Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.
PLoS One. 2012;7(2):e31237. doi: 10.1371/journal.pone.0031237. Epub 2012 Feb 21.
The epidemiology of non-Typhi Salmonella (NTS) bacteremia in Africa will likely evolve as potential co-factors, such as HIV, malaria, and urbanization, also change.
As part of population-based surveillance among 55,000 persons in malaria-endemic, rural and malaria-nonendemic, urban Kenya from 2006-2009, blood cultures were obtained from patients presenting to referral clinics with fever ≥38.0°C or severe acute respiratory infection. Incidence rates were adjusted based on persons with compatible illnesses, but whose blood was not cultured.
NTS accounted for 60/155 (39%) of blood culture isolates in the rural and 7/230 (3%) in the urban sites. The adjusted incidence in the rural site was 568/100,000 person-years, and the urban site was 51/100,000 person-years. In both sites, the incidence was highest in children <5 years old. The NTS-to-typhoid bacteremia ratio in the rural site was 4.6 and in the urban site was 0.05. S. Typhimurium represented >85% of blood NTS isolates in both sites, but only 21% (urban) and 64% (rural) of stool NTS isolates. Overall, 76% of S. Typhimurium blood isolates were multi-drug resistant, most of which had an identical profile in Pulse Field Gel Electrophoresis. In the rural site, the incidence of NTS bacteremia increased during the study period, concomitant with rising malaria prevalence (monthly correlation of malaria positive blood smears and NTS bacteremia cases, Spearman's correlation, p = 0.018 for children, p = 0.16 adults). In the rural site, 80% of adults with NTS bacteremia were HIV-infected. Six of 7 deaths within 90 days of NTS bacteremia had HIV/AIDS as the primary cause of death assigned on verbal autopsy.
NTS caused the majority of bacteremias in rural Kenya, but typhoid predominated in urban Kenya, which most likely reflects differences in malaria endemicity. Control measures for malaria, as well as HIV, will likely decrease the burden of NTS bacteremia in Africa.
随着潜在的共同因素（如 HIV、疟疾和城市化）的变化，非洲非伤寒沙门氏菌（NTS）菌血症的流行病学情况可能会发生变化。
作为 2006 年至 2009 年间在肯尼亚疟疾流行的农村和非疟疾流行的城市中对 55000 人进行的基于人群的监测的一部分，从发热≥38.0°C 或严重急性呼吸道感染的就诊患者中采集血培养。发病率根据有相似疾病但未进行血液培养的患者进行了调整。
NTS 占农村地区 155 例血培养分离株中的 60 例（39%）和城市地区 230 例中的 7 例（3%）。农村地区的调整发病率为 568/100000 人年，城市地区为 51/100000 人年。在这两个地区，发病率均在<5 岁的儿童中最高。农村地区的 NTS 与伤寒菌血症的比值为 4.6，城市地区为 0.05。农村和城市地区血 NTS 分离株中，鼠伤寒沙门氏菌占比均超过 85%，但粪便 NTS 分离株中仅分别占 21%（城市）和 64%（农村）。总体而言，76%的鼠伤寒沙门氏菌血分离株对多种药物具有耐药性，其中大多数在脉冲场凝胶电泳中的图谱相同。在农村地区，随着疟疾发病率的上升（疟疾阳性血涂片和 NTS 菌血症病例的每月相关性，Spearman 相关性，儿童为 p=0.018，成人 p=0.16），NTS 菌血症的发病率在研究期间有所增加。在农村地区，80%的 NTS 菌血症成人感染了 HIV。在 NTS 菌血症后 90 天内死亡的 6 例中，有 6 例因艾滋病毒/艾滋病而被作为主要死因进行了口头尸检。
NTS 是肯尼亚农村地区菌血症的主要原因，但在肯尼亚城市地区，伤寒沙门氏菌占主导地位，这很可能反映了疟疾流行率的差异。疟疾以及艾滋病毒的控制措施可能会降低非洲 NTS 菌血症的负担。
