Invasive nontyphoidal Salmonella disease in southern India: a 5-year experience from a tertiary care hospital
Background/aim: The current study was carried out to describe the clinical presentation, antimicrobial susceptibility pattern, and
outcome of invasive nontyphoidal Salmonella disease (iNTS) in a tertiary care center.
Materials and methods: A 5-year hospital-based retrospective study was carried out on blood culture-confirmed cases of iNTS. Medical
records of patients were reviewed to obtain information on demography, clinical manifestations, comorbidities, complications, immune
status, treatment, and clinical outcome.
Results: A total of 40 blood culture-confirmed cases of iNTS were diagnosed during the study period. Among these 40 isolates, 9
(22.5%) were identified as Salmonella Typhimurium. Fever (67.5%) with gastrointestinal disturbance (40%) was the most common
clinical presentation. The majority of the patients were immunosuppressed (75%). All isolates were susceptible to all the antimicrobials
tested. Ceftriaxone (92.5%) was the most common antimicrobial used in our setting. A total of 15% patients died during the hospital
stay.
Conclusion: We conclude that iNTS disease is a severe infection prevailing in India with a high mortality rate. Anemia and diabetes
were the two most common comorbidities. Though all NTS organisms isolated were sensitive to all the antimicrobials tested, we suggest
that continued surveillance is necessary to monitor the presence of multidrug-resistant strains.
___
- Ao TT, Feasey NA, Gordon MA, Keddy KH, Angulo FJ, Crump
JA. Global burden of invasive nontyphoidal Salmonella disease,
2010. Emerg Infect Dis 2015; 21: 941.
- Kariuki S, Revathi G, Kariuki N, Kiiru J, Mwituria J, Muyodi
J, Githinji JW, Kagendo D, Munyalo A, Hart CA. Invasive
multidrug-resistant nontyphoidal Salmonella infections
in Africa: zoonotic or anthroponotic transmission? J Med
Microbiol 2006; 55: 585-591.
- Mtove G, Amos B, Von Seidlein L, Hendriksen I, Mwambuli
A, Kimera J, Mallahiyo R, Kim DR, Ochiai RL, Clemens JD et
al. Invasive salmonellosis among children admitted to a rural
Tanzania hospital and a comparison with previous studies.
PLoS One 2010; 5: e9244.
- Tabu C, Breiman RF, Ochieng B, Aura B, Cosmas L, Audi A,
Olack B, Bigogo G, Ongus JR, Fields P et al. Differing burden
and epidemiology of non-typhi Salmonella bacteremia in rural
and urban Kenya, 2006–2009. PLoS One 2012; 7: e31237.
- Biggs HM, Lester R, Nadjm B, Mtove G, Todd JE, Kinabo
GD, Philemon R, Amos B, Morrissey AB, Reyburn H et al.
Invasive Salmonella infections in areas of high and low malaria
transmission intensity in Tanzania. Clin Infect Dis 2014; 58:
638-647.
- Laupland KB, Schønheyder HC, Kennedy KJ, Lyytikäinen O,
Valiquette L, Galbraith J, Collignon P. Salmonella enterica
bacteremia: a multi-national population-based cohort study.
BMC Infect Dis 2010; 10: 95.
- Graham SM, Walsh AL, Molyneux EM, Phiri AJ, Molyneux ME.
Clinical presentation of nontyphoidal Salmonella bacteremia
in Malawian children. T Roy Soc Trop Med H 2000; 94: 310-
314.
- Gordon MA, Graham SM, Walsh AL, Wilson L, Phiri A,
Molyneux E, Zijlstra EE, Heyderman RS, Hart CA, Molyneux
ME. Epidemics of invasive Salmonella enterica serovar
Enteritidis and S. enterica serovar Typhimurium infection
associated with multidrug resistance among adults and
children in Malawi. Clin Infect Dis 2008; 46: 963-969.
- Million Death Study Collaborators. Causes of neonatal and
child mortality in India: a nationally representative mortality
survey. Lancet 2010; 376: 1853-1860.
