Bacteraemia complicating severe malaria in children

Bacteraemia associated with severe malaria in childhood is a sporadically r eported phenomenon but its incidence and clinical importance are unknown. W e have reviewed clinical and laboratory data from 783 Kenyan children seque ntially admitted with a primary diagnosis of severe malaria. The overall in cidence of bacteraemia in children with severe malaria was 7.8% (95% CI 5.5 -10.0); however, in children under 30 months of age the incidence was 12.0% (95% CI 8.3-15.7). The presence of bacteraemia was associated with a 3-fol d increase in mortality (33.3% vs. 10.4%, P < 0.001). We conclude that inva sive bacterial disease may contribute to the pathophysiology of the clinica l syndrome of severe malaria in an important subgroup of children. We recom mend that young children with severe malaria be treated with broad-spectrum antibiotics in addition to antimalarial drugs.