Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital.
OBJECTIVE
To describe the prevalence, aetiology and prognostic implications of coexisting invasive bacterial disease in children admitted with severe malaria in a rural Mozambican Hospital.


METHODS
Retrospective study of data systematically collected from June 2003 to May 2007 in a rural Mozambican hospital, from all children younger than 5 years admitted with severe malaria.


RESULTS
Seven thousand and forty-three children were admitted with a diagnosis of malaria. 25.2% fulfilled the criteria for severe malaria. 5.4% of the children with severe malaria and valid blood culture results had a concomitant bacteraemia. Case fatality rates of severe malaria cases rose steeply when bacteraemia was also present (from 4.0% to 22.0%, P < 0.0001), and bacteraemia was an independent risk factor for death among severe malaria patients (adjusted OR 6.2, 95% CI 2.8-13.7, P = 0.0001). Streptococcus pneumoniae, Gram-negative bacteria, Staphilococcus aureus and non-typhoid Salmonella (NTS) were the most frequently isolated microorganisms among severe malaria cases. Their frequency and associated case fatality rates (CFR) varied according to age and to syndromic presentation. Streptococcus pneumoniae had a relatively low CFR, but was consistently associated with severe malaria syndromes, or anaemia severity groups. No clear-cut relationship between malarial anaemia and NTS bacteraemia was found.


CONCLUSIONS
The coexistence of malaria and invasive bacterial infections is a frequent and life-threatening condition in many endemic African settings. In Mozambique, S. pneumoniae is the leading pathogen in this interaction, possibly as a consequence of the high HIV prevalence in the area. Measures directed at reducing the burden of both those infections are urgently needed to reduce child mortality in Africa.
Bassat
Quique
Q
Barcelona Center for International Health Research, University of Barcelona, Barcelona, Spain. quique.bassat@cresib.cat
Guinovart
Caterina
C
Sigaúque
Betuel
B
Mandomando
Inácio
I
Aide
Pedro
P
Sacarlal
Jahit
J
Nhampossa
Tacilta
T
Bardají
Azucena
A
Morais
Luís
L
Machevo
Sonia
S
Letang
Emilio
E
Macete
Eusébio
E
Aponte
John J
JJ
Roca
Anna
A
Menéndez
Clara
C
Alonso
Pedro L
PL
D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies