Editing Salmonella (section)

=== Invasive ===
While, in developed countries, nontyphoidal serotypes present mostly as gastrointestinal disease, in sub-Saharan Africa, these serotypes can create a major problem in bloodstream infections, and are the most commonly isolated bacteria from the blood of those presenting with fever. Bloodstream infections caused by nontyphoidal salmonellae in Africa were reported in 2012 to have a [[case fatality rate]] of 20–25%. Most cases of invasive nontyphoidal ''Salmonella'' infection (iNTS) are caused by ''Salmonella enterica'' Typhimurium or ''Salmonella enterica'' Enteritidis. A new form of ''Salmonella'' Typhimurium (ST313) emerged in the southeast of the African continent 75 years ago, followed by a second wave which came out of central Africa 18 years later. This second wave of iNTS possibly originated in the [[Congo Basin]], and early in the event picked up a gene that made it resistant to the antibiotic [[chloramphenicol]]. This created the need to use expensive antimicrobial drugs in areas of Africa that were very poor, making treatment difficult. The increased prevalence of iNTS in sub-Saharan Africa compared to other regions is thought to be due to the large proportion of the African population with some degree of immune suppression or impairment due to the burden of [[HIV]], [[malaria]], and malnutrition, especially in children. The genetic makeup of iNTS is evolving into a more typhoid-like bacterium, able to efficiently spread around the human body. Symptoms are reported to be diverse, including fever, [[hepatosplenomegaly]], and respiratory symptoms, often with an absence of gastrointestinal symptoms.<ref>{{cite journal | vauthors = Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon MA | title = Invasive non-typhoidal salmonella disease: an emerging and neglected tropical disease in Africa | journal = Lancet | volume = 379 | issue = 9835 | pages = 2489–2499 | date = June 2012 | pmid = 22587967 | pmc = 3402672 | doi = 10.1016/S0140-6736(11)61752-2 }}</ref>