沙门氏菌是欧洲[4]Spina A, Kerr KG, Cormican M, et al. Spectrum of enteropathogens detected by the FilmArray GI panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect. 2015;21:719-728.http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)00408-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25908431?tool=bestpractice.com和美国食源性疾病最常见的病因之一,[5]Voetsch AC, Van Gilder TJ, Angulo FJ, et al. FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States. Clin Infect Dis. 2004;38:S127-S134.https://cid.oxfordjournals.org/content/38/Supplement_3/S127.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/15095181?tool=bestpractice.com[6]Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:607-625.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627714/pdf/10511517.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10511517?tool=bestpractice.com[7]Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States - major pathogens. Emerg Infect Dis. 2011;17:7-15.http://www.ncbi.nlm.nih.gov/pubmed/21192848?tool=bestpractice.com也是全球腹泻疾病的四大关键病因之一。WHO: Salmonella (non-typhoidal) fact sheet据美国疾病预防控制中心 (US Centers for Disease Control and Prevention) 估计,每年有 940 万食源性病例发生(依据主动和被动监测数据),其中最常见的病原体是诺如病毒 (58%)、其次是非伤寒沙门氏菌属 (11%)。[8]Crim SM, Griffin PM, Tauxe R, et al; Centers for Disease Control and Prevention (CDC). Preliminary incidence and trends of infection with pathogens transmitted commonly through food: Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2014. MMWR Morb Mortal Wkly Rep. 2015;64:495-499.https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6418a4.htmhttp://www.ncbi.nlm.nih.gov/pubmed/25974634?tool=bestpractice.com在美国每年超过120食源性疾病估计由伤寒导致,其中超过23000例住院以及450例死亡。[9]Centers for Disease Control and Prevention. An atlas of Salmonella in the United States, 1968-2011. 2013. http://www.cdc.gov (last accessed 4 April 2017).http://www.cdc.gov/salmonella/pdf/salmonella-atlas-508c.pdf
2006年英国报道大约12500例由沙门氏菌引起的独立下消化道感染,最常见的是肠炎沙门氏菌。[10]Public Health England. Salmonella by serotype 2000 to 2010. December 2010. https://www.gov.uk (last accessed 4 April 2017).https://www.gov.uk/government/publications/salmonella-by-serotype/salmonella-by-serotype-2000-to-2010在美国,感染的发生率约15例/100000人年。[8]Crim SM, Griffin PM, Tauxe R, et al; Centers for Disease Control and Prevention (CDC). Preliminary incidence and trends of infection with pathogens transmitted commonly through food: Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2014. MMWR Morb Mortal Wkly Rep. 2015;64:495-499.https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6418a4.htmhttp://www.ncbi.nlm.nih.gov/pubmed/25974634?tool=bestpractice.com
并且沙门氏菌是一个重要的病因,并占美国食源性疾病死亡病例的30%。[6]Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:607-625.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627714/pdf/10511517.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10511517?tool=bestpractice.com
