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      Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review.

      Author(s): , 1
      Publication date (Electronic):
      Journal: BMC medicine
      Publisher: Springer Science and Business Media LLC

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          Abstract

          Severe malaria remains a major cause of pediatric hospital admission across Africa. Invasive bacterial infection (IBI) is a recognized complication of Plasmodium falciparum malaria, resulting in a substantially worse outcome. Whether a biological relationship exists between malaria infection and IBI susceptibility remains unclear. We, therefore, examined the extent, nature and evidence of this association.

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          Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster.

          B Brabin, E Dorman, PF Beales (2000)
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            Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study

            Bjørn Blomberg, Karim P Manji, Willy K Urassa … (2007)
            Background Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. Methods We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. Results The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828) of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9%) of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5%) was more than double that of malaria (20.2%) and Gram-positive bloodstream infection (16.7%). Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. Conclusion Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal outcome calls for renewed efforts to curb the further emergence of resistance, improve HIV care and nutrition for children.
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              Microvascular sequestration of parasitized erythrocytes in human falciparum malaria: a pathological study.

              E Pongponratn, M Aikawa, B Punpoowong … (1991)
              Thirty-nine falciparum malaria autopsy cases from the Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand were divided into two groups that had had either cerebral malaria (CM) or non-cerebral malaria (NCM). We then studied significant pathological differences between these groups in order to investigate the correlation between parasitized erythrocyte (PRBC) sequestration in small blood vessels in the brain, heart, lungs and small intestines. We found that the percentage of PRBC sequestration in the organs which we studied was higher in the CM patients than in the NCM patients. The difference of PRBC sequestration among the organs of two groups was significant (P less than 0.05). In the CM group, the average percentage of PRBC sequestration in the brain was significantly higher than in the heart, lungs and small intestines (P less than 0.05). No statistically significant difference was found between PRBC sequestration in the brains, hearts, lungs and small intestines in the NCM group (P greater than 0.05). Our study indicates that severity of malaria in the CM patients depends on PRBC sequestration, especially in the brain. A combination of functional disturbances of the other organs, in addition to the cerebral pathology, may augment the severity of the disease.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Med
                Title: BMC medicine
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1741-7015
                ISSN (Print): 1741-7015
                Publication date (Electronic): Feb 19 2014
                Volume: 12
                Affiliations
                [1 ] Department of Paediatrics, Faculty of Medicine, Imperial College, Wellcome Trust Centre for Clinical Tropical Medicine, St Mary's Campus Norfolk Place, London W2 1PG, UK. k.maitland@imperial.ac.uk.
                Article
                Publisher Item ID: 1741-7015-12-31
                DOI: 10.1186/1741-7015-12-31
                PMC ID: 3928319
                PubMed ID: 24548672
                SO-VID: 2e66226f-0ede-4f6b-9e38-65069e88bc7e
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