Abstract
BackgroundApproximately 6% of children hospitalized 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.MethodsBlood cultures were performed on sequential prospectively studied adult patients with strictly defined severe falciparum malaria admitted to a single referral center in Vietnam between 1991 and 2003.ResultsIn 845 Vietnamese adults with severe falciparum malaria admission blood cultures were positive in 9 (1.07%: 95% confidence interval [CI], .37–1.76%); Staphylococcus aureus in 2, Streptococcus pyogenes in 1, Salmonella Typhi in 3, Non-typhoid Salmonella in 1, Klebsiella pneumoniae in 1, and Haemophilus influenzae type b in 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 nonbacteremic severe malaria patients (risk ratio, 3.44; 95% CI, 1.62–7.29). In patients with >20% parasitemia the prevalence of concomitant bacteremia was 5.2% (4/76; 95% CI, .2–10.3%) compared with 0.65% (5/769; 0.08–1.2%) in patients with <20% parasitemia, a risk ratio of 8.1 (2.2–29.5).ConclusionsIn 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, emphasizing the importance of quantitative blood smear microscopy assessment, but it is not indicated in most adults with severe falciparum malaria.
Highlights
6% of children hospitalized with severe falciparum malaria in Africa are bacteremic
In endemic areas, where the majority of symptomatic malaria occurs in children, malaria is associated with an increased risk of bacteremia [2,3,4,5,6,7,8,9]
This risk is greatest in severe falciparum malaria
Summary
Blood cultures were performed on sequential prospectively studied adult patients with strictly defined severe falciparum malaria admitted to a single referral center in Vietnam between 1991 and 2003. Patients were included in the studies if they (or an accompanying relative) gave informed consent, they had asexual forms of Plasmodium falciparum on a peripheral-blood smear, were older than 14 years, were not in the first trimester of pregnancy, were not intravenous drug users, had received less than 3 g of quinine or 2 doses of artemisinin or a derivative in the previous 48 hours, were not allergic to the study drugs, and had 1 or more of the following: Glasgow Coma Scale score less than 11 (indicating cerebral malaria), anemia (hematocrit, 2.5 mg/dL [50 μmol/L]) with a parasite density greater than 100 000/μL, acute kidney injury (urine output, 3 mg/dL [250 μmol/L]), hypoglycemia (blood glucose,
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