Abstract
BackgroundWe conducted a surveillance study to determine the leading causes of bloodstream infection in febrile patients seeking treatment at three district hospitals in Pemba Island, Zanzibar, Tanzania, an area with low malaria transmission.MethodsAll patients above two months of age presenting to hospital with fever were screened, and blood was collected for microbiologic culture and malaria testing. Bacterial sepsis and malaria crude incidence rates were calculated for a one-year period and were adjusted for study participation and diagnostic sensitivity of blood culture.ResultsBlood culture was performed on 2,209 patients. Among them, 166 (8%) samples yielded bacterial growth; 87 (4%) were considered as likely contaminants; and 79 (4%) as pathogenic bacteria. The most frequent pathogenic bacteria isolated were Salmonella Typhi (n = 46; 58%), followed by Streptococcus pneumoniae (n = 12; 15%). The crude bacteremia rate was 6/100,000 but when adjusted for potentially missed cases the rate may be as high as 163/100,000. Crude and adjusted rates for S. Typhi infections and malaria were 4 and 110/100,000 and 4 and 47/100,000, respectively. Twenty three (51%), 22 (49%) and 22 (49%) of the S.Typhi isolates were found to be resistant toward ampicillin, chloramphenicol and cotrimoxazole, respectively. Multidrug resistance (MDR) against the three antimicrobials was detected in 42% of the isolates.ConclusionsIn the presence of very low malaria incidence we found high rates of S. Typhi and S. pneumoniae infections on Pemba Island, Zanzibar. Preventive measures such as vaccination could reduce the febrile disease burden.
Highlights
Falciparum malaria has been the leading cause of febrile illness among patients in sub-Saharan Africa presenting to hospitals for treatment
Limited diagnostic facilities have led to a lack of data on community-acquired invasive bacterial infection [5]
One (0.04%) patient had a co-infection of bacteremia and malaria (Plasmodium falciparum), whereas 28 (1%) had malaria (P. falciparum) with a negative blood culture (Figure 2)
Summary
Falciparum malaria has been the leading cause of febrile illness among patients in sub-Saharan Africa presenting to hospitals for treatment. Recent reviews have tried to overcome this problem by aggregating available information on bloodstream infections [6] and extrapolating incidence rates [7]. These are limited by the diversity of the continent and its populations. We conducted a surveillance study to determine the leading causes of bloodstream infection in febrile patients seeking treatment at three district hospitals in Pemba Island, Zanzibar, Tanzania, an area with low malaria transmission
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