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22 - Typhoid, paratyphoid and non-typhoid Salmonella infections

from Section 5 - Bacterial infections

Published online by Cambridge University Press:  05 March 2013

By
Nicholas Feasey  and
Melita Gordon
Edited by
David Mabey ,
Geoffrey Gill ,
Eldryd Parry ,
Martin W. Weber  and
Christopher J. M. Whitty
David Mabey
Affiliation:
London School of Hygiene and Tropical Medicine
Geoffrey Gill
Affiliation:
University of Liverpool
Eldryd Parry
Affiliation:
Tropical Health Education Trust
Martin W. Weber
Affiliation:
World Health Organization, Jakarta
Christopher J. M. Whitty
Affiliation:
London School of Hygiene and Tropical Medicine
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Summary

The problem in Africa

Salmonella infections are among the commonest bacterial isolates from blood cultures throughout Africa. WHO estimates that 12.5 million cases of typhoid fever occur annually world-wide. Most cases are in Asia, but typhoid remains endemic in some areas of Africa, and epidemics are also reported. Invasive non-typhoid salmonella (NTS) infections, a long-standing and common cause of illness and death in African infants and children, have further increased among children and significantly increased among adults as a result of the HIV epidemic.

Whenever an African patient has few signs, yet is ill with a fever, invasive Salmonella infection (either typhoid or non-typhoid) is high on the list of differential diagnoses. Host factors (age, nutrition, malaria, HIV) and local environmental factors will determine whether typhoidal or non-typhoidal disease is most likely. The management of Salmonella sepsis has been complicated by the recent emergence of multidrug resistance.

The organism

Salmonellae are Gram-negative, motile, facultatively anaerobic bacilli, which produce acid on glucose fermentation, reduce nitrates and do not ferment lactose. They can be grown easily on a variety of media. Use of a selective agar, such as XLD or MacConkeys, may be useful if attempting to differentiate them from other organisms, for example, when culturing faeces.

Type
Chapter
Information
Principles of Medicine in Africa , pp. 308 - 315
Publisher: Cambridge University Press
Print publication year: 2013

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