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Clinical definition for invasive Salmonella infection in African children
J S Cheesbrough1, B C Taxman, S D Green
1Tropical Microbiology Centre, University Department of Medical Microbiology, Liverpool, United Kingdom.
Insights
A new clinical definition accurately identifies invasive salmonellosis in African children, even without bacteremia. This aids in diagnosing this common febrile illness, distinguishing it from malaria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Tropical Medicine
Background:
- Invasive salmonellosis is a frequent pediatric illness in tropical Africa.
- It often presents as a nonspecific febrile illness, clinically resembling malaria.
- Early and accurate diagnosis is crucial for effective treatment.
Purpose of the Study:
- To evaluate a clinical definition for identifying invasive salmonellosis in children.
- To differentiate invasive salmonellosis from malaria in a resource-limited setting.
Main Methods:
- A specific clinical definition was applied to children aged 1-15 years.
- Criteria included prolonged fever, lack of a clear infection focus, and negative malaria smears.
- Blood cultures and Salmonella serology were used for confirmation.
Main Results:
- Of 120 children meeting the definition, 46% had bacteremia with Salmonella species.
- Salmonella serology indicated invasive disease in 62% of non-bacteremic children.
- The definition demonstrated a specificity of at least 60%.
Conclusions:
- Invasive salmonellosis without detectable bacteremia is common in this population.
- The developed clinical definition aids in recognizing invasive salmonellosis.
- This definition improves diagnostic accuracy for febrile illnesses in African children.
Background:
Invasive salmonellosis is common among children in tropical Africa, typically presenting as a nonspecific febrile illness that is difficult to distinguish clinically from malaria. This study examines the performance of a clinical definition devised to aid its recognition among children ages 1 to 15 years presenting to a mission hospital in rural Zaire.
Methods:
Invasive salmonellosis was defined by: (1) illness requiring admission to hospital in the opinion of an experience pediatrician; (2) history of fever for 5 or more days; (3) no focus of infection on clinical examination; and (4) negative or only scanty positive thick film for malarial parasites. Children fulfilling all these criteria were treated with ciprofloxacin after culture of blood and feces. The primary outcome measure was blood culture-confirmed salmonellosis. Secondary measures were final clinical diagnosis and serologic evidence of recent salmonellosis.
Results:
Of 120 children fulfilling the definition, 55 (46%) were bacteremia; in 46 (38%) Salmonella species were isolated. In the majority of the nonbacteremic children no definite cause for the fever could be found. Salmonella serology supported invasive salmonellosis as the diagnosis in 62% of the nonbacteremic children.
Conclusion:
Salmonella serology suggested that invasive salmonellosis without detectable bacteremia was common. The addition of blood culture-proved and serologically diagnosed cases indicates that the definition has a specificity of at least 60%.