- Clinical and Laboratory Standards Institute. Performance
Standards for Antimicrobial Susceptibility Testing: 24th
Informational Supplement, M100-S24. Wayne, PA, USA:
Clinical and Laboratory Standards Institute; 2014.
- Lan NP, Phuong TL, Huu HN, Thuy L, Mather AE, Park
SE, Marks F, Thwaites GE, Chau NV, Thompson CN et al.
Invasive nontyphoidal Salmonella infections in Asia: clinical
observations, disease outcome and dominant serovars from an
infectious disease hospital in Vietnam. PLoS Neglect Trop D
2016; 10: e0004857.
- Li CW, Chen PL, Lee NY, Lee HC, Chang CM, Lee CC, Ko
WC. Non-typhoidal Salmonella bacteremia among adults: an
adverse prognosis in patients with malignancy. J Microbiol
Immunol 2012; 45: 343-349.
- Dhanoa A, Fatt QK. Non-typhoidal Salmonella bacteraemia:
epidemiology, clinical characteristics, and its association with
severe immunosuppression. Ann Clin Microb Anti 2009; 8: 15.
- Khan MI, Ochiai RL, Von Seidlein L, Dong B, Bhattacharya
SK, Agtini MD, Bhutta ZA, Do GC, Ali M, Kim DR et al. Non-
typhoidal Salmonella rates in febrile children at sites in five
Asian countries. Trop Med Int Health 2010; 15: 960-963.
- Gordon MA. Invasive non-typhoidal Salmonella disease:
epidemiology, pathogenesis and diagnosis. Curr Opin Infect
Dis 2011; 24: 484.
- Mandomando I, Bassat Q, Sigaúque B, Massora S, Quintó L,
Ácacio S, Nhampossa T, Vubil D, Garrine M, Macete E et al.
Invasive Salmonella infections among children from rural
Mozambique, 2001–2014. Clin Infect Dis 2015; 61: S339-345.
- Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon
MA. Invasive non-typhoidal Salmonella disease: an emerging
and neglected tropical disease in Africa. Lancet 2012; 379:
2489-2499.
- Gordon MA. Salmonella infections in immunocompromised
adults. J Infection 2008; 56: 413-422.
- Brenchley JM, Douek DC. HIV infection and the
gastrointestinal immune system. Mucosal Immunol 2008; 1:
23.
- MacLennan CA, Gilchrist JJ, Gordon MA, Cunningham
AF, Cobbold M, Goodall M, Kingsley RA, van Oosterhout
JJ, Msefula CL, Mandala WL et al. Dysregulated humoral
immunity to nontyphoidal Salmonella in HIV-infected African
adults. Science 2010; 328: 508-512.
- Gondwe EN, Molyneux ME, Goodall M, Graham SM,
Mastroeni P, Drayson MT, MacLennan CA. Importance of
antibody and complement for oxidative burst and killing of
invasive nontyphoidal Salmonella by blood cells in Africans. P
Natl Acad Sci USA 2010; 107: 3070-3075.
- Roux CM, Butler BP, Chau JY, Paixao TA, Cheung KW, Santos
RL, Luckhart S, Tsolis RM. Both hemolytic anemia and malaria
parasite-specific factors increase susceptibility to nontyphoidal
Salmonella enterica serovar typhimurium infection in mice.
Infect Immun 2010; 78: 1520-1527.
- Williams TN, Uyoga S, Macharia A, Ndila C, McAuley CF,
Opi DH, Mwarumba S, Makani J, Komba A, Ndiritu MN et
al. Bacteraemia in Kenyan children with sickle-cell anemia: a
retrospective cohort and case-control study. Lancet 2009; 374:
1364-1370.
- Retornaz F, Fournier PE, Seux V, Jacomo V, Soubeyrand J.
A case of Salmonella enteritidis septicemia complicated by
disseminated intravascular coagulation, severe hepatitis,
rhabdomyolysis and acute renal failure. Eur J Clin Microbiol
1999; 18: 830-831.
