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Concomitant bacteremia in adults with severe falciparum malaria

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Phu, Nguyen Hoan, Day, Nicholas P J, Tuan, Phung Quoc, Mai, Nguyen Thi Hoang, Chau, Tran Thi Hong, Van Chuong, Ly, Vinh, Ha, Loc, Pham Phu, Sinh, Dinh Xuan, Hoa, Nguyen Thi Tuyet, Waller, Deborah J, Wain, John, Jeyapant, Atthanee, Watson, James A, Farrar, Jeremy J, Hien, Tran Tinh, Parry, Christopher and White, Nicholas J (2020) 'Concomitant bacteremia in adults with severe falciparum malaria'. Clinical Infectious Diseases. (In Press)

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Abstract

Background
Approximately 6% of children hospitalised with severe falciparum malaria in Africa are also bacteremic. It is therefore recommended that all children with severe malaria should receive broad spectrum antibiotics in addition to parenteral artesunate. Empirical antibiotics are not recommended currently for adults with severe malaria.

Methods
Blood cultures were performed on sequential prospectively studied adult patients with strictly defined severe falciparum malaria admitted to a single referral centre in Vietnam between 1991 and 2003.

Results
In 845 Vietnamese adults with severe falciparum malaria admission blood cultures were positive in 9 (1.07%: 95%CI 0.37 to 1.76%); S. aureus 2, S. pyogenes 1, S. Typhi 3, Non-typhoid Salmonella 1, K. pneumoniae 1, H. influenzae type b 1. Bacteremic patients presented usually with a combination of jaundice, acute renal failure and high malaria parasitemia. Four bacteremic patients died compared with 108 (12.9%) of 836 non-bacteremic severe malaria patients; risk ratio 3.44 (95%CI 1.62 to 7.29). In patients with >20% parasitemia the prevalence of concomitant bacteremia was 5.2% (4/76: 95%CI 0.2 to 10.3%) compared with 0.65% (5/769: 0.08 to 1.2%) in patients with <20% parasitemia, a risk ratio of 8.1 (2.2 to 29.5).

Conclusions
In contrast to children, the prevalence of concomitant bacteremia in adults with severe malaria is low. Administration of empirical antibiotics, in addition to artesunate, is warranted in the small subgroup of patients with very high parasitemias, emphasising the importance of quantitative blood smear microscopy assessment, but it is not indicated in the majority of adults with severe falciparum malaria.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 256 Antimalarials
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/ciaa191
Depositing User: Stacy Murtagh
Date Deposited: 16 Apr 2020 12:58
Last Modified: 29 Oct 2020 10:36
URI: https://archive.lstmed.ac.uk/id/eprint/14207

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