Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania
BackgroundFebrile illness is the commonest cause of hospitalization in children <5 years in sub-Saharan Africa, and bacterial bloodstream infections and malaria are major causes of death.MethodsFrom March 2017 to July 2018, we enrolled 2,226 children aged 0–5 years hospitalized due to fever i...
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Frontiers Media S.A.
2020-09-01
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Online Access: | https://www.frontiersin.org/article/10.3389/fmicb.2020.02118/full |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Sabrina J. Moyo Sabrina J. Moyo Joel Manyahi Joel Manyahi Bjørn Blomberg Bjørn Blomberg Marit Gjerde Tellevik Marit Gjerde Tellevik Nahya Salim Masoud Said Aboud Karim Manji Adam P. Roberts Kurt Hanevik Kurt Hanevik Kristine Mørch Kristine Mørch Nina Langeland Nina Langeland |
spellingShingle |
Sabrina J. Moyo Sabrina J. Moyo Joel Manyahi Joel Manyahi Bjørn Blomberg Bjørn Blomberg Marit Gjerde Tellevik Marit Gjerde Tellevik Nahya Salim Masoud Said Aboud Karim Manji Adam P. Roberts Kurt Hanevik Kurt Hanevik Kristine Mørch Kristine Mørch Nina Langeland Nina Langeland Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania Frontiers in Microbiology bacteraemia malaria antimicrobial resistance P. falciparum Tanzania |
author_facet |
Sabrina J. Moyo Sabrina J. Moyo Joel Manyahi Joel Manyahi Bjørn Blomberg Bjørn Blomberg Marit Gjerde Tellevik Marit Gjerde Tellevik Nahya Salim Masoud Said Aboud Karim Manji Adam P. Roberts Kurt Hanevik Kurt Hanevik Kristine Mørch Kristine Mørch Nina Langeland Nina Langeland |
author_sort |
Sabrina J. Moyo |
title |
Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania |
title_short |
Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania |
title_full |
Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania |
title_fullStr |
Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania |
title_full_unstemmed |
Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania |
title_sort |
bacteraemia, malaria, and case fatality among children hospitalized with fever in dar es salaam, tanzania |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Microbiology |
issn |
1664-302X |
publishDate |
2020-09-01 |
description |
BackgroundFebrile illness is the commonest cause of hospitalization in children <5 years in sub-Saharan Africa, and bacterial bloodstream infections and malaria are major causes of death.MethodsFrom March 2017 to July 2018, we enrolled 2,226 children aged 0–5 years hospitalized due to fever in four major public hospitals of Dar es Salaam, namely, Amana, Temeke, and Mwananyamala Regional Hospitals and Muhimbili National Hospital. We recorded social demographic and clinical data, and we performed blood-culture and HIV-antibody testing. We used qPCR to quantify Plasmodium falciparum parasitaemia and Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) to identify bacterial isolates. Disk diffusion method was used for antimicrobial susceptibility testing.ResultsNineteen percent of the children (426/2,226) had pathogens detected from blood. Eleven percent (236/2,226) of the children had bacteraemia/fungaemia and 10% (204/2,063) had P. falciparum malaria. Ten children had concomitant malaria and bacteraemia. Gram-negative bacteria (64%) were more frequent than Gram-positive (32%) and fungi (4%). Over 50% of Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL) producers and multidrug resistant. Methicillin resistant Staphylococcus aureus (MRSA) was found in 11/42 (26.2%). The most severe form of clinical malaria was associated with high parasitaemia (>four million genomes/μL) of P. falciparum in plasma. Overall, in-hospital death was 4% (89/2,146), and it was higher in children with bacteraemia (8%, 18/227) than malaria (2%, 4/194, p = 0.007). Risk factors for death were bacteraemia (p = 0.03), unconsciousness at admission (p < 0.001), and admission at a tertiary hospital (p = 0.003).ConclusionCompared to previous studies in this region, our study showed a reduction in malaria prevalence, a decrease in in-hospital mortality, and an increase in antimicrobial resistance (AMR) including ESBLs and multidrug resistance. An increase of AMR highlights the importance of continued strengthening of diagnostic capability and antimicrobial stewardship programs. We also found malaria and bacteraemia contributed equally in causing febrile illness, but bacteraemia caused higher in-hospital death. The most severe form of clinical malaria was associated with P. falciparum parasitaemia. |
