title: Invasive Salmonellosis in Kilifi, Kenya.
abstract: BACKGROUND
  Invasive salmonelloses are a major cause of morbidity and mortality in Africa, but the incidence and case fatality of each disease vary markedly by region. We aimed to describe the incidence, clinical characteristics, and antimicrobial susceptibility patterns of invasive salmonelloses among children and adults in Kilifi, Kenya.
  
  
  METHODS
  We analyzed integrated clinical and laboratory records for patients presenting to the Kilifi County Hospital between 1998 and 2014. We calculated incidence, and summarized clinical features and multidrug resistance.
  
  
  RESULTS
  Nontyphoidal Salmonella (NTS) accounted for 10.8% and 5.8% of bacteremia cases in children and adults, respectively, while Salmonella Typhi accounted for 0.5% and 2.1%, respectively. Among 351 NTS isolates serotyped, 160 (45.6%) were Salmonella Enteritidis and 152 (43.3%) were Salmonella Typhimurium. The incidence of NTS in children aged <5 years was 36.6 per 100 000 person-years, being highest in infants aged <7 days (174/100 000 person-years). The overall incidence of NTS in children varied markedly by location and declined significantly during the study period; the pattern of dominance of the NTS serotypes also shifted from Salmonella Enteritidis to Salmonella Typhimurium. Risk factors for invasive NTS disease were human immunodeficiency virus infection, malaria, and malnutrition; the case fatality ratio was 22.1% (71/321) in children aged <5 years and 36.7% (11/30) in adults. Multidrug resistance was present in 23.9% (84/351) of NTS isolates and 46.2% (12/26) of Salmonella Typhi isolates.
  
  
  CONCLUSIONS
  In Kilifi, the incidence of invasive NTS was high, especially among newborn infants, but typhoid fever was uncommon. NTS remains an important cause of bacteremia in children <5 years of age.
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Esther
authors.initials: E
authors.lastname: Muthumbi
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Morpeth
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Michael
authors.initials: M
authors.lastname: Ooko
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mwanzu
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Salim
authors.initials: S
authors.lastname: Mwarumba
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Neema
authors.initials: N
authors.lastname: Mturi
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Etyang
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
authors.affiliation: Centre for Microbiological Research, Kenya Medical Research Institute, Nairobi.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kariuki
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D044342:Malnutrition; D008875:Middle Aged; D012307:Risk Factors; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000187:drug effects / Q000302:isolation & purification*; D012477:Salmonella enteritidis / Q000187:drug effects / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification; D012486:Salmonella typhimurium / Q000187:drug effects / Q000302:isolation & purification; D014435:Typhoid Fever / Q000453:epidemiology; D055815:Young Adult
keywords: Kenya; Salmonella; Typhi; incidence; nontyphoidal