Journal article
Concomitant bacteremia in adults with severe falciparum malaria
- Abstract:
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Background Approximately 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.
Methods 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.
Results In 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).
Conclusions In 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, 192.7KB, Terms of use)
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- Publisher copy:
- 10.1093/cid/ciaa191
Authors
- Publisher:
- Oxford University Press
- Journal:
- Clinical Infectious Diseases More from this journal
- Volume:
- 71
- Issue:
- 9
- Pages:
- e465–e470
- Publication date:
- 2020-02-28
- Acceptance date:
- 2020-02-25
- DOI:
- EISSN:
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1537-6591
- ISSN:
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1058-4838
- Pmid:
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32107527
- Language:
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English
- Keywords:
- Pubs id:
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1090407
- Local pid:
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pubs:1090407
- Deposit date:
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2020-03-08
Terms of use
- Copyright holder:
- Phu et al.
- Copyright date:
- 2020
- Rights statement:
- © The Authors 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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