The epidemiology of extraintestinal non-typhoid Salmonella in Israel: the effects of patients' age and sex.
ABSTRACT Extraintestinal disease occurs in 5-8% of non-typhoid Salmonella enterica (NTS) infections and is more likely to be associated with hospitalization and death. The study examined the epidemiology of extraintestinal NTS infections in Israel and the possible effects of patients' age and sex. NTS isolates passively submitted to the National Salmonella Reference Center during 1996-2006 were the source for the study cohort. Poisson regression models were used to assess incidence trends over the study years and to evaluate the effects of patients' age and sex on the incidence of extraintestinal NTS manifestations. A total of 36,822 stool and 1,415 (3.7%) patient-unique NTS isolates from blood (74.1%), urine (18.3%), and other sources (3.7%) were studied. Serotypes Enteritidis, Virchow, and Typhimurium accounted for 66.3% of the isolates. Analysis showed a highly significant quadratic (U-shaped) relationship between patients' age and the incidence of extraintestinal isolation (p < 0.001), with increasing risk in the two extremes of age. Differences between the incidence of blood and urine sources were significant in patients <10 and >or=60 years old (relative risk [RR] = 5.88, 95% confidence interval [CI] 3.36-10.30, p < 0.001 and RR = 1.66, 95% CI 1.09-2.53, p = 0.017, respectively). Males >or=60 years of age were more likely than females of the same age to have bacteremia (RR = 1.90, 95% CI 1.39-2.61, p > 0.001) and less likely to have urinary NTS isolation (RR = 0.50, 95% CI 0.28-0.89, p = 0.018). Serotype Virchow had the highest incidence in patients <10 years of age, while serotype Enteritidis had the highest incidence in patients >or=60 years old. The study revealed a complex effect of patients' age and sex on the epidemiology of extraintestinal NTS manifestations.
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ABSTRACT: Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: - Medication: Ciprofloxacin Clinical Procedure:- Specialty: Infectious Diseases. Unusual clinical course. Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be involved as well. We describe a case of invasive salmonellosis caused by Salmonella typhimurium involving the chest wall in a 73-year-old man. The patient had suffered from gastroenteritis followed by left basal pneumonia with pleural effusion 7 weeks before. The CT scan of the chest wall showed a pericostal abscess with shirt-stud morphology near the left last cartilaginous arch. The abscess was surgically drained and patient was cured after a 40-day ciprofloxacin treatment. A review of the literature on extra-intestinal non-typhoid salmonellosis shows that pleuropulmonary and soft-tissue infections are uncommon. We argue that non-typhoid Salmonella might be considered as a possible cause of chest wall abscess in individuals with recent history of gastroenteritis complicated by pneumonia and pleural effusion.The American journal of case reports. 01/2013; 14:502-506.
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ABSTRACT: SUMMARY The overall incidence and serotype distribution of non-typhoid Salmonella (NTS) may vary between different geographical localities. To investigate possible regional differences and the effect of demographic factors, we studied 15 865 episodes of laboratory-confirmed NTS infection in Israel. Using Poisson models we found significant variation in the average annual incidence rate of NTS in 15 administrative sub-districts, which was inversely associated with the percent of rural residency (incidence rate ratio 0·75, 95% confidence interval 0·65-0·86, P < 0·001). Variation was also found in the relative incidence of the most prominent serotypes (Enteritidis, Virchow, Typhimurium, Hadar, Infantis), which was affected by rural residency, the percent of non-Jewish population in the sub-district, and the percent of population aged ⩾55 years in the sub-district. Rural residency had a major effect on the epidemiology of salmonellosis in Israel. Future research is required to understand whether decreased incidence in rural areas is an under-detection bias or reflects true differences in NTS illnesses.Epidemiology and Infection 12/2012; · 2.87 Impact Factor
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ABSTRACT: BACKGROUND: In Canada, surveillance systems have highlighted the increasing trend of Salmonella enterica serovar Enteritidis (S. Enteritidis) human infections. Our study objectives were to evaluate the epidemiology of S. Enteritidis infections in Ontario using surveillance data from January 1, 2007 through December 31, 2009. METHODS: Annual age-and-sex-adjusted incidence rates (IRs), annual and mean age-adjusted sex-specific IRs, and mean age-and-sex-adjusted IRs by public health unit (PHU), were calculated for laboratory-confirmed S. Enteritidis cases across Ontario using direct standardization. Multivariable Poisson regression with PHU as a random effect was used to estimate incidence rate ratios (IRRs) of S. Enteritidis infections among years, seasons, age groups, and sexes. RESULTS: The annual age-and-sex-adjusted IR per 100,000 person-years was 4.4 [95% CI 4.0-4.7] in 2007, and 5.2 [95% CI 4.8-5.6] in both 2008 and 2009. The annual age-adjusted sex-specific IRs per 100,000 person-years ranged from 4.5 to 5.5 for females and 4.2 to 5.2 for males. The mean age-adjusted sex-specific IR was 5.1 [95% CI 4.8-5.4] for females and 4.8 [95% CI 4.5-5.1] for males. High mean age-and-sex-adjusted IRs (6.001-8.10) were identified in three western PHUs, one northern PHU, and in the City of Toronto. Regression results showed a higher IR of S. Enteritidis infections in 2009 [IRR = 1.18, 95% CI 1.06-1.32; P = 0.003] and 2008 [IRR = 1.17, 95% CI 1.05-1.31; P = 0.005] compared to 2007. Compared to the fall season, a higher IR of S. Enteritidis infections was observed in the spring [IRR = 1.14, 95% CI 1.01-1.29; P = 0.040]. Children 0--4 years of age (reference category), followed by children 5--9 years of age [IRR = 0.64, 95% CI 0.52-0.78; P < 0.001] had the highest IRR. Adults >= 60 years of age and 40--49 years of age [IRR = 0.31, 95% CI 0.26-0.37; P < 0.001] had the lowest IRR. CONCLUSIONS: The study findings suggest that there was an increase in the incidence of S. Enteritidis infections in Ontario from 2007 to 2008--2009, and indicate seasonal, demographic, and regional differences, which warrant further public health attention.BMC Infectious Diseases 05/2013; 13(1):212. · 3.03 Impact Factor