title: The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa.
abstract: BACKGROUND
  Country-specific studies in Africa have indicated that Plasmodium falciparum is associated with invasive nontyphoidal Salmonella (iNTS) disease. We conducted a multicenter study in 13 sites in Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania to investigate the relationship between the occurrence of iNTS disease, other systemic bacterial infections, and malaria.
  
  
  METHODS
  Febrile patients received a blood culture and a malaria test. Isolated bacteria underwent antimicrobial susceptibility testing, and the association between iNTS disease and malaria was assessed.
  
  
  RESULTS
  A positive correlation between frequency proportions of malaria and iNTS was observed (P = .01; r = 0.70). Areas with higher burden of malaria exhibited higher odds of iNTS disease compared to other bacterial infections (odds ratio [OR], 4.89; 95% CI, 1.61-14.90; P = .005) than areas with lower malaria burden. Malaria parasite positivity was associated with iNTS disease (OR, 2.44; P = .031) and gram-positive bacteremias, particularly Staphylococcus aureus, exhibited a high proportion of coinfection with Plasmodium malaria. Salmonella Typhimurium and Salmonella Enteritidis were the predominant NTS serovars (53/73; 73%). Both moderate (OR, 6.05; P = .0001) and severe (OR, 14.62; P < .0001) anemia were associated with iNTS disease.
  
  
  CONCLUSIONS
  A positive correlation between iNTS disease and malaria endemicity, and the association between Plasmodium parasite positivity and iNTS disease across sub-Saharan Africa, indicates the necessity to consider iNTS as a major cause of febrile illness in malaria-holoendemic areas. Prevention of iNTS disease through iNTS vaccines for areas of high malaria endemicity, targeting high-risk groups for Plasmodium parasitic infection, should be considered.
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Se Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Gi Deok
authors.initials: GD
authors.lastname: Pak
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins University, Baltimore, Maryland.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Bjerregaard-Andersen
authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya Emory Global Health Institute, Emory University, Atlanta, Georgia.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Duke Global Health Institute, Duke University, Durham, North Carolina Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ligia Maria
authors.initials: LM
authors.lastname: Cruz Espinoza
authors.affiliation: University of Gezira, Wad Medani, Sudan.
authors.forename: Muna Ahmed
authors.initials: MA
authors.lastname: Eltayeb
authors.affiliation: University of Gezira, Wad Medani, Sudan.
authors.forename: Nagla
authors.initials: N
authors.lastname: Gasmelseed
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Julian T
authors.initials: JT
authors.lastname: Hertz
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Justin
authors.initials: J
authors.lastname: Im
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Jaeger
authors.affiliation: Schiphra Hospital, Ouagadougou, Burkina Faso.
authors.forename: Leon
authors.initials: L
authors.lastname: Parfait Kabore
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Vera
authors.initials: V
authors.lastname: von Kalckreuth
authors.affiliation: National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Frank
authors.initials: F
authors.lastname: Konings
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krumkamp
authors.affiliation: Jenner Institute, Nuffield Department of Medicine, University of Oxford Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom.
authors.forename: Calman A
authors.initials: CA
authors.lastname: MacLennan
authors.affiliation: Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: Institute Pasteur Senegal, Dakar.
authors.forename: Aissatou
authors.initials: A
authors.lastname: Ahmet Niang
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Nichols
authors.affiliation: Kenya Medical Research Institute (KEMRI), Nairobi.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Olack
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ursula
authors.initials: U
authors.lastname: Panzner
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Park
authors.affiliation: University of Antananarivo, Madagascar.
authors.forename: Henintsoa
authors.initials: H
authors.lastname: Rabezanahary
authors.affiliation: University of Antananarivo, Madagascar.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Rakotozandrindrainy
authors.affiliation: Schiphra Hospital, Ouagadougou, Burkina Faso Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sampo
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine.
authors.forename: Nimako
authors.initials: N
authors.lastname: Sarpong
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schütt-Gerowitt
authors.affiliation: National Institute for Communicable Diseases.
authors.forename: Arvinda
authors.initials: A
authors.lastname: Sooka
authors.affiliation: Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso.
authors.forename: Abdramane Bassiahi
authors.initials: AB
authors.lastname: Soura
authors.affiliation: Institute Pasteur Senegal, Dakar Université Cheikh Anta Diop de Dakar, Senegal.
authors.forename: Amy Gassama
authors.initials: AG
authors.lastname: Sow
authors.affiliation: Institute Pasteur Senegal, Dakar.
authors.forename: Adama
authors.initials: A
authors.lastname: Tall
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Mekonnen
authors.initials: M
authors.lastname: Teferi
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Biruk
authors.initials: B
authors.lastname: Yeshitela
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Fielding School of Public Health, University of California, Los Angeles.
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
authors.affiliation: Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D019779:Salmonella enterica; D055815:Young Adult
keywords: NTS; Plasmodium; Salmonella; invasive NTS; malaria