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Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo

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Abstract

Salmonella enterica is the leading cause of bloodstream infection in children in sub-Saharan Africa, but few data are available from Central-Africa. We documented during the period November 2011 to May 2012 an epidemic increase in invasive Salmonella bloodstream infections in HGR Bwamanda, a referral hospital in Equateur Province, DR Congo. Salmonella spp. represented 90.4 % (103 out of 114) of clinically significant blood culture isolates and comprised Salmonella Typhimurium (54.4 %, 56 out of 103), Salmonella Enteritidis (28.2 %, 29 out of 103) and Salmonella Typhi (17.5 %, 18 out of 103), with Salmonella Enteritidis accounting for most of the increase. Most (82 out of 103, 79.6 %) isolates were obtained from children < 5 years old. Median ages of patients infected with Salmonella Typhimurium and Salmonella Enteritidis were 14 months (14 days to 64 years) and 19 months (3 months to 8 years) respectively. Clinical presentation was non-specific; the in-hospital case fatality rate was 11.1 %. More than two thirds (69.7 %, 53 out of 76) of children < 5 years for whom laboratory data were available had Plasmodium falciparum infection. Most (83/85, 97.6 %) non-typhoid Salmonella isolates as well as 6/18 (33.3 %) Salmonella Typhi isolates were multidrug resistant (i.e. resistant to the first-line oral antibiotics amoxicillin, trimethoprim-sulfamethoxazole and chloramphenicol), one (1.0 %) Salmonella Typhimurium had decreased ciprofloxacin susceptibility owing to a point mutation in the gyrA gene (Gly81Cys). Multilocus variable-number tandem-repeat (MLVA) analysis of the Salmonella Enteritidis isolates revealed closely related patterns comprising three major and four minor profiles, with differences limited to one out of five loci. These data show an epidemic increase in clonally related multidrug-resistant Salmonella bloodstream infection in children in DR Congo.

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Acknowledgements

The antibiotic resistance surveillance project in DR Congo is funded by Project 2.01 of the Third Framework Agreement between the Belgian Directorate General of Development Cooperation and the Institute of Tropical Medicine, Antwerp, Belgium. Marie-France Phoba has a scholarship of the Foundation Marguerite-Marie Delacroix, Tienen, Belgium.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Microbiology, National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo

    M.-F. Phoba, O. Lunguya & J.-J. Muyembe

  2. Department of Microbiology, University Hospital of Kinshasa, Kinshasa, The Democratic Republic of Congo

    M.-F. Phoba, O. Lunguya & J.-J. Muyembe

  3. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

    H. De Boeck & J. Jacobs

  4. Health Zone and Hospital of Bwamanda, Bwamanda, The Democratic Republic of Congo

    B. B. Ifeka & J. Dawili

  5. Belgian National Reference Centre for Salmonella, Institute of Public Health, Brussels, Belgium

    R. Vanhoof & S. Bertrand

  6. Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium

    C. Van Geet

  7. Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium

    H. De Boeck

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  1. M.-F. Phoba
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Correspondence to H. De Boeck.

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Phoba, MF., De Boeck, H., Ifeka, B.B. et al. Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo. Eur J Clin Microbiol Infect Dis 33, 79–87 (2014). https://doi.org/10.1007/s10096-013-1931-8

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  • DOI: https://doi.org/10.1007/s10096-013-1931-8

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