Nontyphoidal salmonellal septicemia in Gabonese children infected with Schistosoma intercalatum
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D Gendrel1, M Kombila, G Beaudoin-Leblevec
1Hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Schistosoma intercalatum infections in children with severe salmonellal septicemia are common in Gabon. Antiparasitic therapy was necessary for antibiotic treatment to reduce fever, suggesting a significant interaction between these infections.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Parasitology
Background:
- Schistosoma intercalatum relapses have been noted in Central Africa.
- Enteric fever is a significant health concern in affected regions.
Purpose of the Study:
- To investigate the prevalence of Schistosoma intercalatum infection in children hospitalized with septicemic salmonellosis in Libreville, Gabon.
- To explore potential interactions between S. intercalatum and Salmonella species in pediatric cases.
Main Methods:
- Rectal biopsies were performed on 70 HIV-seronegative children hospitalized for septicemic salmonellosis.
- Histopathological examination of biopsies identified Schistosoma intercalatum eggs.
- Salmonella species were isolated and identified from blood cultures.
Main Results:
- Schistosomal eggs were found in 90.6% of patients with nontyphoidal Salmonella septicemia and 64.7% of those with Salmonella typhi/paratyphi septicemia.
- Coinfection did not alter clinical symptoms compared to enteric fever alone.
- Fever reduction in 30 patients required both antibiotic and antiparasitic treatment.
Conclusions:
- Strong evidence suggests interactions between Schistosoma intercalatum and Salmonella in children with severe nontyphoidal salmonellal septicemia.
- Antiparasitic treatment is crucial for managing severe Salmonella infections in co-infected children.
- This highlights the importance of considering parasitic infections in febrile illnesses in endemic areas.
Abstract:
Relapses of enteric fever induced by Schistosoma intercalatum have been observed to occur in central Africa. In Libreville, Gabon, 70 children (ages, 2.1-15.9 years) who were seronegative for human immunodeficiency virus and were hospitalized for septicemic salmonellosis underwent rectal biopsy for diagnosis of S. intercalatum infection. A nontyphoidal Salmonella species was isolated from 53 of the 70 patients: Salmonella typhimurium in 14 cases; Salmonella enteritidis in 7 cases; Salmonella galiema in 4 cases; Salmonella arizonae in 3 cases; and other species in 25 cases. Schistosomal eggs were present in the rectal mucosa of 48 (90.6%) of these 53 patients, in 11 (64.7%) of 17 patients with septicemia due to Salmonella typhi or Salmonella paratyphi, and in 21 (38.2%; P < .001) of 55 controls. Clinical symptoms were not different among patients coinfected with S. intercalatum and nontyphoidal Salmonella vs. those with enteric fever. Treatment with antibiotics induced apyrexia only after administration of antiparasitic therapy in 30 patients. These data strongly suggest interactions between S. intercalatum and Salmonella in infected children with clinically severe nontyphoidal salmonellal septicemia.