尽管非伤寒沙门氏菌是成人中胃肠炎的常见病因,但是婴儿和幼童是罹患该病的高危人群。此外,老年人比青年到中年间的人更易感。长期居住于护理院的老年人暴发沙门氏菌病已有报道。[11]Greig JD, Lee MB. Enteric outbreaks in long-term care facilities and recommendations for prevention: a review. Epidemiol Infect. 2009;137:145-155.http://www.ncbi.nlm.nih.gov/pubmed/18474129?tool=bestpractice.com分布于年龄两端的人群易患较重、较复杂的感染。值得注意的是,不论年龄、种族和性别,均可能感染沙门氏菌,所以任何年龄组都存在感染的风险。大多数感染发生在每年的温季(五月至十月),与其它食源性疾病类似(非全部)。
2008年美国出现沙门氏菌病全国性暴发(圣保罗型沙门氏菌)记录在案的有1500例病例,其中21%患者住院。辣椒与此次暴发密切相关,突出防止农产品污染的重要性。[12]Barton Behravesh C, Mody RK, Jungk J, et al. 2008 outbreak of Salmonella Saintpaul infections associated with raw produce. N Engl J Med. 2011;364:918-927.http://www.nejm.org/doi/full/10.1056/NEJMoa1005741#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/21345092?tool=bestpractice.com感染沙门氏菌的家禽食物是最常导致感染患者死亡的,而农产品导致暴发流行近半数。[13]Painter JA, Hoekstra RM, Ayers T, et al. Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities by using outbreak data, United States, 1998-2008. Emerg Infect Dis. 2013;19:407-415.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647642/http://www.ncbi.nlm.nih.gov/pubmed/23622497?tool=bestpractice.com
非伤寒沙门氏菌感染在发展中地区也常见,如亚洲、非洲及南美洲国家,是当地小儿腹泻的重要原因。[14]Adkins HJ, Escamilla J, Santiago LT, et al. Two-year survey of etiologic agents of diarrheal disease at San Lazaro Hospital, Manila, Republic of the Philippines. J Clin Microbiol. 1987;25:1143-1147.http://jcm.asm.org/cgi/reprint/25/7/1143http://www.ncbi.nlm.nih.gov/pubmed/3038946?tool=bestpractice.com[15]Saidi SM, Iijima Y, Sang WK, et al. Epidemiological study on infectious diarrheal diseases in children in a coastal rural area of Kenya. Microbiol Immunol. 1997;41:773-778.http://www.ncbi.nlm.nih.gov/pubmed/9403500?tool=bestpractice.com[16]Morpeth SC, Ramadhani HO, Crump JA. Invasive non-Typhi Salmonella disease in Africa. Clin Infect Dis. 2009;49:606-611.https://cid.oxfordjournals.org/content/49/4/606.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/19591599?tool=bestpractice.com由于缺少完善的生存资料,迄今为止有关这些地区非伤寒沙门氏菌胃肠炎的发病总数和发病率的数据缺乏。但是有研究估计全球每年因沙门氏菌引起的胃肠炎有9380万例,其中155000例死亡。[17]Majowicz SE, Musto J, Scallan E, et al. The global burden of nontyphoidal Salmonella gastroenteritis. Clin Infect Dis. 2010;50:882-889.http://cid.oxfordjournals.org/content/50/6/882.longhttp://www.ncbi.nlm.nih.gov/pubmed/20158401?tool=bestpractice.com除胃肠炎之外,非伤寒沙门氏菌侵入的血流感染主要出现在患有疟疾和营养不良的儿童,以及患HIV的成人中。非洲儿童中侵袭性疾病的年发病率为175/100000至388/100000,而发达国家则为1/100000。[18]Gordon MA. Invasive nontyphoidal Salmonella disease: epidemiology, pathogenesis and diagnosis. Curr Opin Infect Dis. 2011;24:484-489.http://www.ncbi.nlm.nih.gov/pubmed/21844803?tool=bestpractice.com撒哈拉以南的非洲大陆人群所患侵袭性疾病大部分是由近来出现的两个密切相关谱系的多重耐药的鼠伤寒沙门氏菌所引起。[19]Okoro CK, Kingsley RA, Connor TR, et al. Intracontinental spread of human invasive Salmonella Typhimurium pathovariants in sub-Saharan Africa. Nat Genet. 2012;44:1215-1221.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491877/http://www.ncbi.nlm.nih.gov/pubmed/23023330?tool=bestpractice.com
来自发达国家的旅行者参观这些地区可感染沙门氏菌导致旅行者腹泻,但与其它导致旅行者腹泻的病原体如产肠毒素大肠埃希菌相比并不常见。[20]Gascon J. Epidemiology, etiology, and pathophysiology of traveler's diarrhea. Digestion. 2006;73(suppl 1):102-108.http://www.ncbi.nlm.nih.gov/pubmed/16498258?tool=bestpractice.com