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Review
. 2015 Nov 1;61 Suppl 4(Suppl 4):S272-82.
doi: 10.1093/cid/civ685.

Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013

Karen H Keddy  1 , Arvinda Sooka  2 , Alfred Musekiwa  3 , Anthony M Smith  1 , Husna Ismail  2 , Nomsa P Tau  2 , Penny Crowther-Gibson  4 , Frederick J Angulo  5 , Keith P Klugman  6 ; Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA)
Collaborators, Affiliations
Review

Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013

Karen H Keddy et al. Clin Infect Dis. .

Abstract

Background: The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed.

Methods: From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13.

Results: Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P = .039).Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P < .001).

Conclusions: NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.

Keywords: HIV; Salmonella; Salmonella Typhimurium ST313; meningitis.

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Figures

Figure 1.
Figure 1.
Patients with nontyphoidal Salmonella (NTS) meningitis identified in South Africa, 2003–2013. *Invasive disease was defined as the isolation of NTS from a normally sterile body site. Abbreviations: HIV, human immunodeficiency virus; ST, sequence type.
Figure 2.
Figure 2.
A, Number of cases of nontyphoidal Salmonella (NTS) meningitis (n = 256) by age group, 2003–2013. B, Number of cases of NTS meningitis (n = 111) by age group and mortality, 2003–2013. One patient who recovered did not have an age recorded. C, Number of cases of NTS meningitis (n = 91) by age group and human immunodeficiency virus (HIV) status, 2003–2013. One HIV-infected patient did not have an age recorded.
See this image and copyright information in PMC

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