When we think about Salmonella infections, we usually think about gastroenteritis. However, up to 5% of Salmonella infections result in more invasive infections. Infants and children who are immunocompromised are particularly susceptible to invasive Salmonella infections. This month in Pediatrics, we have 2 separate articles on the impact of Salmonella in children.
In the first article (which has an accompanying video abstract), entitled “Epidemiology of Nontyphoidal Salmonella Bloodstream Infections in Children,” Dr. Tara Greenhow and Amy Alabaster from Kaiser Permanente Northern California analyzed all blood cultures (collected between 1999 and 2018) and stool cultures (collected between 2009 and 2018) from their Northern California population that were positive for nontyphoidal Salmonella (NTS) (10.1542/peds.2023-062357).
They report that:
- The rates of NTS bloodstream infection have not decreased over the last 2 decades, despite efforts to improve food safety.
- More than half (55%) of children with NTS bloodstream infections were younger than 5 years of age; 22% were younger than 1 year of age.
- Salmonella heidelberg was the most common serotype, found in 21% of cases.
- Only 10% had underlying comorbidities.
- Only 3% had focal infections, including osteomyelitis, myocarditis, pneumonia, meningitis, and pancreatitis. Salmonella heidelberg was not found in children with focal infection.
The second article, entitled, “Invasive Bacterial Infections in Children with Sickle Cell Disease: 2014-2019,” by Dr. Jean Gaschignard in France and European colleagues from the BACT-SPRING study group, a research network focused on infections in children with sickle cell disease, report on the increased proportion of invasive infection caused by Salmonella in children with sickle cell disease (10.1542/peds.2022-061061).
The authors report that since the introduction of the 13-valent pneumococcal vaccine:
- Salmonella has surpassed Streptococcus pneumoniae as the most common bacterial pathogen (26% vs. 18%).
- Salmonella is particularly prominent in osteoarticular infections (45%) and bacteremia (23%).
- Streptococcus pneumoniae is more prominent in meningitis (88%) and acute chest syndrome (50%).
- All Streptococcus pneumoniae invasive infections occurred in children 10 years or younger.
These 2 articles raise attention to the potentially increasing importance of Salmonella as an invasive pathogen. It is important to think about this organism in your patient population, and not just when you have a patient with sickle cell disease.
