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Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital
Author(s) -
Bassat Quique,
Guinovart Caterina,
Sigaúque Betuel,
Mandomando Inácio,
Aide Pedro,
Sacarlal Jahit,
Nhampossa Tacilta,
Bardají Azucena,
Morais Luís,
Machevo Sonia,
Letang Emilio,
Macete Eusébio,
Aponte John J.,
Roca Anna,
Menéndez Clara,
Alonso Pedro L.
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02326.x
Subject(s) - malaria , medicine , concomitant , protozoal disease , bacteremia , developing country , pediatrics , surgery , antibiotics , economic growth , immunology , biology , economics , microbiology and biotechnology
Summary Objectives To describe the prevalence, aetiology and prognostic implications of coexisting invasive bacterial disease in children admitted with severe malaria in a rural Mozambican Hospital. Methods Retrospective study of data systematically collected from June 2003 to May 2007 in a rural Mozambican hospital, from all children younger than 5 years admitted with severe malaria. Results Seven thousand and forty‐three children were admitted with a diagnosis of malaria. 25.2% fulfilled the criteria for severe malaria. 5.4% of the children with severe malaria and valid blood culture results had a concomitant bacteraemia. Case fatality rates of severe malaria cases rose steeply when bacteraemia was also present (from 4.0% to 22.0%, P < 0.0001), and bacteraemia was an independent risk factor for death among severe malaria patients (adjusted OR 6.2, 95% CI 2.8–13.7, P = 0.0001). Streptococcus pneumoniae , Gram‐negative bacteria, Staphilococcus aureus and non‐typhoid Salmonella (NTS) were the most frequently isolated microorganisms among severe malaria cases. Their frequency and associated case fatality rates (CFR) varied according to age and to syndromic presentation. Streptococcus pneumoniae had a relatively low CFR, but was consistently associated with severe malaria syndromes, or anaemia severity groups. No clear‐cut relationship between malarial anaemia and NTS bacteraemia was found. Conclusions The coexistence of malaria and invasive bacterial infections is a frequent and life‐threatening condition in many endemic African settings. In Mozambique, S. pneumoniae is the leading pathogen in this interaction, possibly as a consequence of the high HIV prevalence in the area. Measures directed at reducing the burden of both those infections are urgently needed to reduce child mortality in Africa.