A Study Performed with Mozambican Children Underlines the Need to Improve the Treatment and Prevention of Salmonella Infections

An epidemiological study performed between 2001 and 2014 with children admitted to the Manhiça District Hospital in rural Mozambique shows that the incidence of invasive infections by Salmonella has declined in the past years but the mortality remains high (around 10%), particularly among children with severe malnutrition or anemia. Furthermore, the antimicrobial resistance to the most commonly used antibiotics has steadily increased, with a predominance of multidrug-resistant strains. The study, led by researchers from ISGlobal and the Manhiça Health Research Center (CISM) and published in the Journal of Clinical Infectious Diseases, highlights the urgent need to strengthen laboratory capacities in Africa for the prompt diagnosis of these bacterial infections.

Invasive infections by nontyphoidal Salmonella (i.e. all Salmonella serotypes except Typhi and Paratyphi) are a prominent cause of sepsis in small children and HIV-infected adults in Africa, and are associated with a high mortality of up to 25%. However, little is known on the incidence and impact of these infections in children living in sub-Saharan Africa, a crucial information to better define preventive and curative strategies. 

In this study, the authors used data collected over 14 years of microbiological surveillance in order to analyse the epidemiological trends in incidence, serotype distribution and antibiotic resistance of infections by NTS in children under 15 years of age that were admitted to the Manhiça District Hospital. The authors found that even though the number of NTS infections has considerably declined over the past years, it is still high compared to estimates from other countries, likely due to the high prevalence of other conditions such as malnutrition, severe anemia or HIV.  Worryingly, the genetic characterization of the serotypes showed an increasing trend for the ST313 variant that is considered to be more virulent. In addition, the results show that the antimicrobial resistance of NTS has increased, with a prevalence of multidrug resistant strains.

The authors conclude that these results underline the need to further investigate NTS infections in Africa in order to improve treatment and preventive strategies. For this, the description of the specific circulating serotypes will be helpful to better define the choice of first-line antibiotics, design vaccines against defined serotypes and estimate how many infections could be prevented with such vaccines or other specific interventions.  específicas.  

Reference:

Mandomando I, Bassat Q, Sigaúque B, Massora S, Quintó L, et al. Invasive Salmonella Infections Among Children From Rural Mozambique, 2001-2014. Clin Infect Dis. 2015 Nov 1;61 Suppl 4:S339-45.