Invasive nontyphoidal Salmonella disease in southern India: a 5-year experience from a tertiary care hospital

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, andoutcome 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. Medicalrecords of patients were reviewed to obtain information on demography, clinical manifestations, comorbidities, complications, immunestatus, 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 commonclinical presentation. The majority of the patients were immunosuppressed (75%). All isolates were susceptible to all the antimicrobialstested. Ceftriaxone (92.5%) was the most common antimicrobial used in our setting. A total of 15% patients died during the hospitalstay.Conclusion: We conclude that iNTS disease is a severe infection prevailing in India with a high mortality rate. Anemia and diabeteswere the two most common comorbidities. Though all NTS organisms isolated were sensitive to all the antimicrobials tested, we suggestthat 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. Nontyphoidal 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 nontyphoidal 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.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK