Persistent fever in severe malaria in children

Plasmodium falciparum species with reduced susceptibility to chloroquine have emerged in West Africa since the mid 1980s. Local strains, however, remain sensitive to amodiaquine with peripheral parasite clearance achieved within seven days in the majority. Blood cultures from 33 children (aged two to 12 years), who remained pyrexial after clearance of their parasitaemia, isolated causative organisms in 19 (57.6 pc) samples, with Salmonella species the commonest (68.4 pc) of all isolates. Complicating septicaemia needs consideration and early institution of treatment with antibiotics in children with severe malaria. Persistent pyrexia in malaria is not always due to resistance to antimalarials in areas with recent emergence of chloroquine resistant strains. A combination of amodiaquine and cotrimoxazole is suggested as a useful initial treatment.