期刊
CLINICAL INFECTIOUS DISEASES
卷 61, 期 -, 页码 S272-S282出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/civ685
关键词
Salmonella; meningitis; HIV; Salmonella Typhimurium ST313
资金
- Bill & Melinda Gates Foundation [OPP1125993]
- NICD/NHLS
- President's Emergency Plan for AIDS Relief through CDC [5U2GPS001328]
- US Agency for International Development Antimicrobial Resistance Initiative from CDC [U60/CCU022088]
- STD, and TB Prevention, Global AIDS Program Cooperative Agreement [U62/PSO022901]
- CDC, National Center for HIV/AIDS, Viral Hepatitis
- Bill and Melinda Gates Foundation [OPP1125993] Funding Source: Bill and Melinda Gates Foundation
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.
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