title: Malaria is an uncommon cause of adult sepsis in south-western Uganda.
abstract: BACKGROUND
  Malaria is often considered a cause of adult sepsis in malaria endemic areas. However, diagnostic limitations can make distinction between malaria and other infections challenging. Therefore, the objective of this study was to determine the relative contribution of malaria to adult sepsis in south-western Uganda.
  
  
  METHODS
  Adult patients with sepsis were enrolled at the Mbarara Regional Referral Hospital between February and May 2012. Sepsis was defined as infection plus ≥2 of the following: axillary temperature >37.5°C or <35.5°C, heart rate >90 or respiratory rate >20. Severe sepsis was defined as sepsis plus organ dysfunction (blood lactate >4 mmol/L, confusion, or a systolic blood pressure <90 mmHg). Sociodemographic, clinical and laboratory data, including malaria PCR and rapid diagnostic tests, as well as acid fast bacteria sputum smears and blood cultures were collected. Patients were followed until in-patient death or discharge. The primary outcome of interest was the cause of sepsis. Multivariable logistic regression was performed to assess predictors of mortality.
  
  
  RESULTS
  Enrollment included 216 participants who were 51% female with a median age of 32 years (IQR 27-43 years). Of these, 122 (56%) subjects were HIV-seropositive of whom 75 (66%) had a CD4+ T cell count <100 cells/μL. The prevalence of malaria was 4% (six with Plasmodium falciparum, two with Plasmodium vivax). Bacteraemia was identified in 41 (19%) patients. In-hospital mortality was 19% (n = 42). In multivariable regression analysis, Glasgow Coma Score <9 (IRR 4.81, 95% CI 1.80-12.8) and severe sepsis (IRR, 2.07, 95% CI 1.03-4.14), but no specific diagnoses were statistically associated with in-hospital mortality.
  
  
  CONCLUSIONS
  Malaria was an uncommon cause of adult sepsis in a regional referral hospital in south-western Uganda. In this setting, a thorough evaluation for alternate causes of disease in patients presenting with sepsis is recommended.
authors: Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
authors: Mary A
authors: MA
authors: Auma
authors: Mark J
authors: MJ
authors: Siedner
authors: Dan
authors: D
authors: Nyehangane
authors: Aisha
authors: A
authors: Nalusaji
authors: Martha
authors: M
authors: Nakaye
authors: Juliet
authors: J
authors: Mwanga-Amumpaire
authors: Rose
authors: R
authors: Muhindo
authors: L Anthony
authors: LA
authors: Wilson
authors: Yap
authors: Y
authors: Boum
authors: Christopher C
authors: CC
authors: Moore
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology*; D016780:Malaria, Vivax / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology*; D014454:Uganda / Q000453:epidemiology
references: Am J Trop Med Hyg. 2009 May;80(5):723-8
references: 19407113
references: Malar J. 2009 Apr 16;8:66
references: 19371426
references: Clin Infect Dis. 2011 Aug;53(4):e8-15
references: 21810740
references: PLoS One. 2009 Nov 11;4(11):e7782
references: 19907656
references: Am J Trop Med Hyg. 2012 Dec;87(6):1105-11
references: 23091197
references: Crit Care Med. 2012 Jul;40(7):2050-8
references: 22564958
references: Acta Trop. 2012 Mar;121(3):184-95
references: 21420377
references: BMC Med. 2011 Apr 13;9:37
references: 21486498
references: BMJ. 2004 Nov 20;329(7476):1212
references: 15542534
references: AIDS. 2001 May 4;15(7):899-906
references: 11399962
references: Lancet. 2012 Feb 4;379(9814):413-31
references: 22305225
references: Lancet. 2010 May 29;375(9729):1920-37
references: 20488517
references: Malar J. 2007 May 16;6:58
references: 17506881
references: Malar J. 2011 May 18;10:132
references: 21592332
references: Trans R Soc Trop Med Hyg. 2012 Nov;106(11):688-95
references: 23022040
references: Lancet. 2012 Dec 15;380(9859):2095-128
references: 23245604
references: Trans R Soc Trop Med Hyg. 2012 Aug;106(8):504-7
references: 22742942
references: Trans R Soc Trop Med Hyg. 2008 Jan;102(1):25-31
references: 18031779
references: Malar J. 2010 Jan 04;9:2
references: 20044942
references: AIDS. 2001 Dec 7;15(18):2445-50
references: 11740196
references: Crit Care Med. 2006 Jun;34(6):1589-96
references: 16625125
references: Lancet. 2011 Oct 8;378(9799):1316-23
references: 21903251
references: Am J Trop Med Hyg. 2011 Aug;85(2):275-81
references: 21813847
references: Lancet. 2000 Sep 23;356(9235):1051-6
references: 11009139
references: Mol Biochem Parasitol. 1993 Oct;61(2):315-20
references: 8264734
references: Am J Trop Med Hyg. 2005 May;72(5):561-7
references: 15891130
references: Clin Infect Dis. 2012 Jul;55(2):242-50
references: 22511551
references: Am J Trop Med Hyg. 2011 Oct;85(4):697-702
references: 21976575