Malaria Predisposes Kenyan Children to Bacteremia

Strong negative correlation between malaria-protective phenotype of sickle-cell trait, bacteremia

WEDNESDAY, Sept. 7 (HealthDay News) -- Malaria strongly predisposes children to the development of bacteremia in Kenya, according to a study published online Sept. 7 in The Lancet.

J. Anthony G. Scott, M.R.C.P., from the Kenya Medical Research Institute-Wellcome Trust Research Programme in Kilifi, and colleagues investigated whether malaria infection predisposes individuals to bacteremia in a cohort of Kenyan children with a malaria-protective phenotype of sickle-cell trait (HbAS). In a matched case-control study, 292 children aged 3 months to 13 years, hospitalized with bacteremia, were each matched with one or two controls. In a longitudinal case-control study, performed to evaluate the association between HbAS and invasive bacterial disease as malaria incidence decreased, 1,454 children between the ages of 0 and 13 years, hospitalized with bacteremia, and 10,749 controls were assessed. The annual incidence of bacteremia against the community prevalence of malaria during a nine year period was modeled.

The investigators found that sickle-cell disease, HIV, leucocyte hemozoin pigment, and undernutrition correlated positively with bacteremia, while HbAS correlated negatively (odds ratio, 0.36) in the matched case-control study. In the longitudinal study, the incidence of hospital admissions with malaria decreased from 28.5 to 3.45 per 1,000 child-years, with a parallel reduction in protection afforded by HbAS against bacteremia. The incidence of hospital admissions for bacteremia decreased from 2.59 to 1.45 per 1,000 child-years. The bacteremia incidence rate ratio associated with malaria parasitemia was 6.69; in 1999 the community parasite prevalence was 29 percent, and 62 percent of bacteremia cases were attributable to malaria.

"Malaria infection strongly predisposes individuals to bacteremia and can account for more than half of all cases of bacteremia in malaria-endemic areas," the authors write.

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