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

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

doi:10.1093/ofid/ofw028

Cited by 29 publications

(33 citation statements)

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“…8 However, a recent multicenter study from Myanmar identified a much higher rate of significant bacteremia in adults hospitalized with malaria than had been reported previously. 11 There were significant pathogens in the blood cultures of 13% of the patients, and, as in African children, there was a predominance of Gram-negative organisms and an association with more severe illness. Furthermore, most of the bacteremic adults in the series were not suspected of having bacterial coinfection, calling into question the WHO treatment guidelines that recommend empirical antibacterial therapy only in patients with clear clinical evidence of a complicating bacterial disease.…”

Section: Introductionmentioning

confidence: 88%

“…More than 75% of the cases in this series received intravenous antibiotics-usually a third-generation cephalosporin-in addition to their antimalarial therapy. 11 The fact that there was not a single death in the study among the 67 adults hospitalized with falciparum malaria-35 (52%) of whom satisfied criteria for high dependency unit admission 12 -was presented as circumstantial evidence to suggest that empirical antibacterial therapy may improve outcomes in adults with a diagnosis of severe falciparum malaria, particularly the more critically ill. 11 The present study (ANtibiotic THErapy in adults with Malaria [ANTHEM]) was devised to address this question prospectively. The dramatic fall in malaria incidence in Myanmar 13 resulted in premature termination of the study; however, the data are presented here-both separately and pooled with the results of the previously cited study-to inform clinicians working in malaria-endemic regions.…”

Section: Introductionmentioning

confidence: 97%

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Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Aung

Nyein

Htut

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromatographic test and blood film, suggesting a diagnosis of falciparum malaria; four (20%) had bacteremia with a clinically significant pathogen. These case series' data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15%) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77%) and in the remaining three (23%). Bacteremic patients had more severe disease than non-bacteremic patients (median [interquartile range] respiratory coma acidosis malaria score 2 [1-4] versus 1 [1-2], = 0.02) and were more likely to die (2/13 [15%] versus 1/74 [1%], = 0.01). However, bacterial coinfection was suspected clinically in a minority of bacteremic patients (5/13 [38%] compared with 13/70 [19%] of non-bacteremic patients, = 0.11). Concomitant bacteremia in adults diagnosed with falciparum malaria may be more common than previously believed and is difficult to identify clinically in resource-poor settings. Death is more common in these patients, suggesting that clinicians should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria in these locations than is presently recommended.

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Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 97%

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Aung

Nyein

Htut

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…This is less plausible since other investigators found increased malaria parasitemia as least in whole blood as assessed by different methods including blood smears in relation to HIV infection [11,17,18]. Second, the observed increased severity may be due to other concomitant HIV-associated opportunistic co-infections difficult to diagnose in this relative low resource setting [3,19]. This may have been the case, considering the substantial overlap of HIV and malaria prevalence in this region.…”

Section: Discussionmentioning

confidence: 86%

Plasma parasitemia as assessed by quantitative PCR in relation to clinical disease severity in African adults with falciparum malaria with and without HIV co-infection

et al. 2020

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Purpose When considering malaria disease severity, estimation of parasitemia in erythrocytes is important, but sometimes misleading, since the infected erythrocytes may be sequestered in peripheral capillaries. In African children and Asian adults with falciparum malaria, parasitemia as assessed by quantitative PCR (qPCR) in plasma seems to be a valuable indicator of disease severity, but data on African adults as well as the impact of co-infection with HIV is lacking. Methods In 131 patients with falciparum malaria in a public tertiary teaching hospital in Mozambique, plasma malaria parasitemia as assessed by qPCR, compared to qualitative malaria PCR in blood cell fraction, was related to malaria disease severity and HIV co-infection. Results Of the 131 patients with falciparum malaria, based on positive qualitative PCR in the blood cell fraction, 93 patients (72%) had positive malaria qPCR in plasma. Patients with severe malaria as defined by the WHO criteria had higher malaria quantitative plasma parasitemia (median 143 genomes/µL) compared to those with uncomplicated malaria (median 55 genomes/µL, p = 0.037) in univariate analysis, but this difference was attenuated after adjusting for age, sex and HIV coinfection (p = 0.055). A quarter of the patients with severe malaria had negative qPCR in plasma. Conclusions This study of adult African in-patients with falciparum malaria with and without HIV co-infection, neither confirms nor rejects previous studies of malaria qPCR in plasma as an indicator of disease severity in patients with falciparum malaria. There is a need for further and larger studies to clarify if parasitemia as assessed malaria qPCR in plasma could be a surrogate marker of disease severity in falciparum malaria.

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“…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. Le lien entre accès palustre et septicémie n'est pas clair, mais certains auteurs ont évoqué la possibilité d'un déficit immunitaire transitoire concomitant de ces accès palustres (Nyein et al, 2016). Il faut aussi remarquer que la plupart des infections à SCN sont nosocomiales, même en cas d'accès palustre alors que dans notre cas cette infection est d'origine communautaire, car tous les prélèvements positifs ont été réalisés à l'admission du patient (Bruneel et al, 2010).…”

Section: Discussionunclassified

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

Nanoukon¹,

Dassou

Dousso

et al. 2017

ESJ

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In developing countries, coagulase-negative staphylococcal (SCN) infections are often neglected. Here, we describe the identification of a coagulase-negative staphylococcal strain secreting type C staphylococcal enterotoxin (SEC) in a field weakened by severe malaria in a 12-year-old child and summarize the clinical characteristics of the patient. The identification of the strain is carried out by MALDI-TOF mass spectrometry European Scientific Journal August 2017 edition Vol.13, No.24 ISSN: 1857 -7881 (Print) e -ISSN 1857 279 after protein extraction. The toxigenic capacity of the species in question is determined by the polymerase chain reaction (PCR) and the radial immunoprecipitation method. The patient's medical record was used for the study of the correlation between the clinical phenotype of the patient and the production of SEC by the strain. S. epidermidis was identified as the pathogen responsible of bacteremia which induces clinical sepsis, hematemesis and thrombocytopenia. The PCR test revealed that the isolated strain was positive for sec gene and its expression was confirmed by the radial immunoprecipitation assay. The study of the patient's medical record shows that the enterotoxin produced by the strain may have contributed to the severity of the clinical picture with the presence of disseminated intravascular coagulation stigmata (DIC) in a context of sepsis with a urinary starting point. These data suggest that CNS infections may be underestimated due to difficulties in species identification and the toxigenic capacity of some of these isolates. Keywords: Staphylococcus epidermidis, septicemia, enterotoxins; mass spectrometry RésuméDans les pays en voie de développement les infections à staphylocoque à coagulase négative (SCN) sont souvent négligées. Ici, nous décrivons l'identification d'une souche de SCN sécrétrice d'entérotoxine staphylococcique de type C (SEC) sur un terrain fragilisé par un paludisme grave chez un enfant de 12 ans et résumons les caractéristiques clinique du patient. L'identification de la souche est réalisée par la spectrométrie de masse MALDI-TOF après une extration protéique. La capacité toxigénique de l'espèce en cause est déterminée par la réaction de polymérisation en chaine de (PCR) et par le test d'immunoprécipitation radiale. Le dossier médical du patient est exploité pour l'étude de la corrélation entre le phénotype clinique du patient et la production de SEC par la souche. S. epidermidis a été identifié comme l'agent pathogène responsable de la bactériémie ayant induit un sepsis clinique, une hématémèse et une thrombopénie. Le test de PCR a révélé que la souche était positive pour le gène sec dont l'expression a été confirmée par le test d'immunoprécipitation radiale d'Ouctchterlony. L'étude du dossier médical du patient montre que l'entérotoxine produite par la souche à bien pu contribuer à la gravité du tableau clinique avec la présence de stigmates de coagulation intravasculaire disséminée (CIVD) dans un contexte de sepsis à point de départ urinaire. ...

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

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.

Cited by 29 publications

References 19 publications

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria

Plasma parasitemia as assessed by quantitative PCR in relation to clinical disease severity in African adults with falciparum malaria with and without HIV co-infection

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

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