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Co-circulation of Plasmodium and Bacterial DNAs in Blood of Febrile and Afebrile Children from Urban and Rural Areas in Gabon
Gaël Mourembou
Gaël Mourembou
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France.
Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon.
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Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon.
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Sydney Maghendji Nzondo
Sydney Maghendji Nzondo
Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.
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Angélique Ndjoyi-Mbiguino
Angélique Ndjoyi-Mbiguino
Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon.
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Jean Bernard Lekana-Douki
Jean Bernard Lekana-Douki
Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.
Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Sciences de la Santé, Libreville, Gabon.
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Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Sciences de la Santé, Libreville, Gabon.
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Lady Charlène Kouna
Lady Charlène Kouna
Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.
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Pierre Blaise Matsiegui
Pierre Blaise Matsiegui
Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon.
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Rella Zoleko Manego
Rella Zoleko Manego
Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon.
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Irene Pegha Moukandja
Irene Pegha Moukandja
Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.
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Alpha Kabinet Keïta
Alpha Kabinet Keïta
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France.
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Hervé Tissot-Dupont
Hervé Tissot-Dupont
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France.
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Florence Fenollar
Florence Fenollar
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France.
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Didier Raoult
Didier Raoult
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France.
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Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bacteremias exist but are under assessed. This study aimed to assess bacteremias and malaria in children from urban and rural areas in Gabon. DNA extracts from blood samples of 410 febrile and 60 afebrile children were analyzed using quantitative polymerase chain reaction. Plasmodium spp. was the microorganism most frequently detected in febrile (78.8%, 323/410) and afebrile (13.3%, 8/60) children, (P < 0.001). DNA from one or several bacteria were detected in 15 febrile patients (3.7%) but not in the controls (P = 0.1). This DNA was more frequently detected as co-infections among febrile children tested positive for Plasmodium (4.6%, 15/323) than in those tested negative for Plasmodium (0%, 0/87; P = 0.04). The bacteria detected were Streptococcus pneumoniae 2.4% (10/410), Staphylococcus aureus 1.7% (7/410), Salmonella spp. 0.7% (3/410), Streptococcus pyogenes 0.2% (1/410) and Tropheryma whipplei 0.2% (1/410) only in febrile children. Coxiella burnetii, Borrelia spp., Bartonella spp., Leptospira spp., and Mycobacterium tuberculosis were not observed. This paper reports the first detection of bacteremia related to T. whipplei in Gabon and shows that malaria decreases in urban areas but not in rural areas. Co-infections in febrile patients are common, highlighting the need to improve fever management strategies in Gabon.
Author Notes
Financial support: This work was supported by the Institut Hospitalo-Universitaire Méditerranée Infection.
Authors' addresses: Gaël Mourembou, Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France, and Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon, E-mail: gaelmourembou@yahoo.fr. Sydney Maghendji Nzondo, Lady Charlène Kouna, and Irene Pegha Moukandja, Unité de Parasitologie Médicale (UPARAM), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon, E-mails: sydneymaghendji@yahoo.fr, kounaladycharlene@yahoo.fr, and moukandja@hotmail.com. Angélique Ndjoyi-Mbiguino, Département de Microbiologie, Laboratoire National de Référence IST/sida, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon, E-mail: labmicuss@gmail.com. Jean Bernard Lekana-Douki, Unité de Parasitologie Médicale (UPARAM), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon, and Département de Parasitologie Mycologie et de Médecine Tropicale, Université des Science de la Santé, Libreville, Gabon, E-mail: lekana_jb@yahoo.fr. Pierre Blaise Matsiegui and Rella Zoleko Manego, Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon, E-mails: matsiegpb@yahoo.fr and manegorella@yahoo.fr. Alpha Kabinet Keïta, Hervé Tissot-Dupont, Florence Fenollar, and Didier Raoult, Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France, E-mails: kabinet1@hotmail.fr, herve.tissot-dupont@ird.fr, florence.fenollar@univ-amu.fr, and didier.raoult@gmail.com.
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-
1.
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 JA, Whitty CJ, 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.
-
2.
Biggs HM, Lester R, Nadjm B, Mtove G, Todd JE, Kinabo GD, Philemon R, Amos B, Morrissey AB, Reyburn H, Crump JA, 2014. Invasive Salmonella infections in areas of high and low malaria transmission intensity in Tanzania. Clin Infect Dis 58: 638–647.
-
3.
Reddy EA, Shaw AV, Crump JA, 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417–432.
-
4.
Bouyou-Akotet MK, Mawili-Mboumba DP, Kendjo E, Eyang Ekouma A, Abdou Raouf O, Engohang Allogho E, Kombila M, 2012. Complicated malaria and other severe febrile illness in a pediatric ward in Libreville, Gabon. BMC Infect Dis 12: 216.
-
5.
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.
-
6.
Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377–382.
-
7.
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-
8.
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-
9.
English M, Berkley J, Mwangi I, Mohammed S, Ahmed M, Osier F, Muturi N, Ogutu B, Marsh K, Newton CR, 2003. Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital. Bull World Health Organ 81: 166–173.
-
10.
Brent AJ, Ahmed I, Ndiritu M, Lewa P, Ngetsa C, Lowe B, Bauni E, English M, Berkley JA, Scott JA, 2006. Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study. Lancet 367: 482–488.
-
11.
Gwer S, Newton CR, Berkley JA, 2007. Over-diagnosis and co-morbidity of severe malaria in African children: a guide for clinicians. Am J Trop Med Hyg 77: 6–13.
-
12.
Hotez PJ, Kamath A, 2009. Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis 3: e412.
-
13.
Mediannikov O, Fenollar F, Socolovschi C, Diatta G, Bassene H, Molez JF, Sokhna C, Trape JF, Raoult D, 2010. Coxiella burnetii in humans and ticks in rural Senegal. PLoS Negl Trop Dis 4: e654.
-
14.
Parola P, Diatta G, Socolovschi C, Mediannikov O, Tall A, Bassene H, Trape JF, Raoult D, 2011. Tick-borne relapsing fever borreliosis, rural Senegal. Emerg Infect Dis 17: 883–885.
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