Predicting and treating non-typhoidal Salmonella bloodstream infections in children in sub-Saharan Africa

In Northern countries Salmonella causes self-limiting diarrhea, but in sub-Saharan Africa Salmonella is the most common cause of invasive and highly-fatal bacterial infections in children. They mimic severe malaria and are difficult to diagnose. Adequate antibiotic treatment is challenging in resource-limited settings and antibiotic resistance is on the rise. To tackle the public health threat of invasive Salmonella infections, I will address the following epidemiological, diagnostical and therapeutic gaps in knowledge: Invasive Salmonella infections rise during the rainy season and when more malaria infections occur. I will build a model that can predict the frequency of invasive Salmonella infections based on environmental and epidemiological parameters. Some clinical parameters can help to distinguish between invasive Salmonella infections and severe malaria. Based on such parameters, I will build a clinical algorithm that facilitates the diagnosis. I will also test if salivary cortisol concentration is higher in invasive Salmonella infection. If so, it can be developed as an easyto-use diagnostic indicator. The scientific knowledge on the ideal antibiotic treatment for invasive Salmonella infections is small. I will assess if earlier switch from injected to oral antibiotics is not worse than the currently recommended full course of injected antibiotics. I will also investigate whether the recommended dosage is not too low for severely malnourished children.