NON-TYPHI SALMONELLA IN CHILDREN WITH SEVERE MALARIA

Objective: To determine the association between Plasmodium falciparum malaria andnon-typhi Salmonella in children.Design: Cross-sectional hospital based study.Setting: Kilifi District Hospital (KDH) between January 1997 and June 2001.Subjects: Children aged between three months to 123 months (mean age 28.28 months)and who had been admitted to the paediatric or High Dependency Research Ward(HDRW) of the KDH.Methods: A total of 19, 118 blood cultures routinely obtained for all admissions and1,820 clinically indicated stools samples were obtained from 9,147 children admittedwith malaria. The specimens were cultured and antibiotic sensitivity done using standardlaboratory procedures with stringent internal and external quality control in place.Results: The total bacterial pathogens isolated from blood and stool were 1,395/19,118(7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395(18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out ofwhich a total of 101 NTS occurred in children with severe malaria. Out of the 9,147malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS withsevere malaria as a proportion of all malaria admissions for the period varied between0.8% and 1.5%. There was a significant association (p-value=0.032) between clinicaloutcome of death and female sex of the patient. The NTS isolates which occurred withsevere malaria showed various levels of antibiotic resistance. They were resistant toampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%),sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%),amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR)was seen in 34 (33.6%) of the isolates.Conclusions: NTS and severe malaria occurring together are a problem in this areaand that a large number of the isolates are MDR. An elaborate case-controlled studyis required to elucidate the chain of events of both NTS and malaria parasite co-existence