ReviewSalmonella infections in immunocompromised adults
Section snippets
Clinical syndromes caused by Salmonella in humans
Clinical syndromes caused by Salmonella infection among humans are divided into enteric or typhoid fever, caused by Salmonella typhi and Salmonella paratyphi, and a range of clinical syndromes, including diarrhoeal disease, caused by a large number of non-typhoidal salmonellae (NTS). S. typhi and S. paratyphi are human-restricted in their epidemiology and highly adapted in their pathogenesis. Curiously, while typhoid fever is a paradigm for invasive and systemic human Salmonella disease,
Pathogenesis of typhoid fever
Typhoid or enteric fever is a systemic invasive disease caused by S. typhi or S. paratyphi A and B, with a case fatality of 10–20% in untreated cases, but <1% following treatment with appropriate modern antibiotics. Much of our understanding of the highly specialised pathogenesis of typhoid fever (Fig. 1) is extrapolated from early volunteer studies in humans,3 and from the mouse model. Initial gastrointestinal infection causes a short-lived, often asymptomatic enteritis, and there is
NTS diarrhoeal disease in the immunocompetent adult
NTS cause four clinical syndromes in humans – diarrhoeal disease, invasive bacteraemic illness, focal suppurative infection, and asymptomatic carriage in the stool. An individual may manifest several of these. In an immunocompetent host, NTS serovars cause self-limiting diarrhoeal disease that has an untreated case fatality of approximately 0.1%. Acute infective NTS colitis was described in the late 1970s; NTS-associated diarrhoea had previously been erroneously assumed, by analogy with
Summary
NTS cause self-limiting diarrhoeal disease in immunocompetent adults, but both invasive and focal suppurative disease in adults with underlying immunocompromise. Both focal and invasive presentations of NTS are associated with high mortality. The commonest cause of invasive NTS disease worldwide is advanced HIV disease, which is associated most strikingly with recurrent bacteraemia. These associations with immunosuppression and poor outcome are not seen in typhoid fever. Typhoid fever and
Conflict of interest
None declare.
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