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Non-typhi salmonella in children with severe malaria
1Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Insights
Non-typhi Salmonella (NTS) and severe malaria frequently co-occur in children, posing a significant health challenge. Many NTS isolates exhibit multidrug resistance, complicating treatment options for these coinfections.
Area of Science:
- Pediatric Infectious Diseases
- Tropical Medicine
- Microbiology
Background:
- Plasmodium falciparum malaria is a major cause of childhood illness in endemic regions.
- Non-typhi Salmonella (NTS) infections are also significant pediatric pathogens.
- The co-occurrence of malaria and NTS may influence disease severity and outcomes.
Purpose of the Study:
- To investigate the association between Plasmodium falciparum malaria and non-typhi Salmonella infections in hospitalized children.
- To determine the prevalence of NTS in children with malaria and assess antibiotic resistance patterns.
Main Methods:
- A cross-sectional hospital-based study was conducted at Kilifi District Hospital.
- Blood and stool cultures were analyzed from 9,147 children admitted with malaria between 1997 and 2001.
- Antibiotic sensitivity testing was performed on isolated NTS strains.
Main Results:
- Non-typhi Salmonella was identified in 1.10% of malaria admissions.
- NTS was found in 18.6% of positive blood cultures and 28.4% of stool cultures.
- Multidrug resistance (MDR) was observed in 33.6% of NTS isolates, with significant resistance to common antibiotics.
Conclusions:
- The co-existence of NTS and severe malaria is a notable public health issue in the study area.
- A substantial proportion of NTS isolates demonstrate multidrug resistance, necessitating careful antibiotic selection.
- Further case-controlled studies are recommended to understand the interplay between NTS and malaria parasite infections.
Objective:
To determine the association between Plasmodium falciparum malaria and non-typhi Salmonella in children.
Design:
Cross-sectional hospital based study.
Setting:
Kilifi District Hospital (KDH) between January 1997 and June 2001.
Subjects:
Children aged between three months to 123 months (mean age 28.28 months) and who had been admitted to the paediatric or High Dependency Research Ward (HDRW) of the KDH.
Methods:
A total of 19, 118 blood cultures routinely obtained for all admissions and 1,820 clinically indicated stools samples were obtained from 9,147 children admitted with malaria. The specimens were cultured and antibiotic sensitivity done using standard laboratory procedures with stringent internal and external quality control in place.
Results:
The total bacterial pathogens isolated from blood and stool were 1,395/19,118 (7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395 (18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out of which a total of 101 NTS occurred in children with severe malaria. Out of the 9,147 malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS with severe malaria as a proportion of all malaria admissions for the period varied between 0.8% and 1.5%. There was a significant association (p-value=0.032) between clinical outcome of death and female sex of the patient. The NTS isolates which occurred with severe malaria showed various levels of antibiotic resistance. They were resistant to ampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%), sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%), amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR) was seen in 34 (33.6%) of the isolates.
Conclusions:
NTS and severe malaria occurring together are a problem in this area and that a large number of the isolates are MDR. An elaborate case-controlled study is required to elucidate the chain of events of both NTS and malaria parasite co-existence.