparison with previous studies.
BACKGROUND
The importance of invasive salmonellosis in African children is well recognized but there is inadequate information on these infections. We conducted a fever surveillance study in a Tanzanian rural hospital to estimate the case fraction of invasive salmonellosis among pediatric admissions, examine associations with common co-morbidities and describe its clinical features. We compared our main findings with those from previous studies among children in sub-Saharan Africa.


RESULTS
From 1 March 2008 to 28 Feb 2009, 1,502 children were enrolled into the study. We collected clinical information and blood for point of care tests, culture, and diagnosis of malaria and HIV. We analyzed the clinical features on admission and outcome by laboratory-confirmed diagnosis. Pathogenic bacteria were isolated from the blood of 156 (10%) children, of which 14 (9%) were S. typhi, 45 (29%) were NTS and 97 (62%) were other pathogenic bacteria. Invasive salmonellosis accounted for 59/156 (38%) bacteremic children. Children with typhoid fever were significantly older and presented with a longer duration of fever. NTS infections were significantly associated with prior antimalarial treatment, malarial complications and with a high risk for death.


CONCLUSIONS
Invasive salmonellosis, particularly NTS infection, is an important cause of febrile disease among hospitalized children in our rural Tanzanian setting. Previous studies showed considerable variation in the case fraction of S. typhi and NTS infections. Certain suggestive clinical features (such as older age and long duration of fever for typhoid whereas concomitant malaria, anemia, jaundice and hypoglycemia for NTS infection) may be used to distinguish invasive salmonellosis from other severe febrile illness.
Mtove
George
G
National Institute for Medical Research-Amani Centre, Tanga, Tanzania. mtoveg2002@yahoo.co.uk
Amos
Ben
B
von Seidlein
Lorenz
L
Hendriksen
Ilse
I
Mwambuli
Abraham
A
Kimera
Juma
J
Mallahiyo
Rajabu
R
Kim
Deok Ryun
DR
Ochiai
R Leon
RL
Clemens
John D
JD
Reyburn
Hugh
H
Magesa
Stephen
S
Deen
Jacqueline L
JL
D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D012196:Review Literature as Topic; D012480:Salmonella Infections / Q000175:diagnosis / Q000453:epidemiology*; D012485:Salmonella typhi / Q000302:isolation & purification; D013636:Tanzania / Q000453:epidemiology; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology*