Bacterial Coinfections in Travelers with Malaria: Rationale for Antibiotic Therapy

Abstract

e Malaria predisposes children in areas where malaria is endemic to concurrent bacteremia, often with severe outcomes. The importance of bacterial coinfections in patients diagnosed with malaria in nonendemic settings has, however, not been reported. A retrospective analysis of microbiology data was performed in 755 travelers diagnosed with malaria in Sweden. Bacterial cultures from blood and other locations were correlated to clinical outcome and antibiotic treatment. Blood cultures were drawn from 417 (55%) patients (88% of whom were >15 years old), and bacterial isolates of clinical relevance (Salmonella enterica serovar Enteritidis and Escherichia coli) were detected in 2 patients (0.3%). Cultures from other locations (mainly urine, nasopharyngeal, and fecal samples) were obtained from 44% of the patients with 4.9% positivity. Of the 38 patients given antibiotics, 47% had neither severe malaria nor positive cultures and/or radiology signs indicative of treatment. C-reactive protein levels were associated with bacterial infections but had only a fair predictive value. Bacterial coinfections are uncommon among travelers with malaria. These data suggest a weaker association between malaria and bacteremia than previously described in endemic settings and might indicate different patient populations with different pathophysiological mechanisms and microbial environments. The study supports a restrictive antibiotic policy in returning travelers with malaria.

Frequency of bacterial isolates and antibiotics resistance patterns in urine and pus samples.

“…Similar to other studies conducted by various researchers in a different region of the world showed the highest susceptibility to Fosfomycin, Imipenem, Meropenem, and Piperacillin/ Tazobactam. 24 In the current study, the sensitivity of E. coli was Amikacin, Meropenem, Fosfomycin, and Piperacillin/Tazobactam was 99%, 99%, 98%, and 96% respectively. P. aeruginosa was found the second most common gram-negative bacterial isolates in urine and pus samples, which shows frequent resistance to Nitrofurantoin, Amoxicillin/ Clavulanic acid, Nalidixic acid, and Ceftriaxone.…”

Bloodstream infection with Acinetobacter baumanii in a Plasmodium falciparum positive infant: a case report

“…A study in Kenya demonstrated that malaria infections predispose children in a region of high malaria endemicity to BSI [7,10]. Malaria and bacteremia often present with similar clinical symptoms making differential diagnosis difficult [7,8,11,12]. Therefore, it is essential to pay close attention to the identification of bacteremia in children with malaria by blood culture and antibiotic susceptibility testing.…”

Staphylococcus Epidermidis Producteur D’entérotoxine C Impliqué Dans Une Septicémie À Foyer Urinaire

“…La gravité initiale du tableau avec la présence de stigmates de coagulation intravasculaire disséminée (CIVD) ainsi qu'un syndrome hémorragique digestif peuvent être dus tant à l'accès palustre qu'à cette septicémie. L'identification de SCN dans les hémocultures est habituellement considérée comme une simple contamination dans la plupart des études (Were et al, 2011, Sandlund et al, 2013. Mais la survenue dans notre cas d'une dysurie, ainsi que l'identification d'une souche de même espèce et avec le même antibiogramme dans les urines avec production de nitrites nous conduit à confirmer le caractère pathogène de cette souche.…”