title: Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013.
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.
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases.
authors.forename: Arvinda
authors.initials: A
authors.lastname: Sooka
authors.affiliation: International Emerging Infections Programme, South Africa Global Disease Detection Centre, Centers for Disease Control and Prevention, Pretoria.
authors.forename: Alfred
authors.initials: A
authors.lastname: Musekiwa
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases.
authors.forename: Husna
authors.initials: H
authors.lastname: Ismail
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases.
authors.forename: Nomsa P
authors.initials: NP
authors.lastname: Tau
authors.affiliation: Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
authors.forename: Penny
authors.initials: P
authors.lastname: Crowther-Gibson
authors.affiliation: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Angulo
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D012486:Salmonella typhimurium / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D065288:Serogroup; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; Salmonella; Salmonella Typhimurium ST313; meningitis