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Nyein PP, Aung NM, Kyi TT, et al. High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria. Open Forum Infect Dis. 2016;3(1):ofw028doi: 10.1093/ofid/ofw028.
Nyein, P. P., Aung, N. M., Kyi, T. T., Htet, Z. W., Anstey, N. M., Kyi, M. M., & Hanson, J. (2016). High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria. Open forum infectious diseases, 3(1), ofw028. https://doi.org/10.1093/ofid/ofw028
Nyein, Phyo Pyae, et al. "High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria." Open forum infectious diseases vol. 3,1 (2016): ofw028. doi: https://doi.org/10.1093/ofid/ofw028
Nyein PP, Aung NM, Kyi TT, Htet ZW, Anstey NM, Kyi MM, Hanson J. High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria. Open Forum Infect Dis. 2016 Feb 09;3(1):ofw028. doi: 10.1093/ofid/ofw028. eCollection 2016 Jan. PMID: 26989752; PMCID: PMC4794945.
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Open Forum Infect Dis. 2016 Feb 09;3(1):ofw028. doi: 10.1093/ofid/ofw028. eCollection 2016 Jan.

High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria.

Open forum infectious diseases

Phyo Pyae Nyein, Ne Myo Aung, Tint Tint Kyi, Zaw Win Htet, Nicholas M Anstey, Mar Mar Kyi, Josh Hanson

Affiliations

  1. Insein General Hospital , Yangon , Myanmar.
  2. Menzies School of Health Research, Charles Darwin University , Darwin , Australia.

PMID: 26989752 PMCID: PMC4794945 DOI: 10.1093/ofid/ofw028

Abstract

Background.  African children with severe falciparum malaria commonly have concomitant Gram-negative bacteremia, but co-infection has been thought to be relatively rare in adult malaria. Methods.  Adults with a diagnosis of falciparum malaria hospitalized at 4 tertiary referral hospitals in Myanmar had blood cultures collected at admission. The frequency of concomitant bacteremia and the clinical characteristics of the patients, with and without bacteremia, were explored. Results.  Of 67 adults hospitalized with falciparum malaria, 9 (13% [95% confidence interval, 5.3%-21.6%]) were also bacteremic on admission, 7 (78%) with Gram-negative enteric organisms (Escherichia coli [n = 3], typhoidal Salmonella species [n = 3], nontyphoidal Salmonella [n = 1]). Bacteremic adults had more severe disease (median Respiratory Coma Acidosis Malaria [RCAM] score 3; interquartile range [IQR], 1-4) than those without bacteremia (median RCAM score 1; IQR, 1-2) and had a higher frequency of acute kidney injury (50% vs 16%, P = .03). Although 35 (52%) were at high risk of death (RCAM score ≥2), all 67 patients in the study survived, 51 (76%) of whom received empirical antibiotics on admission. Conclusions.  Bacteremia was relatively frequent in adults hospitalized with falciparum malaria in Myanmar. Like children in high transmission settings, bacteremic adults in this low transmission setting were sicker than nonbacteremic adults, and were often difficult to identify at presentation. Empirical antibiotics may also be appropriate in adults hospitalized with falciparum malaria in low transmission settings, until bacterial infection is excluded.

Keywords: antibiotics; bacteremia; clinical management; falciparum malaria; salmonella

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