1921
Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromatographic test and blood film, suggesting a diagnosis of falciparum malaria; four (20%) had bacteremia with a clinically significant pathogen. These case series’ data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15%) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77%) and in the remaining three (23%). Bacteremic patients had more severe disease than non-bacteremic patients (median [interquartile range] respiratory coma acidosis malaria score 2 [1–4] versus 1 [1–2], = 0.02) and were more likely to die (2/13 [15%] versus 1/74 [1%], = 0.01). However, bacterial coinfection was suspected clinically in a minority of bacteremic patients (5/13 [38%] compared with 13/70 [19%] of non-bacteremic patients, = 0.11). Concomitant bacteremia in adults diagnosed with falciparum malaria may be more common than previously believed and is difficult to identify clinically in resource-poor settings. Death is more common in these patients, suggesting that clinicians should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria in these locations than is presently recommended.

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References

  1. Berkley J, Mwarumba S, Bramham K, Lowe B, Marsh K, , 1999. Bacteraemia complicating severe malaria in children. Trans R Soc Trop Med Hyg 93: 283286. [Google Scholar]
  2. 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. [Google Scholar]
  3. Bronzan RN, 2007. Bacteremia in Malawian children with severe malaria: prevalence, etiology, HIV coinfection, and outcome. J Infect Dis 195: 895904. [Google Scholar]
  4. Prada J, Alabi SA, Bienzle U, , 1993. Bacterial strains isolated from blood cultures of Nigerian children with cerebral malaria. Lancet 342: 1114. [Google Scholar]
  5. Church J, Maitland K, , 2014. Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review. BMC Med 12: 31. [Google Scholar]
  6. Hogan B, Fever Without Source Study Group , 2018. Malaria coinfections in febrile pediatric inpatients: a hospital-based study from Ghana. Clin Infect Dis 66: 18381845. [Google Scholar]
  7. Nadjm B, 2010. WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study. BMJ 340: c1350. [Google Scholar]
  8. World Health Organization, 2014. Severe malaria. Trop Med Int Health 19 (Suppl 1): 7131. [Google Scholar]
  9. Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L, , 2013. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 11: 623639. [Google Scholar]
  10. Hendriksen IC, 2013. Defining falciparum-malaria-attributable severe febrile illness in moderate-to-high transmission settings on the basis of plasma PfHRP2 concentration. J Infect Dis 207: 351361. [Google Scholar]
  11. Nyein PP, Aung NM, Kyi TT, Htet ZW, Anstey NM, Kyi MM, Hanson J, , 2016. High frequency of clinically significant bacteremia in adults hospitalized with falciparum malaria. Open Forum Infect Dis 3: ofw028. [Google Scholar]
  12. Hanson J, 2010. A simple score to predict the outcome of severe malaria in adults. Clin Infect Dis 50: 679685. [Google Scholar]
  13. Mu TT, Sein AA, Kyi TT, Min M, Aung NM, Anstey NM, Kyaw MP, Soe C, Kyi MM, Hanson J, , 2016. Malaria incidence in Myanmar 2005–2014: steady but fragile progress towards elimination. Malar J 15: 503. [Google Scholar]
  14. Imwong M, 2017. The spread of artemisinin-resistant Plasmodium falciparum in the Greater Mekong subregion: a molecular epidemiology observational study. Lancet Infect Dis 17: 491497. [Google Scholar]
  15. Imwong M, Hien TT, Thuy-Nhien NT, Dondorp AM, White NJ, , 2017. Spread of a single multidrug resistant malaria parasite lineage (PfPailin) to Vietnam. Lancet Infect Dis 17: 10221023. [Google Scholar]
  16. World Health Organization, 2012. Management of Severe Malaria: A Practical Handbook, 3rd edition. Geneva, Switzerland: World Health Organization.
  17. Aung NM, Kaung M, Kyi TT, Kyaw MP, Min M, Htet ZW, Anstey NM, Kyi MM, Hanson J, , 2015. The safety of a conservative fluid replacement strategy in adults hospitalised with malaria. PLoS One 10: e0143062. [Google Scholar]
  18. Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM, , 2014. The fluid management of adults with severe malaria. Crit Care 18: 642. [Google Scholar]
  19. Kaung M, Kyi TT, Aung NM, Kyaw MP, Min M, Htet ZW, Anstey NM, Kyi MM, Hanson J, , 2015. The prognostic utility of bedside assessment of adults hospitalized with malaria in Myanmar: a retrospective analysis. Malar J 14: 63. [Google Scholar]
  20. Hanson J, 2014. Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis. PLoS One 9: e87020. [Google Scholar]
  21. World Health Organization, 2016. World Malaria Report. Geneva, Switzerland: World Health Organization.
  22. Dondorp A, Nosten F, Stepniewska K, Day N, White N, South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) Group; , 2005. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 366: 717725. [Google Scholar]
  23. Hanson J, 2011. Laboratory prediction of the requirement for renal replacement in acute falciparum malaria. Malar J 10: 217. [Google Scholar]
  24. Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB, , 1975. Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. Lancet 1: 12111213. [Google Scholar]
  25. Davis JS, Cheng AC, McMillan M, Humphrey AB, Stephens DP, Anstey NM, , 2011. Sepsis in the tropical top end of Australia’s northern territory: disease burden and impact on indigenous Australians. Med J Aust 194: 519524. [Google Scholar]
