Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana
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Date
2018
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Clinical Infectious Diseases
Abstract
Background. The epidemiology of pediatric febrile illness is shifting in sub-Saharan Africa, but malaria remains a major cause of
childhood morbidity and mortality. The present study describes causes of febrile illness in hospitalized children in Ghana and aims
to determine the burden of malaria coinfections and their association with parasite densities.
Methods. In a prospective study, children (aged ≥30 days and ≤15 years) with fever ≥38.0°C were recruited after admission to
the pediatric ward of a primary hospital in Ghana. Malaria parasitemia was determined and blood, stool, urine, respiratory, and
cerebrospinal fluid specimens were screened for parasitic, bacterial, and viral pathogens. Associations of Plasmodium densities with
other pathogens were calculated.
Results. From November 2013 to April 2015, 1238 children were enrolled from 4169 admissions. A clinical/microbiological
diagnosis could be made in 1109/1238 (90%) patients, with Plasmodium parasitemia (n = 728/1238 [59%]) being predominant. This
was followed by lower respiratory tract infections/pneumonia (n = 411/1238 [34%]; among detected pathogens most frequently
Streptococcus pneumoniae, n = 192/299 [64%]), urinary tract infections (n = 218/1238 [18%]; Escherichia coli, n = 21/32 [66%]),
gastrointestinal infections (n = 210 [17%]; rotavirus, n = 32/97 [33%]), and invasive bloodstream infections (n = 62 [5%]; Salmonella
species, n = 47 [76%]). In Plasmodium-infected children the frequency of lower respiratory tract, gastrointestinal, and bloodstream
infections increased with decreasing parasite densities.
Conclusions. In a hospital setting, the likelihood of comorbidity with a nonmalarial disease is inversely correlated with increas ing
blood levels of malaria parasites. Hence, parasite densities provide important information as an indicator for the probability of
coinfection, in particular to guide antimicrobial medication
Description
This article is published by Clinical Infectious Diseases and is also available at https://doi.org/10.1093/cid/cix1120