WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study

Nadjm, Behzad; Amos, Ben; Mtove, George; Ostermann, Jan; Chonya, Semkini; Wangai, Hannah; Kimera, Juma; Msuya, Walii; Mtei, Frank; Dekker, Denise; Malahiyo, Rajabu; Olomi, Raimos; Crump, John A.; Whitty, Christopher J M; Reyburn, Hugh

doi:10.1136/bmj.c1350

Cited by 151 publications

(193 citation statements)

References 43 publications

Supporting

Mentioning

183

Contrasting

Order By: Relevance

“…However, blood culture lacks sensitivity and early recognition and treatment of blood stream infections has the potential to avert progression to severe disease with high associated mortality [14,28]. While RDTs can improve targeting of anti-malarial drugs there is no comparable test for bacterial disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Mtove

Hendriksen

Amos

et al. 2011

Malar J

View full text Add to dashboard Cite

BackgroundWHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT). However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa.MethodsChildren 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days.ResultsOver the course of one year, 965 children were enrolled; 158 (16.4%) were RDT-positive and treated with artemether-lumefantrine and 807 (83.4%) were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6%) children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2%) children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9%) children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7) and specificity of 96.3% (95%CI 96.3-98.4).ConclusionsUse of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive bacterial disease is uncommon in children with non-severe illness and most cases occurred in infants with a current fever.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Mtove

Hendriksen

Amos

et al. 2011

Malar J

View full text Add to dashboard Cite

show abstract

“…Salmonella is the most common bacterial coinfection in children with severe malaria [63][64][65]. Current WHO treatment guidelines suggest a low threshold for beginning antibiotic therapy in these children.…”

Section: Antibioticsmentioning

confidence: 99%

Pediatric Cerebral Malaria: A Scourge of Africa

et al. 2012

View full text Add to dashboard Cite

Cerebral malaria, defined as an otherwise unexplained coma in a patient with Plasmodium falciparum parasitemia, affects up to 1 million people per year, the vast majority of them being children living in sub-Saharan Africa. Despite optimal treatment, this condition kills 15% of those affected and leaves 30% of survivors with neurologic sequelae. The clinical diagnosis is hampered by its poor specificity, but the presence or absence of a malarial retinopathy in cerebral malaria has proven to be important in the differentiation of underlying coma etiology. Both antimalarials and intense supportive care are necessary for optimal treatment. As of yet, clinical trials of adjunctive therapies have not improved the high rates of mortality and morbidity. Survivors are at high risk of neurologic sequelae including epilepsy, neurodisabilities and cognitive–behavioral problems. The neuroanatomic and functional bases of these sequelae are being elucidated. Although adjunctive therapy trials continue, the best hope for African children may lie in disease prevention. Strategies include bednets, chemoprophylaxis and vaccine development.

show abstract

“…In 2010, Nadjm and others reported that the prevalence of invasive bacterial diseases was higher in malaria slide-negative patients and caused 17% of mortality. 1 The link between malaria and specific Gram-negative bacteria such as non-typhi Salmonella has, however, been reported in Africa. 1,2 In addition, it has been argued that the presence of malaria must not rule out the existence of other bloodstream infections, including bacteremias, in areas with high malaria prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…1 The link between malaria and specific Gram-negative bacteria such as non-typhi Salmonella has, however, been reported in Africa. 1,2 In addition, it has been argued that the presence of malaria must not rule out the existence of other bloodstream infections, including bacteremias, in areas with high malaria prevalence. 3 Thus, the WHO (World Health Organization) guidelines for the management of acute febrile illness in children recommend the use of an appropriate antibiotic in children exhibiting certain signs of severe illnesses.…”

Section: Introductionmentioning

confidence: 99%

Co-circulation of Plasmodium and Bacterial DNAs in Blood of Febrile and Afebrile Children from Urban and Rural Areas in Gabon

Mourembou

Nzondo

Ndjoyi-Mbiguino

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bacteremias exist but are under assessed. This study aimed to assess bacteremias and malaria in children from urban and rural areas in Gabon. DNA extracts from blood samples of 410 febrile and 60 afebrile children were analyzed using quantitative polymerase chain reaction. Plasmodium spp. was the microorganism most frequently detected in febrile (78.8%, 323/410) and afebrile (13.3%, 8/60) children, (P < 0.001). DNA from one or several bacteria were detected in 15 febrile patients (3.7%) but not in the controls (P = 0.1). This DNA was more frequently detected as co-infections among febrile children tested positive for Plasmodium (4.6%, 15/323) than in those tested negative for Plasmodium (0%, 0/87; P = 0.04). The bacteria detected were Streptococcus pneumoniae 2.4% (10/410), Staphylococcus aureus 1.7% (7/410), Salmonella spp. 0.7% (3/410), Streptococcus pyogenes 0.2% (1/410) and Tropheryma whipplei 0.2% (1/410) only in febrile children. Coxiella burnetii, Borrelia spp., Bartonella spp., Leptospira spp., and Mycobacterium tuberculosis were not observed. This paper reports the first detection of bacteremia related to T. whipplei in Gabon and shows that malaria decreases in urban areas but not in rural areas. Co-infections in febrile patients are common, highlighting the need to improve fever management strategies in Gabon.

show abstract

WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study

Cited by 151 publications

References 43 publications

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Pediatric Cerebral Malaria: A Scourge of Africa

Co-circulation of Plasmodium and Bacterial DNAs in Blood of Febrile and Afebrile Children from Urban and Rural Areas in Gabon

Contact Info

Product

Resources

About