The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa.
BACKGROUND: Country-specific studies in Africa have indicated that Plasmodium falciparum is associated with invasive nontyphoidal Salmonella (iNTS) disease. We conducted a multicenter study in 13 sites in Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania to investigate the relationship between the occurrence of iNTS disease, other systemic bacterial infections, and malaria. METHODS: Febrile patients received a blood culture and a malaria test. Isolated bacteria underwent antimicrobial susceptibility testing, and the association between iNTS disease and malaria was assessed. RESULTS: A positive correlation between frequency proportions of malaria and iNTS was observed (P = .01; r = 0.70). Areas with higher burden of malaria exhibited higher odds of iNTS disease compared to other bacterial infections (odds ratio [OR], 4.89; 95% CI, 1.61-14.90; P = .005) than areas with lower malaria burden. Malaria parasite positivity was associated with iNTS disease (OR, 2.44; P = .031) and gram-positive bacteremias, particularly Staphylococcus aureus, exhibited a high proportion of coinfection with Plasmodium malaria. Salmonella Typhimurium and Salmonella Enteritidis were the predominant NTS serovars (53/73; 73%). Both moderate (OR, 6.05; P = .0001) and severe (OR, 14.62; P < .0001) anemia were associated with iNTS disease. CONCLUSIONS: A positive correlation between iNTS disease and malaria endemicity, and the association between Plasmodium parasite positivity and iNTS disease across sub-Saharan Africa, indicates the necessity to consider iNTS as a major cause of febrile illness in malaria-holoendemic areas. Prevention of iNTS disease through iNTS vaccines for areas of high malaria endemicity, targeting high-risk groups for Plasmodium parasitic infection, should be considered.
Park, SE; Pak, GD; Aaby, P; Adu-Sarkodie, Y; Ali, M; Aseffa, A; Biggs, HM; Bjerregaard-Andersen, M; Breiman, RF; Crump, JA; Cruz Espinoza, LM; Eltayeb, MA; Gasmelseed, N; Hertz, JT; Im, J; Jaeger, A; Parfait Kabore, L; von Kalckreuth, V; Keddy, KH; Konings, F; Krumkamp, R; MacLennan, CA; Meyer, CG; Montgomery, JM; Ahmet Niang, A; Nichols, C; Olack, B; Panzner, U; Park, JK; Rabezanahary, H; Rakotozandrindrainy, R; Sampo, E; Sarpong, N; Schütt-Gerowitt, H; Sooka, A; Soura, AB; Sow, AG; Tall, A; Teferi, M; Yeshitela, B; May, J; Wierzba, TF; Clemens, JD; Baker, S; Marks, F
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