MacLennan Calman A, Msefula Chisomo L, Gondwe Esther N, Gilchrist James J, Pensulo Paul, Mandala Wilson L, Mwimaniwa Grace, Banda Meraby, Kenny Julia, Wilson Lorna K, Phiri Amos, MacLennan Jenny M, Molyneux Elizabeth M, Molyneux Malcolm E, Graham Stephen M
Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
School of Immunity and Infection, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
PLoS Negl Trop Dis. 2017 Dec 7;11(12):e0006027. doi: 10.1371/journal.pntd.0006027. eCollection 2017 Dec.
Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8-35.1), dyspnea (OR 4.2; 95%CI 1.5-12.0) and HIV infection (OR 3.3; 95%CI 1.1-10.2) were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children.
非伤寒沙门氏菌通常会在非洲儿童中引发侵袭性疾病，且往往是致命的。这些感染的临床诊断因缺乏明确的临床综合征而受阻。耐药性意味着经验性抗生素治疗常常无效，而且目前尚无可用疫苗。该研究的目的是确定非洲因侵袭性沙门氏菌病住院儿童的死亡风险因素。我们于2006年在布兰太尔的伊丽莎白女王中央医院进行了一项前瞻性研究，纳入连续的经微生物学确诊为侵袭性沙门氏菌病的儿童。通过逻辑回归模型，利用临床表现、合并症和结局的数据来确定有住院死亡风险的儿童。在一个日历年中，连续263名儿童出现侵袭性沙门氏菌病。中位年龄为16个月（范围0至15岁），256名儿童中有52名（20%；95%置信区间15 - 25%）死亡。非伤寒血清型导致了263例中的248例（94%）。259株分离菌中有211株（81%）对多种药物耐药。263名儿童中有251名出现菌血症，6名患有脑膜炎，6名两者皆有。184/240（77%；95%置信区间71 - 82%）的儿童有呼吸道症状，123/240（51%；95%置信区间45 - 58%）有胃肠道症状，101/240（42%；95%置信区间36 - 49%）有重叠的临床综合征。7个月以下发病（比值比10.0；95%置信区间2.8 - 35.1）、呼吸困难（比值比4.2；95%置信区间1.5 - 12.0）和艾滋病毒感染（比值比3.3；95%置信区间1.1 - 10.2）是住院死亡的独立风险因素。马拉维的侵袭性沙门氏菌病的特点是死亡率高、多重耐药分离菌的患病率高以及临床表现不具特异性。幼儿、有呼吸困难的儿童和感染艾滋病毒的儿童在马拉维沙门氏菌相关死亡中承担着不成比例的负担。改善侵袭性沙门氏菌病预防、诊断和管理的策略应针对这些儿童。
