Invasive Non-typhoidal Salmonella Infections in Asia: Clinical Observations, Disease Outcome and Dominant Serovars from an Infectious Disease Hospital in Vietnam

PLoS Negl Trop Dis. 2016 Aug 11;10(8):e0004857. doi: 10.1371/journal.pntd.0004857. eCollection 2016 Aug.

Abstract

Invasive non-typhoidal Salmonella (iNTS) infections are now a well-described cause of morbidity and mortality in children and HIV-infected adults in sub-Saharan Africa. In contrast, the epidemiology and clinical manifestations of iNTS disease in Asia are not well documented. We retrospectively identified >100 cases of iNTS infections in an infectious disease hospital in Southern Vietnam between 2008 and 2013. Clinical records were accessed to evaluate demographic and clinical factors associated with iNTS infection and to identify risk factors associated with death. Multi-locus sequence typing and antimicrobial susceptibility testing was performed on all organisms. Of 102 iNTS patients, 71% were HIV-infected, >90% were adults, 71% were male and 33% reported intravenous drug use. Twenty-six/92 (28%) patients with a known outcome died; HIV infection was significantly associated with death (p = 0.039). S. Enteritidis (Sequence Types (ST)11) (48%, 43/89) and S. Typhimurium (ST19, 34 and 1544) (26%, 23/89) were the most commonly identified serovars; S. Typhimurium was significantly more common in HIV-infected individuals (p = 0.003). Isolates from HIV-infected patients were more likely to exhibit reduced susceptibility against trimethoprim-sulfamethoxazole than HIV-negative patients (p = 0.037). We conclude that iNTS disease is a severe infection in Vietnam with a high mortality rate. As in sub-Saharan Africa, HIV infection was a risk factor for death, with the majority of the burden in this population found in HIV-infected adult men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents / therapeutic use
  • Ceftriaxone / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Fluoroquinolones / therapeutic use
  • HIV Infections / epidemiology
  • HIV Infections / microbiology*
  • Hospitals
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multilocus Sequence Typing
  • Multivariate Analysis
  • Retrospective Studies
  • Salmonella Infections / drug therapy
  • Salmonella Infections / epidemiology*
  • Salmonella Infections / mortality*
  • Salmonella enterica / classification
  • Salmonella enterica / isolation & purification
  • Serogroup
  • Sex Factors
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Typhoid Fever
  • Vietnam / epidemiology

Substances

  • Anti-Infective Agents
  • Fluoroquinolones
  • Ceftriaxone
  • Trimethoprim, Sulfamethoxazole Drug Combination