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- Title
High genetic similarity between non-typhoidal Salmonella isolated from paired blood and stool samples of children in the Democratic Republic of the Congo.
- Authors
Phoba, Marie-France; Barbé, Barbara; Ley, Benedikt; Van Puyvelde, Sandra; Post, Annelies; Mattheus, Wesley; Deborggraeve, Stijn; Lunguya, Octavie; Jacobs, Jan
- Abstract
Background: Non-typhoidal Salmonella (NTS) serotypes Typhimurium and Enteritidis are a major cause of bloodstream infections in children in sub-Saharan Africa but their reservoir is unknown. We compared pairs of NTS blood and stool isolates (with the same NTS serotype recovered in the same patient) for genetic similarity. Methods: Between November 2013 and April 2017, hospital-admitted children (29 days to 14 years) with culture-confirmed NTS bloodstream infections were enrolled in a cross-sectional study at Kisantu Hospital, DR Congo. Stool cultures for Salmonella were performed on a subset of enrolled children, as well as on a control group of non-febrile hospital-admitted children. Pairs of blood and stool NTS isolates were assessed for genetic similarity by multiple-locus variable-number of tandem repeats (MLVA) and genomics analysis. Results: A total of 299 children with NTS grown from blood cultures (Typhimurium 68.6%, Enteritidis 30.4%, other NTS 1.0%) had a stool sample processed; in 105 (35.1%) of them NTS was detected (Typhimurium 70.5%, Enteritidis 25.7%, other NTS 3.8%). A total of 87/105 (82.9%) pairs of blood and stool NTS isolates were observed (representing 29.1% of the 299 children). Among 1598 controls, the proportion of NTS stool excretion was 2.1% (p < 0.0001). MLVA types among paired isolates were identical in 82/87 (94.3%) pairs (27.4% of the 299 children; 61/66 (92.4%) in Typhimurium and 21/21 (100%) in Enteritidis pairs). Genomics analysis confirmed high genetic similarity within 41/43 (95.3%) pairs, showing a median SNP difference of 1 (range 0–77) and 1 (range 0–4) for Typhimurium and Enteritidis pairs respectively. Typhimurium and Enteritidis isolates belonged to sequence types ST313 lineage II and ST11 respectively. Conclusion: Nearly 30% of children with NTS bloodstream infection showed stool excretion of an NTS isolate with high genetic similarity, adding to the evidence of humans as a potential reservoir for NTS. Author summary: Non-typhoidal Salmonella (NTS) is an important cause of bloodstream infections in sub-Saharan Africa, but little is known about its reservoir and transmission. We assessed the possibility of a human reservoir by culturing stool samples from children with NTS found in their blood. Next, we compared the obtained blood and stool NTS isolates for genetic similarity. We found that a high proportion of children with NTS in their blood also had NTS in their stool (35.1%) when compared to a control group of children without suspicion of bloodstream infection (2.1%). We observed that Salmonella Typhimurium and Salmonella Enteritidis were the main serotypes isolated from blood and stool, and that their proportions were similar within the different populations. We found that 94.3% of the paired NTS blood and stool isolates (or 27.4% of children with NTS in their blood and a stool culture done) were genetically similar to each other. This observation adds to the evidence of a potential human reservoir for NTS.
- Subjects
SUB-Saharan Africa; SALMONELLA; SALMONELLA typhimurium; SALMONELLA enteritidis; BLOOD sampling; TANDEM repeats; SEROTYPES
- Publication
PLoS Neglected Tropical Diseases, 2020, Vol 14, Issue 7, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0008377