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Invasive Infections with Nontyphoidal in Sub-Saharan Africa

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  • Authors: Barbara E. Mahon1, Patricia I. Fields2
  • Editors: W. Michael Scheld3, James M. Hughes4, Richard J. Whitley5
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329; 2: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329; 3: Department of Infectious Diseases, University of Virginia Health System, Charlottesville, VA; 4: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 5: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
  • Source: microbiolspec May 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0015-2016
  • Received 27 January 2016 Accepted 29 February 2016 Published 27 May 2016
  • Barbara E. Mahon, bmahon@cdc.gov
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  • Abstract:

    Invasive nontyphoidal (NTS) infections in Africa cause an enormous burden of illness. These infections are often devastating, with mortality estimated at 20%, even with appropriate antimicrobial therapy. Two major groups—young children and HIV-infected adults—suffer the great majority of these infections. In children, younger age itself, as well as malaria, malnutrition, and HIV infection, are prominent risk factors. In adults, HIV infection is by far the most important risk factor. The most common serotypes in invasive infections are serotypes Typhimurium and Enteritidis. In recent years, a specific strain of Typhimurium, multilocus sequence type 313, has caused epidemics of invasive disease. Little is known about risk factors for exposure to NTS, making the design of rational interventions to decrease exposure difficult. Antimicrobial therapy is critically important for treatment of invasive NTS infections. Thus, the emergence and spread of resistance to agents commonly used for treatment of invasive NTS infection, now including third-generation cephalosporins, is an ominous development. Already, many invasive NTS infections are essentially untreatable in many health care facilities in sub-Saharan Africa. Several candidate vaccines are in early development and, if safe and effective, could be promising. Interventions to prevent exposure to NTS (e.g., improved sanitation), to prevent the occurrence of disease if exposure does occur (e.g., vaccination, malaria control), and to prevent severe disease and death in those who become ill (e.g., preserving antimicrobial effectiveness) are all important in reducing the toll of invasive NTS disease in sub-Saharan Africa.

  • Citation: Mahon B, Fields P. 2016. Invasive Infections with Nontyphoidal in Sub-Saharan Africa. Microbiol Spectrum 4(3):EI10-0015-2016. doi:10.1128/microbiolspec.EI10-0015-2016.

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content/journal/microbiolspec/10.1128/microbiolspec.EI10-0015-2016
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/content/journal/microbiolspec/10.1128/microbiolspec.EI10-0015-2016
2016-05-27
2017-07-23

Abstract:

Invasive nontyphoidal (NTS) infections in Africa cause an enormous burden of illness. These infections are often devastating, with mortality estimated at 20%, even with appropriate antimicrobial therapy. Two major groups—young children and HIV-infected adults—suffer the great majority of these infections. In children, younger age itself, as well as malaria, malnutrition, and HIV infection, are prominent risk factors. In adults, HIV infection is by far the most important risk factor. The most common serotypes in invasive infections are serotypes Typhimurium and Enteritidis. In recent years, a specific strain of Typhimurium, multilocus sequence type 313, has caused epidemics of invasive disease. Little is known about risk factors for exposure to NTS, making the design of rational interventions to decrease exposure difficult. Antimicrobial therapy is critically important for treatment of invasive NTS infections. Thus, the emergence and spread of resistance to agents commonly used for treatment of invasive NTS infection, now including third-generation cephalosporins, is an ominous development. Already, many invasive NTS infections are essentially untreatable in many health care facilities in sub-Saharan Africa. Several candidate vaccines are in early development and, if safe and effective, could be promising. Interventions to prevent exposure to NTS (e.g., improved sanitation), to prevent the occurrence of disease if exposure does occur (e.g., vaccination, malaria control), and to prevent severe disease and death in those who become ill (e.g., preserving antimicrobial effectiveness) are all important in reducing the toll of invasive NTS disease in sub-Saharan Africa.

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