Clinical and epidemiological characteristics of invasive non-typhoidal Salmonella disease in Ghana
8 affiliations
- 1Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Ghana
- 2Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Ghana
- 3Department of Community Health, Kwame Nkrumah University of Science and Technology, Ghana
- 4Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Ghana
- 5School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- 6KNUST-IVI Collaborative Centre, Agogo, Ashanti Region, Ghana
- 7Department of Child Health, Kwame Nkrumah University of Science and Technology, Ghana
- 8International Vaccine Institute, Seoul, South Korea
Abstract
Background: Invasive non-typhoidal Salmonella (iNTS) disease remains a significant public health threat in sub-Saharan Africa (SSA). Although the disease is important, its clinical characteristics are not well described in literature. This study describes the clinico-epidemiological profile of iNTS disease in Ghana aiming to bridge important knowledge gaps and inform more effective management strategies. Methods: The study spanned 8 years and utilized selected fever surveillance sites in Ghana. Patients with fever and/or history of fever for ≥ 3 consecutive days within the week prior to visit were approached and blood sample taken after consenting for investigations including blood culture. iNTS isolates were recovered using BACTEC blood culture, identified by Analytical Profile Index (API), sero-grouped using the Kauffmann–White scheme and confirmed by Illumina whole genome sequencing. Conditional logistic regression was used to assess associations between clinical and laboratory features and iNTS blood culture positivity in a 1:3 age-, sex-, and residence-matched case–control analysis. Results: Of 271 blood-culture-derived bacterial pathogens, 15.5% (42/271) were identified as iNTS making it the second most common cause of bacteremia. iNTS disease exhibited seasonality with peak detections coinciding with the rainy seasons in Ghana. 23.7% (9/38) of iNTS isolates were multidrug-resistant (MDR), of which 5.3% (2/38) were extensively drug-resistant including resistance to ceftriaxone and ciprofloxacin. Several factors showed crude associations with iNTS disease; however, only anaemia retained its association after adjustment of other factors (aOR=2.41 p = 0.030). Conclusion: iNTS is a major cause of bloodstream infections with the highest burden in children under 5 years of age with susceptibility to the infection amplified by anaemia. The Salmonella serovars involved are increasingly becoming multidrug-resistant, including resistance to critical antibiotics.
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BibTeX
@article{agyapong2026clinical,
title = {{Clinical and epidemiological characteristics of invasive non-typhoidal Salmonella disease in Ghana}},
author = {Francis Opoku Agyapong and Michael Owusu and Michael Owusu-Ansah and Sampson Twumasi-Ankrah and Kennedy Gyau Boahen and Gifty Nkrumah and Ezekiel Bonwin Ackah and Rachel Laadi Sulla and Akua Serwaa Boafo and Nathaniel Nsiah-Poku and Portia Okyere Boakye and Anthony Enimil and Yaw Adu-Sarkodie and Ellis Owusu-Dabo and Florian Marks},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0362186},
url = {https://doi.org/10.1371/journal.pone.0362186},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical and epidemiological characteristics of invasive non-typhoidal Salmonella disease in Ghana
AU - Francis Opoku Agyapong
AU - Michael Owusu
AU - Michael Owusu-Ansah
AU - Sampson Twumasi-Ankrah
AU - Kennedy Gyau Boahen
AU - Gifty Nkrumah
AU - Ezekiel Bonwin Ackah
AU - Rachel Laadi Sulla
AU - Akua Serwaa Boafo
AU - Nathaniel Nsiah-Poku
AU - Portia Okyere Boakye
AU - Anthony Enimil
AU - Yaw Adu-Sarkodie
AU - Ellis Owusu-Dabo
AU - Florian Marks
PY - 2026
DA - 2026/11/06
JO - PLOS One
DO - 10.1371/journal.pone.0362186
UR - https://doi.org/10.1371/journal.pone.0362186
AB - Background: Invasive non-typhoidal Salmonella (iNTS) disease remains a significant public health threat in sub-Saharan Africa (SSA). Although the disease is important, its clinical characteristics are not well described in literature. This study describes the clinico-epidemiological profile of iNTS disease in Ghana aiming to bridge important knowledge gaps and inform more effective management strategies. Methods: The study spanned 8 years and utilized selected fever surveillance sites in Ghana. Patients with fever and/or history of fever for ≥ 3 consecutive days within the week prior to visit were approached and blood sample taken after consenting for investigations including blood culture. iNTS isolates were recovered using BACTEC blood culture, identified by Analytical Profile Index (API), sero-grouped using the Kauffmann–White scheme and confirmed by Illumina whole genome sequencing. Conditional logistic regression was used to assess associations between clinical and laboratory features and iNTS blood culture positivity in a 1:3 age-, sex-, and residence-matched case–control analysis. Results: Of 271 blood-culture-derived bacterial pathogens, 15.5% (42/271) were identified as iNTS making it the second most common cause of bacteremia. iNTS disease exhibited seasonality with peak detections coinciding with the rainy seasons in Ghana. 23.7% (9/38) of iNTS isolates were multidrug-resistant (MDR), of which 5.3% (2/38) were extensively drug-resistant including resistance to ceftriaxone and ciprofloxacin. Several factors showed crude associations with iNTS disease; however, only anaemia retained its association after adjustment of other factors (aOR=2.41 p = 0.030). Conclusion: iNTS is a major cause of bloodstream infections with the highest burden in children under 5 years of age with susceptibility to the infection amplified by anaemia. The Salmonella serovars involved are increasingly becoming multidrug-resistant, including resistance to critical antibiotics.
SN - 1932-6203
ER -