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Abstract
Clinical syndromes caused by Salmonella infection in humans are divided into typhoid
fever, caused by Salmonella typhi and Salmonella paratyphi, and a range of clinical
syndromes, including diarrhoeal disease, caused by a large number of non-typhoidal
salmonella serovars (NTS). Typhoid is a human-restricted and highly adapted invasive
disease, but shows little association with immunocompromise. In contrast, NTS have
a broad vertebrate host range, epidemiology that often involves food animals, and
have a dramatically more severe and invasive presentation in immunocompromised adults,
in particular in the context of HIV. Immunocompromise among adults, including underlying
severe or progressive disease, chronic granulomatous disease, defects or blockade
of specific cytokines (particularly IL-12/IL-23/IL-17 and TNF), and HIV, is associated
with suppurative foci and with primary bacteraemic disease, which may be recurrent.
These patients have markedly increased mortality. Worldwide, invasive recurrent NTS
bacteraemia associated with advanced HIV disease is a huge problem, and the epidemiology
in this context may be more human-restricted than in other settings. This review will
describe the presentation and pathogenesis of NTS in different categories of immunocompromised
adults, contrasted to typhoid fever.