Africa: Bacterial Infection Misdiagnosed as Severe Malaria in Children

By Mary Hearty

Finding malaria parasites in a blood smear or a positive rapid diagnostic test (RDT) in a sick child does not necessarily mean that malaria is the cause of the illness.

This is according to a research published in The Lancet titled: Substantial Misdiagnosis of Severe Malaria in African Children.

The researchers who reviewed the study from different journals found strong evidence showing that about a third of African children diagnosed with severe malaria have another cause (probably bacterial infections) for their potentially lethal illness.

They noted that malaria is the usual diagnosis in a hospitalized febrile African child with a positive blood smear or RDT. They added that differentiating severe bacterial infections from severe malaria is difficult, and the two commonly coexist.

For this reason, it is recommended that all children with suspected severe malaria should receive both parenteral artesunate and parenteral antibiotics, the researchers affirmed.

Unfortunately, they observed that this advice is often not followed, or the antibiotics are delayed until the child deteriorates—by which time it might be too late.

“If children do not receive effective antibiotics immediately, and they would do so if the malaria test was negative, then the positive malaria blood test becomes, perversely, a risk factor for dying from bacterial sepsis,” the researchers cautioned.

In the community, where parenteral drug administration is not possible, they advised pre-referral rectal artesunate should be given. Also, they suggested that Pre-referral rectal formulations of broad-spectrum antibiotics should be developed.