title: Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa.
abstract: The aim of this study was to define factors associated with HIV-infected versus uninfected patients with invasive nontyphoidal Salmonella (iNTS) and factors associated with mortality, which are inadequately described in Africa.Laboratory-based surveillance for iNTS was undertaken. At selected sentinel sites, clinical data (age, sex, HIV status, severity of illness, and outcome) were collected.Surveillance was conducted in Gauteng, South Africa, from 2003 to 2013. Clinical and microbiological differences between HIV-infected and uninfected patients were defined and risk factors for mortality established.Of 4886 iNTS infections in Gauteng from 2003 to 2013, 3106 (63.5%) were diagnosed at sentinel sites. Among persons with iNTS infections, more HIV-infected persons were aged ≥5 years (χ = 417.6; P < 0.001) and more HIV-infected children were malnourished (χ = 5.8; P = 0.02). Although 760 (30.6%) patients died, mortality decreased between 2003 [97/263 (36.9%)] and 2013 [926/120 (21.7%)]. On univariate analysis, mortality was associated with patients aged 25 to 49 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.7-2.7; P < 0.001 and ≥50 years (OR = 3.0; 95% CI = 2.2-4.1; P < 0.001) compared with children < 5 years, HIV-infected patients (OR = 2.4; 95% CI = 1.7-3.4; P < 0.001), and severe illness (OR = 5.4; 95% CI = 3.6-8.1; P < 0.001). On multivariate analysis, mortality was associated with patients aged ≥50 years [adjusted OR (AOR) = 3.6, 95% CI = 2.1-6.1, P < 0.001] and severe illness (AOR = 6.3; 95% CI = 3.8-10.5; P < 0.001).Mortality due to iNTS in Gauteng remains high primarily due to disease severity. Interventions must be aimed at predisposing conditions, including HIV, other immune-suppressive conditions, and malignancy.
authors.affiliation: Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service Faculty of Health Sciences, University of the Witwatersrand, Johannesburg International Emerging Infections Program, South Africa Global Disease Detection Centre, Centers for Disease Control and Prevention, Pretoria National Health Laboratory Service Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg Sefako Makgatho University, Pretoria University of Limpopo, Polokwane, South Africa Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA Bill and Melinda Gates Foundation, Seattle, WA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.forename: Alfred
authors.initials: A
authors.lastname: Musekiwa
authors.forename: Arvinda
authors.initials: A
authors.lastname: Sooka
authors.forename: Alan
authors.initials: A
authors.lastname: Karstaedt
authors.forename: Trusha
authors.initials: T
authors.lastname: Nana
authors.forename: Sharona
authors.initials: S
authors.lastname: Seetharam
authors.forename: Maphoshane
authors.initials: M
authors.lastname: Nchabaleng
authors.forename: Ruth
authors.initials: R
authors.lastname: Lekalakala
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012480:Salmonella Infections / Q000401:mortality* / Q000821:virology*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult