Invasive nontyphoidal Salmonella disease: epidemiology, pathogenesis and diagnosis

This review highlights and discusses important publications over the past 12 months providing new insights on invasive nontyphoidal Salmonella (iNTS) disease.

There have been informative new estimates of the burden of iNTS in Asia and in high-resource, low-incidence settings. Important information has emerged in the last year about the relationships between HIV, malaria, iNTS and typhoid fever in adults and children in Africa. HIV causes susceptibility to iNTS disease, but has been shown to be protective against typhoid fever. Clinical guidelines for presumptive diagnosis frequently fail to identify iNTS disease in Africa, and there remains a need for improved diagnostic tools. Experimental studies in humans have helped us to understand the intracellular pathogenesis of iNTS and to direct the search for appropriate protein vaccine targets.

The most important remaining gap in our knowledge is probably an understanding of how NTS is transmitted, and the nature of the relationship between diarrhoeal disease, carriage and invasive disease in Africa, so that diagnostic and prevention tools can be appropriately directed.