Invasive non-typhoidal salmonella disease: an emerging and neglected tropical disease in Africa.
Invasive non-typhoidal salmonella disease: an emerging and neglected tropical disease in Africa.
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DOI：
10.1016/s0140-6736(11)61752-2
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发表时间：
2012-06-30
期刊：
影响因子：
168.9
通讯作者：
Gordon, Melita A.
中科院分区：
文献类型：
--
作者：
Feasey, Nicholas A.;Dougan, Gordon;Kingsley, Robert A.;Heyderman, Robert S.;Gordon, Melita A.
非伤寒沙门氏菌的侵袭性菌株已成为非洲成人和儿童血流感染的一个重要病因，相关病死率为20% - 25%。非洲侵袭性非伤寒沙门氏菌病的临床表现多样：发热、肝脾肿大和呼吸道症状常见，而小肠结肠炎的特征往往不明显。最重要的危险因素在成人是艾滋病病毒感染，在儿童是疟疾、艾滋病病毒和营养不良。一种独特的肠炎沙门氏菌鼠伤寒变种基因型ST313已在撒哈拉以南非洲成为一个新的致病分支，可能已经适应在人体内引起侵袭性疾病。多重耐药的ST313已在几个非洲国家引发流行，并促使世界上最贫困的卫生服务机构使用昂贵的抗菌药物。对感染艾滋病病毒的成人的全身细胞和体液免疫反应的研究揭示了导致侵袭性非伤寒沙门氏菌病的关键宿主免疫缺陷。因此，这种新出现的病原体可能已经适应了非洲由艾滋病病毒、疟疾和营养不良所提供的生态和免疫 niche（生态位，此处可理解为特定生存环境）。对这种被忽视疾病的流行病学有很好的了解，将为开发和实施疫苗以及公共卫生策略以预防感染和阻断传播开辟新的途径。
Invasive strains of non-typhoidal salmonellae have emerged as a prominent cause of bloodstream infection in African adults and children, with an associated case fatality of 20–25%. The clinical presentation of invasive non-typhoidal salmonella disease in Africa is diverse: fever, hepatosplenomegaly, and respiratory symptoms are common, and features of enterocolitis are often absent. The most important risk factors are HIV infection in adults, and malaria, HIV, and malnutrition in children. A distinct genotype of Salmonella enterica var Typhimurium, ST313, has emerged as a new pathogenic clade in sub-Saharan Africa, and might have adapted to cause invasive disease in human beings. Multidrug-resistant ST313 has caused epidemics in several African countries, and has driven the use of expensive antimicrobial drugs in the poorest health services in the world. Studies of systemic cellular and humoral immune responses in adults infected with HIV have revealed key host immune defects contributing to invasive non-typhoidal salmonella disease. This emerging pathogen might therefore have adapted to occupy an ecological and immunological niche provided by HIV, malaria, and malnutrition in Africa. A good understanding of the epidemiology of this neglected disease will open new avenues for development and implementation of vaccine and public health strategies to prevent infections and interrupt transmission.