  26. White NJ, Turner GD, Day NP, Dondorp AM, , 2013. Lethal malaria: Marchiafava and Bignami were right. J Infect Dis 208: 192198. [Google Scholar]
  27. Dorovini-Zis K, Schmidt K, Huynh H, Fu W, Whitten RO, Milner D, Kamiza S, Molyneux M, Taylor TE, , 2011. The neuropathology of fatal cerebral malaria in Malawian children. Am J Pathol 178: 21462158. [Google Scholar]
  28. MacPherson GG, Warrell MJ, White NJ, Looareesuwan S, Warrell DA, , 1985. Human cerebral malaria. A quantitative ultrastructural analysis of parasitized erythrocyte sequestration. Am J Pathol 119: 385401. [Google Scholar]
  29. Yeo TW, Lampah DA, Kenangalem E, Tjitra E, Weinberg JB, Granger DL, Price RN, Anstey NM, , 2014. Decreased endothelial nitric oxide bioavailability, impaired microvascular function, and increased tissue oxygen consumption in children with falciparum malaria. J Infect Dis 210: 16271632. [Google Scholar]
  30. Wilairatana P, Meddings JB, Ho M, Vannaphan S, Looareesuwan S, , 1997. Increased gastrointestinal permeability in patients with Plasmodium falciparum malaria. Clin Infect Dis 24: 430435. [Google Scholar]
  31. Takem EN, Roca A, Cunnington A, , 2014. The association between malaria and non-typhoid Salmonella bacteraemia in children in sub-Saharan Africa: a literature review. Malar J 13: 400. [Google Scholar]
  32. Church JA, Nyamako L, Olupot-Olupot P, Maitland K, Urban BC, , 2016. Increased adhesion of Plasmodium falciparum infected erythrocytes to ICAM-1 in children with acute intestinal injury. Malar J 15: 54. [Google Scholar]
  33. Bruneel F, Gachot B, Timsit JF, Wolff M, Bedos JP, Regnier B, Vachon F, , 1997. Shock complicating severe falciparum malaria in European adults. Intensive Care Med 23: 698701. [Google Scholar]
  34. Cunnington AJ, Njie M, Correa S, Takem EN, Riley EM, Walther M, , 2012. Prolonged neutrophil dysfunction after Plasmodium falciparum malaria is related to hemolysis and heme oxygenase-1 induction. J Immunol 189: 53365346. [Google Scholar]
  35. Dasari P, Reiss K, Lingelbach K, Baumeister S, Lucius R, Udomsangpetch R, Bhakdi SC, Bhakdi S, , 2011. Digestive vacuoles of Plasmodium falciparum are selectively phagocytosed by and impair killing function of polymorphonuclear leukocytes. Blood 118: 49464956. [Google Scholar]
  36. Mabey DC, Brown A, Greenwood BM, , 1987. Plasmodium falciparum malaria and Salmonella infections in Gambian children. J Infect Dis 155: 13191321. [Google Scholar]
  37. Cunnington AJ, Riley EM, , 2010. Suppression of vaccine responses by malaria: insignificant or overlooked? Expert Rev Vaccines 9: 409429. [Google Scholar]
  38. Hanson JP, 2013. Fluid resuscitation of adults with severe falciparum malaria: effects on acid-base status, renal function, and extravascular lung water. Crit Care Med 41: 972981. [Google Scholar]
  39. Hanson J, 2012. Relative contributions of macrovascular and microvascular dysfunction to disease severity in falciparum malaria. J Infect Dis 206: 571579. [Google Scholar]
  40. Nguyen HP, 2011. A retrospective analysis of the haemodynamic and metabolic effects of fluid resuscitation in Vietnamese adults with severe falciparum malaria. PLoS One 6: e25523. [Google Scholar]
  41. Warrell DA, Looareesuwan S, Warrell MJ, Kasemsarn P, Intaraprasert R, Bunnag D, Harinasuta T, , 1982. Dexamethasone proves deleterious in cerebral malaria. A double-blind trial in 100 comatose patients. N Engl J Med 306: 313319. [Google Scholar]
  42. Modiano D, Sirima BS, Konate A, Sanou I, Sawadogo A, , 2001. Leucocytosis in severe malaria. Trans R Soc Trop Med Hyg 95: 175176. [Google Scholar]
  43. Fiori B, 2014. Performance of two resin-containing blood culture media in detection of bloodstream infections and in direct matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) broth assays for isolate identification: clinical comparison of the BacT/Alert Plus and Bactec Plus systems. J Clin Microbiol 52: 35583567. [Google Scholar]
  44. McNerney R, , 2015. Diagnostics for developing countries. Diagnostics (Basel) 5: 200209. [Google Scholar]
  45. Bruneel F, Severe Imported Malaria in Adults (SIMA) Study Group , 2010. Severe imported falciparum malaria: a cohort study in 400 critically ill adults. PLoS One 5: e13236. [Google Scholar]
  46. Myat TO, Prasad N, Thinn KK, Win KK, Htike WW, Zin KN, Murdoch DR, Crump JA, , 2014. Bloodstream infections at a tertiary referral hospital in Yangon, Myanmar. Trans R Soc Trop Med Hyg 108: 692698. [Google Scholar]
  47. Dondorp AM, Limmathurotsakul D, Ashley EA, , 2018. What’s wrong in the control of antimicrobial resistance in critically ill patients from low- and middle-income countries? Intensive Care Med 44: 7982. [Google Scholar]
  48. Freund Y, French Society of Emergency Medicine Collaborators Group , 2017. Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 317: 301308. [Google Scholar]
  49. Andriolo BN, Andriolo RB, Salomao R, Atallah AN, , 2017. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev 1: CD010959. [Google Scholar]
  50. Pierrakos C, Vincent JL, , 2010. Sepsis biomarkers: a review. Crit Care 14: R15. [Google Scholar]
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  • Received : 02 May 2018
  • Accepted : 17 Jun 2018
  • Published online : 16 Jul 2018

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