QJM vol. 97 no. 9 © Association of Physicians 2004; all rights reserved.
High mortality of infant bacteraemia clinically indistinguishable from severe malaria
From the 1Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 2Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, 3Institute of Microbiology and Immunology, University of Hamburg, Hamburg, Germany, and 4School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Received 30 January 2004 and in revised form 13 March 2004
Background: Early recognition of children at highest risk of dying and the targeting of appropriate drug therapy are vital to the improvement of paediatric care in developing countries. This will rely upon the development of simple clinically-based algorithms and treatment guidelines.
Aim: To determine the role of bacteraemia in children presenting with clinical signs and symptoms of severe malaria.
Design: Retrospective analysis of blood culture results following prospective data collection.
Methods: We studied 251 children presenting with symptoms and signs of severe malaria to a tertiary referral centre in Ghana. Blood was taken for malaria blood films, bacterial culture and haemograms.
Results: On the basis of clinical signs alone, malaria-film-positive (n = 182) and -negative (n = 69) patients were indistinguishable. Some 40% of film-negative patients were bacteraemic, vs. 12% of film-positive patients. Severe malaria and bacteraemia were not positively associated. Film-negative bacteraemic patients had a mortality of 39%, primarily affecting the age group <30 months.
Discussion: Infants presenting with symptoms and signs of severe malaria but a negative malaria film require immediate antibiotic treatment.
Address correspondence to Dr J.A. Evans, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, D-20359 Hamburg, Germany. E-mail: evans{at}kccr.de
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. C. Moore, S. T. Jacob, R. Pinkerton, P. Banura, D. B. Meya, S. J. Reynolds, N. Kenya-Mugisha, H. Mayanja-Kizza, and W. Michael Scheld for the Promoting Resource-Limit Treatment of Severe Sepsis with Artemether-Lumefantrine Is Associated with Decreased Mortality in Ugandan Patients without Malaria Am J Trop Med Hyg, May 1, 2009; 80(5): 723 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. I R Chandler, R. Mwangi, H. Mbakilwa, R. Olomi, C. J M Whitty, and H. Reyburn Malaria overdiagnosis: is patient pressure the problem? Health Policy Plan., May 1, 2008; 23(3): 170 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Gwer, C. R.J.C. Newton, and J. A. Berkley Over-Diagnosis and Co-Morbidity of Severe Malaria in African Children: A Guide for Clinicians Am J Trop Med Hyg, December 1, 2007; 77(6_Suppl): 6 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. May, J. A. Evans, C. Timmann, C. Ehmen, W. Busch, T. Thye, T. Agbenyega, and R. D. Horstmann Hemoglobin Variants and Disease Manifestations in Severe Falciparum Malaria JAMA, May 23, 2007; 297(20): 2220 - 2226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. POLAGE, G. BEDU-ADDO, A. OWUSU-OFORI, E. FRIMPONG, W. LLOYD, E. ZURCHER, D. HALE, and C. A. PETTI LABORATORY USE IN GHANA: PHYSICIAN PERCEPTION AND PRACTICE. Am J Trop Med Hyg, September 1, 2006; 75(3): 526 - 531. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. P. Mockenhaupt, J. P. Cramer, L. Hamann, M. S. Stegemann, J. Eckert, N.-R. Oh, R. N. Otchwemah, E. Dietz, S. Ehrhardt, N. W. J. Schroder, et al. Toll-like receptor (TLR) polymorphisms in African children: Common TLR-4 variants predispose to severe malaria PNAS, January 3, 2006; 103(1): 177 - 182. [Abstract] [Full Text] [PDF]
|
|