Abstract
BackgroundFever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania, yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients.MethodsThe present study was conducted at Korogwe District Hospital in north-eastern Tanzania. Patients aged between 2 and 59 months with a history of fever or measured axillary temperature ≥37.5°C attending the outpatient clinic were screened for enrolment into the study. Blood culturing was performed using the BACTEC 9050® system. A biochemical analytical profile index and serological tests were used for identification and confirmation of bacterial isolates. In-vitro antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. The identification of Plasmodium falciparum malaria was performed by microscopy with Giemsa stained blood films.ResultsA total of 808 blood cultures were collected between January and October 2013. Bacterial growth was observed in 62/808 (7.7%) of the cultured samples. Pathogenic bacteria were identified in 26/808 (3.2%) cultures and the remaining 36/62 (58.1%) were classified as contaminants. Salmonella typhi was the predominant bacterial isolate detected in 17/26 (65.4%) patients of which 16/17 (94.1%) were from patients above 12 months of age. Streptococcus pneumoniae was the second leading bacterial isolate detected in 4/26 (15.4%) patients. A high proportion of S.typhi 11/17 (64.7%) was isolated during the rainy season. S. typhi isolates were susceptible to ciprofloxacin (n = 17/17, 100%) and ceftriaxone (n = 13/17, 76.5%) but resistant to chloramphenicol (n = 15/17, 88.2%). P. falciparum malaria was identified in 69/808 (8.5%) patients, none of whom had bacterial infection.ConclusionBloodstream bacterial infection was not found to be a common cause of fever in outpatient children; and S. typhi was the predominant isolate. This study highlights the need for rational use of antimicrobial prescription in febrile paediatric outpatients presenting at healthcare facilities in rural Tanzania.
Highlights
Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania, yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients
P. falciparum malaria was identified in 69/808 (8.5%) patients, none of whom had bacterial infection
In the current study, bloodstream bacterial infection was not found to be a common cause of fever in outpatient children from rural Tanzania
Summary
Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania, yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients. Bacterial bloodstream infections are known common causes of febrile illnesses especially among children living in resource poor areas of sub-Saharan Africa [1]. The epidemiology of bacterial infections varies across the world depending on geographical environment, Bacterial infections among inpatient children in many parts of sub-Saharan Africa have been documented to be caused mainly by non-typhoidal Salmonella, Streptococcus pneumoniae, Haemophilus influenzae and Escherichia coli [1, 6, 7]. These signs and symptoms are non-specific and may overlap with other febrile infections making diagnosis in children difficult and challenging in the absence of appropriate laboratory confirmation [13, 14]. Patients are often given the wrong diagnosis, which leads to inappropriate treatment, poor prognosis and promotion of antimicrobial drug resistance [16, 17]
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