1921
Volume 93, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

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.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.14-0494
2015-08-05
2018-12-14
Loading full text...

Full text loading...

/deliver/fulltext/14761645/93/2/276.html?itemId=/content/journals/10.4269/ajtmh.14-0494&mimeType=html&fmt=ahah

References

  1. Chandramohan D, Jaffar S, Greenwood B, , 2002. Use of clinical algorithms for diagnosing malaria. Trop Med Int Health 7: 4552.[Crossref] [Google Scholar]
  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] [Google Scholar]
  3. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva, Switzerland: World Health Organization. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  15. Ayoola OO, Adeyemo AA, Osinusi K, , 2002. Predictors of bacteraemia among febrile infants in Ibadan, Nigeria. J Health Popul Nutr 20: 223229. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.14-0494
Loading
/content/journals/10.4269/ajtmh.14-0494
Loading

Data & Media loading...

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

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error