Volume 93, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Bacteremia may be inappropriately treated as malaria in children admitted with a febrile illness in Africa. We determined the prevalence, clinical features, and spectrum of bacteremia among febrile children younger than 5 years of age admitted with a negative malaria test, but prescribed antimalarials at a referral hospital in Jinja, Uganda. After initial evaluation, a blood sample was drawn from 250 children for a complete blood count and bacterial culture. Of 250 samples cultured, 15 grew organisms presumed to be skin contaminants, and of the remaining 235 samples, 45 (19.1%) had bacteremia. (42%), non-typhoidal (24%), (11%), and (9%) were the most common bacterial isolates. On multivariate analysis, history of weight loss (odds ratio [OR] = 2.75; 95% confidence interval [CI] = 1.27–5.95), presence of pulmonary crackles (OR = 3.63; 95% CI = 1.40–9.45), and leukocytosis (OR = 2.21; 95% CI = 1.09–4.47) were independent predictors of bacteremia. At a referral hospital in Uganda, bacteremia was a remarkably common finding in children with febrile illness who were treated for malaria despite negative malaria test results.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Chandramohan D, Jaffar S, Greenwood B, , 2002. Use of clinical algorithms for diagnosing malaria. Trop Med Int Health 7: 4552.[Crossref]
  2. Nadjm B, Amos B, Mtove G, Ostermann J, Chonya S, Wangai H, Kimera J, Msuya W, Mtei F, Dekker D, Malahiyo R, Olomi R, Crump A, Whitty M, Reyburn H, , 2010. WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study. BMJ 340: c1350.[Crossref]
  3. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva, Switzerland: World Health Organization.
  4. Reddy EA, Shaw AV, Crump JA, , 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417432.[Crossref]
  5. Berkley JA, Lowe BS, Mwangi I, Williams T, Bauni E, Mwarumba S, Ngetsa C, Slack MP, Njenga S, Hart CA, Maitland K, English M, Marsh K, Scott JA, , 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352: 3947.[Crossref]
  6. Okwara FN, Obimbo EM, Wafula EM, Murila FV, , 2004. Bacteraemia, urinary tract infection and malaria in hospitalised febrile children in Nairobi: is there an association? East Afr Med J 81: 4751.[Crossref]
  7. Animut A, Mekonnen Y, Shimelis D, Ephraim E, , 2009. Febrile illnesses of different etiology among outpatients in four health centers in northwestern Ethiopia. Jpn J Infect Dis 62: 107110.
  8. Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, Tibenderana JK, , 2009. Malaria misdiagnosis in Uganda–implications for policy change. Malar J 8: 66.[Crossref]
  9. Barat L, Chipipa J, Kolczak M, Sukwa T, , 1999. Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia? Am J Trop Med Hyg 60: 10241030.
  10. Baltzell K, Elfving K, Shakely D, Ali AS, Msellem M, Gulati S, Martensson A, , 2013. Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers' practices in Zanzibar. Malar J 12: 37.[Crossref]
  11. Opoka RO, Xia Z, Bangirana P, John CC, , 2008. Inpatient mortality in children with clinically diagnosed malaria as compared with microscopically confirmed malaria. Pediatr Infect Dis J 27: 319324.[Crossref]
  12. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ, , 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329: 1212.[Crossref]
  13. Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D'Alessandro U, Coosemans M, , 2006. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg 75: 219225.
  14. World Health Organization, 2009. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A joint statement by the World Health Organization and the United Nations Children's Fund.
  15. Ayoola OO, Adeyemo AA, Osinusi K, , 2002. Predictors of bacteraemia among febrile infants in Ibadan, Nigeria. J Health Popul Nutr 20: 223229.
  16. Were T, Davenport GC, Hittner JB, Ouma C, Vulule JM, Ong'echa JM, Perkins DJ, , 2011. Bacteremia in Kenyan children presenting with malaria. J Clin Microbiol 49: 671676.[Crossref]
  17. Naidoo R, Nuttall J, Whitelaw A, Eley B, , 2013. Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa. PLoS ONE 8: e78396.[Crossref]
  18. Mtove G, Amos B, von Seidlein L, Hendriksen I, Mwambuli A, Kimera J, Mallahiyo R, RyunKim D, Ochiai R, Clemens J, Reyburn H, Magesa S, Deen J, , 2010. Invasive salmonellosis among children admitted to a rural Tanzanian hospital and a comparison with previous studies. PLoS ONE 5: e9244.[Crossref]
  19. MacLennan CA, Gondwe EN, Msefula CL, Kingsley RA, Thomson NR, White SA, Goodall M, Pickard DJ, Graham SM, Dougan G, Hart CA, Molyneux ME, Drayson MT, , 2008. The neglected role of antibody in protection against bacteremia caused by nontyphoidal strains of Salmonella in African children. J Clin Invest 118: 15531562.[Crossref]
  20. Feasey NA, Dougan G, Kingsley RA, Heyderman RS, Gordon MA, , 2012. Invasive non-typhoidal Salmonella disease: an emerging and neglected tropical disease in Africa. Lancet 379: 24892499.[Crossref]
  21. Aiken AM, Mturi N, Njuguna P, Mohammed S, Berkley JA, Mwangi I, Mwarumba S, Kitsao BS, Lowe BS, Morpeth SC, Hall AJ, Khandawalla I, Scott JG, , 2011. Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study. Lancet 378: 20212027.[Crossref]
  22. Daza P, Banda R, Misoya K, Katsulukuta A, Gessner BD, Katsande R, Mhlanga BR, Mueller JE, Nelson CB, Phiri A, Molyneux EM, Molyneux ME, , 2006. The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence. Vaccine 24: 62326239.[Crossref]
  23. Baiden F, Webster J, Owusu-Agyei S, Chandramohan D, , 2011. Would rational use of antibiotics be compromised in the era of test-based management of malaria? Trop Med Int Health 16: 142144.[Crossref]

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  • Received : 06 Aug 2014
  • Accepted : 16 Mar 2015

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