Bacteraemia, urinary tract infection and malaria in hospitalised febrile children in Nairobi: is there an association?

Abstract

Background: There is laboratory evidence of altered immune function in children with malaria. Bacterial infections have been documented to complicate severe forms of malaria. However, it remains unclear whether such infections are attributable to the malaria, other risk factors, or are coincidental. Objective: To determine the prevalence of bacteraemia and urinary tract infections (UTI) in febrile hospitalised children with and without malaria. Design: A cross-sectional survey. Setting: General paediatric wards, Kenyatta National Hospital, Nairobi. Subjects: Children aged between three months and 12 years admitted with an acute febrile illness, with no obvious focus of bacterial infection. Materials and Methods: Using a standardised questionnaire, information on sociodemography, symptomatology, and nutritional status was obtained. Malaria slides, blood and urine cultures were performed on each child. Results: Malaria parasitaemia was present in 158 (60%) of 264 children presenting with acute febrile illness with no obvious focus of bacterial infection. Bacteria were isolated from blood and/or urine of 62 (23%) of all enrolled children. Bacteraemia was prevalent among 11.4% of 158 children with malaria and among 13.2% of 106 without malaria. Gram-positive organisms comprised 28.1% of blood isolates, gram-negative 62.5%, and atypical bacteria 9.4%. UTI was prevalent among 13.3% of 158 children with malaria and 16.0% of 106 children without malaria. Gram-positive organisms comprised 18.4%, gram-negative 78.9%, and atypical bacteria 2.6% of the urine isolates. Presence of malaria parasitaemia was not associated with an increased risk of bacteraemia (OR 0.9, 95% CI [0.4-0.7], or UTI (OR 0.8 95% CI [0.4-1.6] in this study population. Conclusion: Among children hospitalised in Nairobi with fever and no obvious bacterial infective focus, there should be a high index of suspicion for malaria, followed by bacteraemia and UTI. Malaria parasitaemia does not appear to be associated with increased risk of bacterial co-infection.

Co-existence of malaria and urinary tract infection among children under five: A cross-sectional study of the Assin-South Municipality, Ghana

“…The current study, in contrast to earlier studies (Akpede and Skyes, 1992;Okwara et al, 2004) observed a significant association between parasite density and bacteriuria. This could be attributed to the high prevalence of malaria, and the relatively younger age of participants recruited in this study.…”

“…Earlier works by Osegbe et al,(1991), Musa-Asien et al, (2003) and Okwara et al, (2004) reported E. coli as the predominant isolate. However, in agreement with the work of Okunola et al, (2012) Staphylococcus aureus was identified as the main isolate among children in the Assin South Municipality.…”

“…Co-infection of malaria and UTI in children has been reported by several studies conducted across the African continent (Musa-Aisien et al, 2003;Okwara et al, 2004;Okunola et al, 2012). The prevalence of co-infection reported in this study is a little higher than the 13.3% recorded in earlier studies in Nigeria (Okunola et al, 2012).…”

“…Co-existence of urinary tract infection (UTI) with these febrile illnesses especially malaria has been reported by several authors across the African continent (Akpede and Skyes, 1992;Okwara et al, doi: http://dx.doi.org/10.4314/jmbs.v2i4.5…”

Common Epidemiology ofRickettsia felisInfection and Malaria, Africa

“…and R. felis were detected at high levels, mostly during the rainy season and among children <15 years of age (Figure 2), but no coincidental relationship was found. The incidence of co-infection of R. felis and malaria was lower in Senegal (23%) than in Kenya (79%) ( 5 ), but higher than the rate of simultaneous bacterial bloodstream infections and malaria parasitemia, which ranged from 6% in rural Mozambique ( 23 ) to 11% in Nairobi ( 24 ). Mixed infections for rickettsioses, including co-infections with malaria or with other bacteria ( Leptospira spp., Coxiella burnetii , and Burkholderia pseudomallei ) have been described ( 25 ).…”