The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal

• Published in: PloS one 2012-10, Vol.7 (10), p.e47342-e47342
• Main Authors: Dongol, Sabina, Thompson, Corinne N, Clare, Simon, Nga, Tran Vu Thieu, Duy, Pham Thanh, Karkey, Abhilasha, Arjyal, Amit, Koirala, Samir, Khatri, Nely Shrestha, Maskey, Pukar, Poudel, Sanjay, Jaiswal, Vijay Kumar, Vaidya, Sujan, Dougan, Gordon, Farrar, Jeremy J, Dolecek, Christiane, Basnyat, Buddha, Baker, Stephen
• Format: Article
• Language: English
• Subjects: Antiinfectives and antibacterials; Antimicrobial agents; Antimicrobial resistance; Bile; Biology; Blood & organ donations; Care and treatment; Cholecystectomy; Colonization; Epidemiology; Fever; Gallbladder; Gallbladder - microbiology; Gallbladder diseases; Gallstones; Health aspects; Health sciences; Hospitals; Humans; Hygiene; Infections; Infectious diseases; Inflammation; Laboratories; Medicine; Microbiology; Nepal; Organisms; Patients; Risk factors; Salmonella; Salmonella paratyphi A - isolation & purification; Salmonella paratyphi A - pathogenicity; Salmonella typhi - isolation & purification; Salmonella typhi - pathogenicity; Salmonella Typhimurium; Tropical diseases; Typhoid; Typhoid fever; Typhoid Fever - blood; Typhoid Fever - microbiology; Typhoid Fever - transmission; Waterborne diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0047342

Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.