Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana

Hogan, Benedikt; Eibach, Daniel; Krumkamp, Ralf; Sarpong, Nimako; Dekker, Denise; Kreuels, Benno; Maïga-Ascofaré, Oumou; Boahen, Kennedy Gyau; Akenten, Charity Wiafe; Adu‐Sarkodie, Yaw; Owusu‐Dabo, Ellis; May, Jürgen

doi:10.1093/cid/cix1120

Cited by 32 publications

(40 citation statements)

References 26 publications

(35 reference statements)

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“…Between 4.6% and 16% of African children with a positive film for Plasmodium falciparum in whom severe malaria is diagnosed are also bacteremic. [1][2][3][4][5][6] The case fatality rate in these children with coinfection is more than three times greater than the rate in non-bacteremic cases. 1,5 It is not possible to identify the coinfected children clinically or with basic laboratory tests at presentation, 7 and so, the current World Health Organization (WHO) management guidelines recommend that all children diagnosed with severe falciparum malaria in malaria-endemic areas also receive empirical broadspectrum antibacterial therapy.…”

Section: Introductionmentioning

confidence: 86%

“…Meanwhile, 15% of children in the local community were parasitemic and yet asymptomatic; these asymptomatic children were also more likely to have had a lower parasite density suggesting that a proportion of the children presenting with coinfection may have been asymptomatic, if not for the bacterial infection supervening. 6,10 However, from a practical perspective, clinicians caring for critically ill children that require hospitalization in these locations are still obliged to treat both the malaria and bacterial infection, as either can be rapidly fatal without appropriate therapy.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Aung

Nyein

Htut

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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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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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Aung

Nyein

Htut

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Depending on the presented symptoms blood, stool, urine, respiratory and/or cerebrospinal fluid samples were collected and screened for parasitic, viral and bacterial infection by microscopy, culture or PCR. A detailed description of the diagnostic evaluation has previously been published 15 .…”

Section: Methodsmentioning

confidence: 99%

“…Clinical malaria due to P. falciparum was defined as a parasite-density of asexual P. falciparum stages > 12,000/µl and fever ≥ 38.0 °C. The density cut-off was introduced using data of a control group from the study area in order to avoid overdiagnosis 15,16 .…”

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confidence: 99%

A cross-sectional study on risk factors for infection with Parvovirus B19 and the association with anaemia in a febrile paediatric population in Ghana

Herr

Krumkamp

Hogan

et al. 2020

Sci Rep

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Parvovirus B19 (B19V) occurs globally and can cause severe anaemia. The role of co-infections with Plasmodium falciparum (P. falciparum) has been controversially discussed. The study aimed to determine prevalence and severity of B19V infection, and the effect of co-infections on the risk for anaemia. Between November 2013 and April 2015 a total of 1186 hospital visits of children with fever admitted to a hospital in Ghana were recorded. Malaria, B19V and additional diagnostics for fever causes were performed. Recent B19V infection was defined as PCR and/or IgM positivity. Risk factors for a B19V infection and for anaemia were analysed. The prevalence of anaemia was compared between children with/without B19V infection, stratified for the presence of malaria. B19V IgM/PCR was positive in 6.4% (n = 76; 40 IgM + , 30 PCR + , 6 IgM + and PCR +). Among the B19V cases 60.5% had a simultaneous P. falciparum infection. B19V IgM positivity but not PCR positivity was associated with moderate-severe anaemia (OR = 2.6; 95%-CI: 1.3–5.3; P < 0.01 vs. OR = 0.9; 95%-CI: 0.4–1.8; P = 0.70). P. falciparum and IgM positive B19V infection were independent risk factors for anaemia with no evidence of effect modification. Our data show a significant association between B19V infection, defined as IgM but not PCR positivity, and moderate-severe anaemia. A multiplicative effect of B19V and P. falciparum infection was not found.

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“…Fever, caused by bacterial, viral, fungal, and parasitic pathogens, is a leading complaint presented at healthcare centers in sub-Saharan Africa (sSA) (Feikin et al, 2011;Hogan et al, 2018). Ideally, effective individual treatment involves identifying the infectious agents through cultures, serological and molecular tests and subsequently targeting them with appropriate antimicrobials (WHO, 2013).…”

Section: Introductionmentioning

confidence: 99%

Regional Variation of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacterales, Fluoroquinolone-Resistant Salmonella enterica and Methicillin-Resistant Staphylococcus aureus Among Febrile Patients in Sub-Saharan Africa

et al. 2020

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Background: Antimicrobial resistance (AMR) thwarts the curative power of drugs and is a present-time global problem. We present data on antimicrobial susceptibility and resistance determinants of bacteria the WHO has highlighted as being key antimicrobial resistance concerns in Africa, to strengthen knowledge of AMR patterns in the region. Methods: Blood, stool, and urine specimens of febrile patients, aged between ≥ 30 days and ≤ 15 years and hospitalized in Burkina Faso, Gabon, Ghana, and Tanzania were cultured from November 2013 to March 2017 (Patients > 15 years were included in Tanzania). Antimicrobial susceptibility testing was performed for all Enterobacterales and Staphylococcus aureus isolates using disk diffusion method. Extended-spectrum beta-lactamase (ESBL) production was confirmed by double-disk diffusion test and the detection of bla CTX−M , bla TEM and bla SHV. Multilocus sequence typing was conducted for ESBL-producing Escherichia coli and Klebsiella pneumoniae, ciprofloxacin-resistant Salmonella enterica and S. aureus. Ciprofloxacin-resistant

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Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana

Abstract: In malaria patients admitted to the study hospital, the likelihood of a co-diagnosis decreased with an increasing parasite count. In malaria-endemic settings, parasite densities provide important information for patient management, in particular for antimicrobial medication.

Cited by 32 publications

References 26 publications

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

A cross-sectional study on risk factors for infection with Parvovirus B19 and the association with anaemia in a febrile paediatric population in Ghana

Regional Variation of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacterales, Fluoroquinolone-Resistant Salmonella enterica and Methicillin-Resistant Staphylococcus aureus Among Febrile Patients in Sub-Saharan Africa

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