Oral Presentation First Malaria World Congress 2018

Concomitant bacteraemia in hospitalised adults diagnosed with falciparum malaria (#182)

Nick Anstey 1
  1. Menzies School of Health Research, Casuarina, Darwin, NT, Australia

Background: It has been believed that concomitant bacteremia is uncommon in adults with falciparum malaria and so present WHO guidelines only recommended antibacterial therapy if these patients have a clinical syndrome compatible with serious bacterial infection.

Results: Between May 2016 and October 2017, admission blood cultures were collected from 20 consecutive adults in Myanmar hospitalized with a positive immunochromatographic test and a positive blood film suggesting a diagnosis of falciparum malaria; 4 (20%) had bacteremia with a clinically significant pathogen. This case series’ data were pooled with a previously published multi-centre study from Myanmar (n=67) which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Of the 87 patients in the two studies, 13 (15%) had clinically significant bacteraemia on admission, with Gram-negative organisms in 10 (77%) and Staphylococcus aureus in 3 (23%). Bacteraemic patients had more severe disease than non-bacteraemic patients (median (interquartile range) RCAM score 2 (1-4) versus 1 (1-2), p=0.02), a lower semi-quantitative parasitaemia (p=0.047) and were more likely to die (2/13 (15%) versus 1/74 (1%), p=0.02). However, bacterial co-infection was suspected clinically in a minority of bacteraemic patients (5/13 (38%) versus 13/70 (19%) of non-bacteraemic patients, p=0.11).

Conclusions: Concomitant bacteraemia 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 working in these locations should have a lower threshold for commencing empirical antibacterial therapy in adults diagnosed with falciparum malaria than is currently recommended.