Elsevier

The Lancet

Volume 373, Issue 9659, 17–23 January 2009, Pages 267-269
The Lancet

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Non-typhoidal salmonellae: a management challenge for children with community-acquired invasive disease in tropical African countries

https://doi.org/10.1016/S0140-6736(09)60073-8Get rights and content

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References (23)

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    Improvements in nutritional management as a determinant of reduced mortality from community-acquired lower respiratory tract infection in hospitalized children from rural central Africa

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      S. aureus, S. pneumoniae, H. influenza, K. pneumonia and Escherichia coli have been identified as the most common bacterial pathogens in severely malnourished children with pneumonia [38]. Non-typhoid Salmonella species have also been recognized as important pathogens causing invasive sepsis with clinical features of pneumonia in malaria and HIV-endemic parts of sub-Saharan Africa [39], but its relevance in other settings has not been confirmed [40,41]. Group B streptococci and the atypical bacterium Chlamydia trachomatis may infect babies during vaginal delivery and are mainly restricted to the perinatal period [34]; other atypical bacteria are common respiratory pathogens across the age range.

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      A study of bacteraemia in adults in Malawi69 noted that a combination of high fever and splenomegaly suggested invasive disease, but that diagnosis cannot reliably be made without microbiological tests. In young children especially, a problematic clinical overlap exists with the presentations of pneumonia and malaria,70–72 and paediatric guidelines for empirical diagnosis and treatment in low-income settings fail to identify or treat invasive non-typhoidal salmonella disease. Patients with invasive disease frequently present with apparent focal infection, particularly of the lower respiratory tract, which is commonly attributable to co-infection with other pathogens such as Mycobacterium tuberculosis73 and Streptococcus pneumoniae.68

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      In bacteremia, a third generation cephalosporin or intravenous fluoroquinolone are recommended for 7–14 days. Localized infections require surgical debridement and endovascular infections surgical resection.40,115,160 Treatment concerns are rising globally with the increasing number of expanded-spectrum B-lactamase NTS detected.161–163

    • Impact of human immunodeficiency virus infection on the etiology and outcome of severe pneumonia in malawian children

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      S. typhimurium was the second most common isolate from blood culture after pneumococcus, consistent with earlier reports from rural and urban settings in tropical Africa.14–17 It is debatable how often these children actually have pneumonia rather than septicaemia with clinical overlap.14,18 Three confirmed bacterial “pneumonia” cases had a normal chest x-ray and all had S. typhimurium isolated from blood culture.

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