Clinical presentation of non-typhoidal Salmonella bacteraemia in Malawian children

We report the clinical presentation and outcome of 299 Malawian children wi th non-typhoidal Salmonella (NTS) bacteraemia and no evidence of focal seps is, admitted to Queen Elizabeth Central Hospital (QECH), Blantyre, over a 2 6-month period (February 1996-April 1998). A peak incidence during the rain y season was noted. Salmonella typhimurium (79%) and S. enteritidis (13%) w ere the commonest isolates. For children aged >6 months, NTS bacteraemia wa s significantly associated with malarial parasitaemia (RR 1.5 [1.2, 2.2], P < 0.01) and with severe anaemia (RR 7.2 [3.4, 15.3], P < 0.0001), when com pared to other common pathogens causing childhood bacteraemia. Clinical ove rlap with malaria and anaemia, and the presence of malarial parasitaemia on admission, may delay diagnosis. NTS bacteraemia was commonly diagnosed fol lowing blood transfusion. Resistance in vitro to ampicillin (79%), co-trimo xazole (72%) and gentamicin (55%) was very common, and was rare to chloramp henicol (0.3%) which is the antibiotic of choice for NTS sepsis at QECH. Ov erall mortality was high (23%). Young age and clinical HIV infection were r isk factors for mortality. Recurrences of NTS bacteraemia following antibio tic therapy were common among children with clinical HIV infection.