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Classifying extraintestinal non-typhoid Salmonella infections
J M Ramos1, P García-Corbeira, J M Aguado
1Department of Medical Microbiology, Fundación Jiménez Díaz, Madrid, Spain.
Abstract:
Non-typhoid Salmonella infection in man has been divided into five clinical groups: gastroenteritis, enteric fever, bacteraemia, chronic carrier state and localized infection. This classification has neither pathogenic nor prognostic significance. We retrospectively reviewed the charts of 183 patients with extraintestinal salmonellosis who presented to our institution during a period of 32 years. Patients were classified into four groups: primary bacteraemia (PB), enteritis-associated bacteraemia (secondary bacteraemia) (SB), digestive focal infection (DI) and non-digestive focal infection (NDI). Sex, age, acquisition, underlying disease and outcome were compared between patients with bacteraemia and diseases with focal infection. The differences found between PB and SB were: community acquisition (66% in PB and 85% in SB, p = 0.06) severe immunosuppression (53% in PB and 15% in SB, p < 0.001) and mortality (37% in PB and 3% in SB, p < 0.001). The differences found between NDI and DI were: age over 60 years (45% in NDI and 18% in DI, p < 0.05), severe immunosuppression (51% in NDI and 12% DI, p < 0.001) and associated bacteraemia (38% in NDI and 6% in DI, p < 0.001). This classification of extraintestinal salmonellosis may have pathogenic and prognostic implications, and could help us to understand the clinical significance of this disease.
Insights
A new classification for extraintestinal salmonellosis distinguishes between primary bacteraemia (PB), secondary bacteraemia (SB), digestive focal infection (DI), and non-digestive focal infection (NDI), offering prognostic insights.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Non-typhoid Salmonella infections present diverse clinical manifestations.
- Existing classifications lack pathogenic and prognostic significance.
- Extraintestinal salmonellosis requires a more clinically relevant categorization.
Purpose of the Study:
- To develop and validate a new classification for extraintestinal salmonellosis.
- To assess the pathogenic and prognostic implications of this novel classification.
- To differentiate between various forms of invasive Salmonella infections.
Main Methods:
- Retrospective chart review of 183 patients with extraintestinal salmonellosis over 32 years.
- Classification into four groups: primary bacteraemia (PB), enteritis-associated bacteraemia (SB), digestive focal infection (DI), and non-digestive focal infection (NDI).
- Comparison of demographic, clinical, and outcome data between groups.
Main Results:
- Significant differences observed between PB and SB regarding community acquisition, immunosuppression, and mortality.
- Key distinctions between NDI and DI include age, immunosuppression, and associated bacteraemia.
- The proposed classification demonstrates potential pathogenic and prognostic value.
Conclusions:
- The novel classification of extraintestinal salmonellosis into PB, SB, DI, and NDI holds clinical significance.
- This classification aids in understanding the distinct pathogenic mechanisms and prognostic outcomes.
- Further research can leverage this framework to improve patient management and outcomes.