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

Abstract

Across tropical Africa, febrile children are treated for malaria either with or without confirmation thus resulting in failure to diagnose and treat other co-morbidities like urinary tract infections (UTI) and upper respiratory tract infection (URTI) that may coexist with malaria. This crosssectional study examined coexisting malaria with UTI and further assessed the antimicrobial susceptibility pattern of the isolated organisms among children aged <5 years presenting with fever. Between December 2012 and May 2013, 284 children were recruited from the Saint Francis Xavier Hospital, in the Central Region of Ghana through purposive sampling. Thick and thin blood films were used for the diagnosis of malaria and urine samples were collected in sterile, wide-mouthed, leak proof containers for culture and sensitivity. Organisms isolated were identified and tested for their antimicrobial sensitivity patterns using the Kirby-Bauer disc diffusion method. Prevalence of malaria with coexisting UTI was 15.8% with majority (58.0%) of the participants being female. Age was significantly (p=0.025) associated with malaria and UTI co-infection with the highest prevalence of co-infection (35.6%) recorded amongst the 13-24 months age group; gender was not associated with co-infection (p>0.05). Malaria parasitaemia (1+ to 3+) was significantly (p=0.001) associated with bacteriuria. Staphylococcus aureus (30.3%), Escherichia coli (20.4%) and Proteus species (5.3%) were isolated and these isolates were highly susceptible to Gentamicin (GEN), Ciprofloxacin (CIP) and Nitrofurantoin (NIT) but were resistant to ampicillin (AMP). Staphylococcus aureus was the predominant cause of the UTI and the isolates were highly resistant to ampicillin but susceptible to gentamicin, ciprofloxacin and nitrofurantoin.

Retrospective Analysis of Malarial Parasitemia and Bacteremia in Febrile Episodes Seen at Tertiary Hospital at Nguru, Nigeria

“…that can precipitate malaria disease in most cases [15]. In our study, S. aureus accounted for 66.7% of the total pathogens isolated, which is consistent with other studies [19,21,25], followed by Salmonella spp (19.6%), E. coli (7.8%), Coliforms (3.9%) and Steptococcus pneumoniae 2.0%. However, the observed variation in the bacterial pathogens isolation is known to be influenced by socio-demographic variables, microbiological and clinical indices.…”

“…Factors that may be responsible for the low SPN isolation rate are, possible overgrowth by other bacterial pathogen or the fastidious nature of the pathogen. E. coli is the leading pathogens implicated in urinary tract infection, a comorbdity in febrile episodes [6,19]. Three of the 4 E. coli isolates were recovered from patients with malarial fever, which futhered affirmed the malaria, UTI implication in febrile illness.…”

“…Clinical implication of malarial and bacteremia as predisposing risk factor for febrile illness have been well documented [1,10,[11][12][13][14]. However, in malarial endemic region, invasive bacteremia due to Non-typhoidal Salmonella spp predispose to malaria, dependent on the geographical location, seasonal and climatic pattern, socio-demographical variables and comorbdities-urinary tract infection, acute respiratory tract infection, HIV/AIDS, malnutrition and typhoid fever [14,15,16] Wide ranged of bacterial pathogens from enteric gram-negative Enterobactericaea, to gram-positive bacteria has been implicated in febrile episode [6,9,[10][11][12][13][14][15][16][17][18][19][20][21]. Non-malarial agents associated with febrile illness such as brucellosis, leptosporosis, salmonellosis are emerging in region with high livestock population and poor sanitation [12,13].…”

Evaluation of parental perception of childhood urinary tract infection in Ondo, Southwestern Nigeria

“…23 Non-specific symptoms like fever in children are often attributed to malaria in endemic regions. 3,26 There is a need to enlighten the public on the possibility of UTI in febrile young children with extra-renal complaints, especially when they are not responsive to standard antimalarial therapy. Also, there was a misconception among our study participants that UTI occurs only in adults.…”

“…1 It can occur alone or alongside other paediatric disorders. 2,3 It can be classified into upper UTI (pyelonephritis) and lower UTI (cystitis). 4 It is usually caused by bowel flora especially Escherichia coli.…”