title: The decline of typhoid and the rise of non-typhoid salmonellae and fungal infections in a changing HIV landscape: bloodstream infection trends over 15 years in southern Vietnam.
abstract: The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh City, Vietnam, from 1994-2008. Amongst 66,111 blood cultures performed, a clinically relevant pathogen was isolated in 7645 episodes (positivity rate; 116/1000 cultures). Salmonella Typhi was the predominant pathogen until 2002; however, a considerable annual decline in the proportion of S. Typhi was observed (OR 0.6993, 95% CI [0.6885, 0.7103], p<0.0001). Conversely, there was a significant increase in the proportions of non-typhoidal Salmonella (NTS), Cryptococcus neoformans and Penicillium marneffei, concurrent with increasing HIV prevalence. These data document a substantial longitudinal shift in bloodstream infection etiology in southern Vietnam. We propose such changes are related to increasing economic prosperity and HIV prevalence, and this pattern marks a substantial change in the epidemiology of invasive salmonellosis in Southeast Asia.
authors.affiliation: The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam.
authors.forename: Tran Vu Thieu
authors.initials: TV
authors.lastname: Nga
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.forename: Thuy
authors.initials: T
authors.lastname: Le
authors.forename: Nguyen Phu Huong
authors.initials: NP
authors.lastname: Lan
authors.forename: To Song
authors.initials: TS
authors.lastname: Diep
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Nguyen Van Minh
authors.initials: NV
authors.lastname: Hoang
authors.forename: Le Thi
authors.initials: le T
authors.lastname: Dung
authors.forename: John
authors.initials: J
authors.lastname: Wain
authors.forename: Christiane
authors.initials: C
authors.lastname: Dolecek
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: Nguyen Van Vinh
authors.initials: NV
authors.lastname: Chau
authors.forename: Tran Tinh
authors.initials: TT
authors.lastname: Hien
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Day
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D010407:Penicillium / Q000302:isolation & purification / Q000472:pathogenicity*; D015995:Prevalence; D012480:Salmonella Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D014435:Typhoid Fever / Q000453:epidemiology* / Q000209:etiology; D014744:Vietnam / Q000453:epidemiology