title: Frequency of severe malaria and invasive bacterial infections among children admitted to a rural hospital in Burkina Faso.
abstract: BACKGROUND
  Although severe malaria is an important cause of mortality among children in Burkina Faso, data on community-acquired invasive bacterial infections (IBI, bacteremia and meningitis) are lacking, as well as data on the involved pathogens and their antibiotic resistance rates.
  
  
  METHODS
  The present study was conducted in a rural hospital and health center in Burkina Faso, in a seasonal malaria transmission area. Hospitalized children (<15 years) presenting with T≥38.0°C and/or signs of severe illness were enrolled upon admission. Malaria diagnosis and blood culture were performed for all participants, lumbar puncture when clinically indicated. We assessed the frequency of severe malaria (microscopically confirmed, according to World Health Organization definitions) and IBI, and the species distribution and antibiotic resistance of the bacterial pathogens causing IBI.
  
  
  RESULTS
  From July 2012 to July 2013, a total of 711 patients were included. Severe malaria was diagnosed in 292 (41.1%) children, including 8 (2.7%) with IBI co-infection. IBI was demonstrated in 67 (9.7%) children (bacteremia, n = 63; meningitis, n = 6), 8 (11.8%) were co-infected with malaria. Non-Typhoid Salmonella spp. (NTS) was the predominant isolate from blood culture (32.8%), followed by Salmonella Typhi (18.8%), Streptococcus pneumoniae (18.8%) and Escherichia coli (12.5%). High antibiotic resistance rates to first line antibiotics were observed, particularly among Gram-negative pathogens. In addition, decreased ciprofloxacin susceptibility and extended-spectrum beta lactamase (ESBL) production was reported for one NTS isolate each. ESBL production was observed in 3/8 E. coli isolates. In-hospital mortality was 8.2% and case-fatality rates for IBI (23.4%) were significantly higher compared to severe malaria (6.8%, p<0.001).
  
  
  CONCLUSIONS
  Although severe malaria was the main cause of illness, IBI were not uncommon and had higher case-fatality rates. The high frequency, antibiotic resistance rates and mortality rates of community acquired IBI require improvement in hygiene, better diagnostic methods and revision of current treatment guidelines.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium ; Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium.
authors.forename: Jessica
authors.initials: J
authors.lastname: Maltha
authors.affiliation: IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Issa
authors.initials: I
authors.lastname: Guiraud
authors.affiliation: IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Bérenger
authors.initials: B
authors.lastname: Kaboré
authors.affiliation: IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Palpouguini
authors.initials: P
authors.lastname: Lompo
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ley
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bottieau
authors.affiliation: Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium ; Pediatrics, University of Leuven, Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Van Geet
authors.affiliation: IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Jacobs
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology / Q000469:parasitology; D003710:Demography; D004352:Drug Resistance, Microbial; D006760:Hospitalization / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications* / Q000453:epidemiology*