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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.

The Microbiological and Clinical Characteristics of Invasive Salmonella in Gallbladders from Cholecystectomy Patients in Kathmandu, Nepal