Bacteraemia and urinary tract infection complicating malarial infection in children admitted at Kenyatta National Hospital

Abstract

Background: Morbidity and mortality from malaria remains high, even with appropriate treatment. Complicating pathologies may contribute to this state. There is laboratory evidence of altered immune function at different stages of the malarial illness. Various studies have reported the occurrence of bacterial infections in various sites in children with severe malaria. Given that peripheral parasitaemia is not a reliable measure of total parasite load, and therefore does not correspond to severity of the illness, the risk for invasive bacterial disease may be present even in non-severe forms of malaria. Studies to demonstrate the magnitude of bacterial co-morbidity in non-severe forms of malaria, especially in non-endemic areas, are sparse and nonconclusive. This study aims at defining the association between bactereamia, U.T.I and malarial infection in a non-endemic area. Objective: To determine if malaria parasitaemia is associated with an increased risk of occurrence of bacteraemia and urinary tract infections. Study site: Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya. Design: A cross-sectional survey comparing two groups. Methodology: Study subjects were children aged between 3 months and 12 years admitted with an acute febrile illness, but no obvious focus of infection. One group of children had fever and a positive'malaria slide whereas the comparison group had fever with a negative slide for malaria. Children with diagnosed septic conditions, known chronic illnesses or severe malnutrition were excluded. The parent or guardian was interviewed using standard questionnaire that collected information on their age, sex, and socio-demographic characteristics. The Child's nutrition status was assessed and classified according to the Wellcome classification. A sample of blood was drawn, and a specimen of urine obtained from each child. These were cultured on appropriate culture media and the positive isolates identified. Results: A total of264 children were recruited in the months of January to March 2001. Of these, 158 had a positive slide, and 106 a negative slide for malaria. The male: female ratio in both groups was 3:2. The two groups were of comparable age profile, nutrition status, and socio-demographic characteristics except room density, a measure of crowding. The prevalence of bacteraemia in those with malaria was 11.4%, which was not significantly different from 13.2% found in those with a negative slide (P value = 0.66, OR = 0.85,95% CI = 0.40 - 1.78). Of those with malaria, 13.3% had 'significant bacteriuria' compared to 16.0% in those without malaria. This difference was not significant (P value = 0.53, OR = 0.80,95% CI = 0.40 - 1.60). Conclusions and recommendations: Children admitted with fever and a positive slide for malaria have a similar risk of having concurrent bacteraemia and/or bacteriuria as those admitted with fever and a negative malaria slide. Therefore, one should have a high index of suspicion for these infections when faced with a child with fever and no focus of infection, regardless of the slide report. However, the presence of a positive slide does pot put the child at a higher risk.