Pediatric invasive bacterial disease in areas of high malaria transmission

January 01, 0001

Pediatric invasive bacterial disease in areas of high malaria transmission

This group of UK, US, and Tanzanian researchers sought to assess the WHO’s "Guidelines for care at the first-referral level in developing countries" in an area of intense malaria transmission. They also sought to identify the pathogens involved in bacterial infections in children with and without malaria. They performed a prospective study in District hospital in Muheza, northeast Tanzania. Enrollees were children aged 2 months to 13 years admitted for febrile illness.

The researchers report: "Over one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum, 341 (9.4%) had invasive bacterial disease, and 142 (3.9%) were seropositive for HIV. The prevalence of invasive bacterial disease was lower in slide positive children (100/2195, 4.6%) than in slide negative children (241/1444, 16.7%). Non-typhi Salmonella was the most frequently isolated organism (52/100 (52%) of organisms in slide positive children and 108/241 (45%) in slide negative children). Mortality among children with invasive bacterial disease was significantly higher (58/341, 17%) than in children without invasive bacterial disease (126/3298, 3.8%), and this was true regardless of the presence of P falciparum parasitaemia. The sensitivity and specificity of WHO criteria in identifying invasive bacterial disease in slide positive children were 60.0% and 53.5%, compared with 70.5% and 48.1% in slide negative children. In children with WHO criteria for invasive bacterial disease, only 99/211(47%) of isolated organisms were susceptible to the first recommended antimicrobial agent."

The researchers concluded: "In an area exposed to high transmission of malaria, current WHO guidelines failed to identify almost a third of children with invasive bacterial disease, and more than half of the organisms isolated were not susceptible to currently recommended antimicrobials. Improved diagnosis and treatment of invasive bacterial disease are needed to reduce childhood mortality."

This study suggests the need for significant revamping of guidelines for treatment of febrile children in parts of the developing world.

For the full abstract, click here.

BMJ 340:c1350, 30 March 2010
© 2010 Nadjm et al
WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study. Behzad Nadjm, clinical Ben Amos, George Mtove, et al. Correspondence to H Reyburn:

Category: B. Blood/Immune Mechanisms. Keywords: fever, malaria, invasive bacterial disease, Salmonella, guidelines, prospective study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 25 May 2010

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