- Janssen van Doorn K, Pierard D, Spapen H. Acute renal
dysfunction in salmonella gastroenteritis. J Clin Gastroenterol
2006; 40: 910-912.
- Campistol JM, Villa FP, Montoliu J, Moreno A, Revert L.
Rhabdomyolysis and acute renal failure associated with
Salmonella enteritidis infection. J Hosp Infect 1989; 14: 267-
268.
- Lin WR, Chang CT, Yen TH, Lin JL. Diarrhea associated acute
renal failure in a patient with Salmonella enteritidis sepsis.
Renal Failure 2002; 24: 535-538.
- Man A, Sheniac A. Rhabdomyolysis associated with Salmonella
group C gastroenteritis in a patient suffering from chronic
renal failure. Nephron 1991; 59: 317-318.
- Abdulla AJ, Moorhead JF, Sweny P. Acute tubular necrosis due
to rhabdomyolysis and pancreatitis associated with Salmonella
enteritidis food poisoning. Nephrol Dial Transpl 1993; 8: 672-
673.
- Rus RR, Kersnik Levart T. Acute pyelonephritis with renal
abscesses and acute renal failure after Salmonella infection.
Acta Paediatr 2010; 99: 470-473.
- Blaauw AA, Tobe TJ, Derksen RW, Bijlsma JW. A patient with
systemic lupus erythematosus and Salmonella enteritidis
bacteraemia complicated by rhabdomyolysis and acute
cholecystitis. Rheumatology 2000; 39: 110-112.
- Chetanbhai MF, Eshwara KV, Vinay P, Chiranjay M.
Nontyphoidal salmonellosis and multiple ring enhancing
lesions in the brain of an HIV infected adult: a diagnostic
dilemma. Asian Pac J Trop Dis 2015; 2: 151-152.
- Randhawa VS, Mehta G, Das A, Chugh A, Aneja S. Rare
serotype non-typhoidal Salmonella sepsis. Indian J Pediatr
2006; 73: 1039-1040.
- Fomda BA, Charoo BA, Bhat JA, Reyaz N, Maroof P, Naik
MI. Recurrent meningitis due to Salmonella enteritidis: a case
report from Kashmir India. Indian J Med Microbi 2012; 30:
474.
- Vandana KE, Bairy I, Rao PS, Kabir B. Prolonged fever in HIV
disease due to Salmonella enteritidis. Indian J Med Microbi
2008; 26: 399.
- Shahane V, Muley V, Kagal A, Bharadwaj R. Non-typhoid
salmonellosis: emerging infection in Pune? Indian J Med
Microbi 2007; 25: 173.
- Okoro CK, Kingsley RA, Connor TR, Harris SR, Parry CM,
Al-Mashhadani MN, Kariuki S, Msefula CL, Gordon MA,
De Pinna E et al. Intracontinental spread of human invasive
Salmonella Typhimurium pathovariants in sub-Saharan
Africa. Nat Genet 2012; 44: 1215.
- Kingsley RA, Msefula CL, Thomson NR, Kariuki S, Holt KE,
Gordon MA, Harris D, Clarke L, Whitehead S, Sangal V et al.
Epidemic multiple drug resistant Salmonella Typhimurium
causing invasive disease in sub-Saharan Africa have a distinct
genotype. Genome Res 2009; 19: 2279-2287.
- Angelo KM, Reynolds J, Karp BE, Hoekstra RM, Scheel CM,
Friedman C. Antimicrobial resistance among nontyphoidal
Salmonella isolated from blood in the United States, 2003–
2013. J Infect Dis 2016; 214: 1565-1570.
- Shahunja KM, Leung DT, Ahmed T, Bardhan PK, Ahmed
D, Qadri F, Ryan ET, Chisti MJ. Factors associated with non-
typhoidal Salmonella bacteremia versus typhoidal Salmonella
bacteremia in patients presenting for care in an urban diarrheal
disease hospital in Bangladesh. PLoS Neglect Trop D 2015; 9:
e0004066.