topic |
bacteraemia malaria antimicrobial resistance P. falciparum Tanzania |
url |
https://www.frontiersin.org/article/10.3389/fmicb.2020.02118/full |
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doaj-d81b5675bcd04f739d29ee7488df2b5e2020-11-25T03:25:49ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2020-09-011110.3389/fmicb.2020.02118558843Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, TanzaniaSabrina J. Moyo0Sabrina J. Moyo1Joel Manyahi2Joel Manyahi3Bjørn Blomberg4Bjørn Blomberg5Marit Gjerde Tellevik6Marit Gjerde Tellevik7Nahya Salim Masoud8Said Aboud9Karim Manji10Adam P. Roberts11Kurt Hanevik12Kurt Hanevik13Kristine Mørch14Kristine Mørch15Nina Langeland16Nina Langeland17Department of Clinical Science, University of Bergen, Bergen, NorwayDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Clinical Science, University of Bergen, Bergen, NorwayDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Clinical Science, University of Bergen, Bergen, NorwayNorwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, NorwayNorwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, NorwayDepartment of Microbiology, Haukeland University Hospital, Bergen, NorwayDepartment of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United KingdomDepartment of Clinical Science, University of Bergen, Bergen, NorwayNorwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, NorwayNorwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Science, University of Bergen, Bergen, NorwayNorwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, NorwayBackgroundFebrile illness is the commonest cause of hospitalization in children <5 years in sub-Saharan Africa, and bacterial bloodstream infections and malaria are major causes of death.MethodsFrom March 2017 to July 2018, we enrolled 2,226 children aged 0–5 years hospitalized due to fever in four major public hospitals of Dar es Salaam, namely, Amana, Temeke, and Mwananyamala Regional Hospitals and Muhimbili National Hospital. We recorded social demographic and clinical data, and we performed blood-culture and HIV-antibody testing. We used qPCR to quantify Plasmodium falciparum parasitaemia and Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) to identify bacterial isolates. Disk diffusion method was used for antimicrobial susceptibility testing.ResultsNineteen percent of the children (426/2,226) had pathogens detected from blood. Eleven percent (236/2,226) of the children had bacteraemia/fungaemia and 10% (204/2,063) had P. falciparum malaria. Ten children had concomitant malaria and bacteraemia. Gram-negative bacteria (64%) were more frequent than Gram-positive (32%) and fungi (4%). Over 50% of Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL) producers and multidrug resistant. Methicillin resistant Staphylococcus aureus (MRSA) was found in 11/42 (26.2%). The most severe form of clinical malaria was associated with high parasitaemia (>four million genomes/μL) of P. falciparum in plasma. Overall, in-hospital death was 4% (89/2,146), and it was higher in children with bacteraemia (8%, 18/227) than malaria (2%, 4/194, p = 0.007). Risk factors for death were bacteraemia (p = 0.03), unconsciousness at admission (p < 0.001), and admission at a tertiary hospital (p = 0.003).ConclusionCompared to previous studies in this region, our study showed a reduction in malaria prevalence, a decrease in in-hospital mortality, and an increase in antimicrobial resistance (AMR) including ESBLs and multidrug resistance. An increase of AMR highlights the importance of continued strengthening of diagnostic capability and antimicrobial stewardship programs. We also found malaria and bacteraemia contributed equally in causing febrile illness, but bacteraemia caused higher in-hospital death. The most severe form of clinical malaria was associated with P. falciparum parasitaemia.https://www.frontiersin.org/article/10.3389/fmicb.2020.02118/fullbacteraemiamalariaantimicrobial resistanceP. falciparumTanzania |