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Concomitant Bacteremia in Adults With Severe Falciparum Malaria

Nguyen Hoan Phu1,2, Nicholas P J Day2,3,4, Phung Quoc Tuan1

  • 1Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 29, 2020
PubMed

Insights

In adults with severe falciparum malaria, bacteremia is uncommon (1.07%). Empirical antibiotics are not recommended for most patients, but may benefit those with very high parasitemia.

Area of Science:

  • Tropical Medicine
  • Infectious Diseases
  • Malariology

Background:

  • Severe falciparum malaria can present with bacteremia, particularly in children (approx. 6%) in Africa.
  • Current recommendations advise broad-spectrum antibiotics for children with severe malaria alongside artesunate.
  • Empirical antibiotic use is not currently advised for adult severe malaria cases.

Purpose of the Study:

  • To investigate the prevalence of bacteremia in adult patients with severe falciparum malaria.
  • To determine the clinical implications and risk factors associated with bacteremia in this population.
  • To inform antibiotic treatment guidelines for severe malaria in adults.

Main Methods:

  • Prospective study of adult patients with severe falciparum malaria admitted to a Vietnamese referral center.
  • Blood cultures were performed at admission for 845 patients between 1991 and 2003.
  • Parasitemia levels were quantified using blood smear microscopy.

Main Results:

  • Bacteremia was detected in 1.07% of adult severe malaria patients.
  • Commonly identified pathogens included Staphylococcus aureus, Streptococcus pyogenes, Salmonella Typhi, and Klebsiella pneumoniae.
  • Bacteremic patients had higher mortality (3.44-fold increased risk) and were more likely to present with jaundice, acute renal failure, and high parasitemia (>20% parasitemia increased bacteremia risk 8.1-fold).

Conclusions:

  • The prevalence of bacteremia in adults with severe malaria is significantly lower than in children.
  • Empirical antibiotic administration is not indicated for most adult severe malaria cases.
  • Consideration of empirical antibiotics may be warranted for a small subset of adults with very high parasitemia, highlighting the importance of quantitative blood smear assessment.
Abstract

Keywords:
Plasmodium falciparumbacteremiamalariasevere malaria

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