Abstract
BackgroundThe increasing incidence of multi-antibiotic-resistant bacterial infections, coupled with the risk of co-infections in malaria-endemic regions, complicates accurate diagnosis and prolongs hospitalization, thereby increasing the total cost of illness. Further, there are challenges in making the correct choice of antibiotic treatment and duration, precipitated by a lack of access to microbial culture facilities in many hospitals in Ghana. The aim of this case report is to highlight the need for blood cultures or alternative rapid tests to be performed routinely in malaria patients, to diagnose co-infections with bacteria, especially when symptoms persist after antimalarial treatment.Case presentationA 6-month old black female child presented to the Agogo Presbyterian Hospital with fever, diarrhea, and a 3-day history of cough. A rapid diagnostic test for malaria and Malaria microscopy was positive for P. falciparum with a parasitemia of 224 parasites/μl. The patient was treated with Intravenous Artesunate, parental antibiotics (cefuroxime and gentamicin) and oral dispersible zinc tablets in addition to intravenous fluids. Blood culture yielded Acinetobacter baumanii, which was resistant to all of the third-generation antibiotics included in the susceptibility test conducted, but sensitive to ciprofloxacin and gentamicin. After augmenting treatment with intravenous ciprofloxacin, all symptoms resolved.ConclusionEven though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream. Bacterial blood cultures and antimicrobial susceptibility testing should be routinely performed to guide treatment options for febril illnesses in Ghana in order to reduce inappropriate use of broad-spectrum antibiotics and limit the development of antimicrobial resistance.
Highlights
Bloodstream infections (BSI) are major causes of hospitalization and mortality worldwide [1, 2]
Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream
Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the presented case highlights the need to perform blood cultures on malaria positive patients, especially when fever persists after parasites have been cleared
Summary
Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the presented case highlights the need to perform blood cultures on malaria positive patients, especially when fever persists after parasites have been cleared. In children with malaria, undetected bacteria may contribute to morbidity due to untreated bacterial infections. With the current rise in resistance among important bacterial pathogens, the necessity for blood (and other specimens) cultures for the enrichment of bacteria cannot be ignored. The ability for laboratories to perform bacterial cultures is, a key to avert the current trend in antibiotic resistance, especially in rural hospital settings. The development of rapid and cost-effective alternatives for the identification of bacterial (co-) infections could be a solution for low-resource settings, where lack of financial means and expertise do not allow blood cultures to be performed
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