Abstract
Among febrile pediatric inpatients in Tanzania, where malaria transmission was intense,
invasive nontyphoidal
Salmonella
was common and
Salmonella
Typhi was uncommon, whereas the inverse was observed at a
site with low malaria transmission.
Background.
The epidemiology of
Salmonella
Typhi and invasive nontyphoidal
Salmonella
(NTS) differs, and prevalence of these pathogens among children in sub-Saharan Africa may
vary in relation to malaria transmission intensity.
Methods.
We compared the prevalence of bacteremia
among febrile pediatric inpatients aged 2 months to 13 years recruited at sites of high
and low malaria endemicity in Tanzania. Enrollment at Teule Hospital, the high malaria
transmission site, was from June 2006 through May 2007, and at Kilimanjaro Christian
Medical Centre (KCMC), the low malaria transmission site, from September 2007 through
August 2008. Automated blood culture, malaria microscopy with Giemsa-stained blood films,
and human immunodeficiency virus testing were performed.
Results.
At Teule, 3639 children were enrolled
compared to 467 at KCMC. Smear-positive malaria was detected in 2195 of 3639
(60.3%) children at Teule and 11 of 460 (2.4%) at KCMC (
P
< .001). Bacteremia was present in 336 of 3639 (9.2%) children at Teule and 20
of 463 (4.3%) at KCMC (
P
< .001). NTS was isolated in 162 of
3639 (4.5%) children at Teule and 1 of 463 (0.2%) at KCMC
(
P
< .001).
Salmonella
Typhi was isolated from 11
(0.3%) children at Teule and 6 (1.3%) at KCMC (
P
=
.008). With NTS excluded, the prevalence of bacteremia at Teule was 5.0% and at
KCMC 4.1% (
P
= .391).
Conclusions.
Where malaria transmission was intense,
invasive NTS was common and
Salmonella
Typhi was uncommon, whereas the
inverse was observed at a low malaria transmission site. The relationship between these
pathogens, the environment, and the host is a compelling area for further research.