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. 2020 Jan;102(1):121-129.
doi: 10.4269/ajtmh.19-0368.

High Circulation of Malaria and Low Prevalence of Bacteremia in Febrile and Afebrile Children in Northeastern Gabon

Célia Scherelle Boumbanda Koyo  1   2   3   4 , Sandrine Lydie Oyegue-Liabagui  5 , Oleg Mediannikov  6   2 , Sébastien Cortaredona  2   1 , Lady Charlene Kouna  3 , Didier Raoult  6   2 , Jean Bernard Lekana-Douki  7   4   3 , Florence Fenollar  1   2
Affiliations

High Circulation of Malaria and Low Prevalence of Bacteremia in Febrile and Afebrile Children in Northeastern Gabon

Célia Scherelle Boumbanda Koyo et al. Am J Trop Med Hyg. 2020 Jan.

Abstract

The epidemiology of febrile illness etiologies is under-explored in resource-poor settings. Establishing a local repertory of microorganisms circulating in blood of febrile and afebrile people is important for physicians. Blood was collected from 428 febrile and 88 afebrile children in Makokou (Gabon) and analyzed using polymerase chain reaction. Plasmodium spp. were the pathogens, which were most detected in febrile children (69.6%; 298/428) and in afebrile children (31.8%; 28/88) (P < 0.0001). Plasmodium falciparum was the most prevalent species in both febrile and afebrile children (66.8% and 27.3%, respectively). No differences were observed between febrile and afebrile children for Plasmodium malariae and Plasmodium ovale (8.2% versus 10.2% and 3.3% versus 3.4%, respectively). Triple infection with P. falciparum, P. malariae, and P. ovale was also detected in 1% of febrile children (4/428). Filariasis due to Mansonella perstans was detected in 10 febrile patients (2.3%), whereas Loa loa was detected in both febrile and afebrile children (1.4% and 2.3%, respectively). Bacterial DNA was detected in only 4.4% (19/428) of febrile children, including 13 (68.4%) who were coinfected with at least one Plasmodium species. These were Haemophilus influenzae (1.6%, 7/428), Streptococcus pneumoniae and Staphylococcus aureus (1.2%, 5/428), and Rickettsia felis (0.9%, 4/428). Coxiella burnetii, Bartonella spp., Borrelia spp., Tropheryma whipplei, Anaplasma spp., Leptospira spp., Streptococcus pyogenes, and Salmonella spp. were not detected. This study also highlights the over-prescription and the overuse of antibiotics and antimalarials. Overall, malaria remains a major health problem in Makokou. Malaria control measures must be reconsidered in this region.

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Conflict of interest statement

Disclosure: Written informed consent from the legal guardian or parents was obtained for each child included. Information collected from participants was treated confidentially, and the data were anonymized. Funding sources played no role in the design and conduct of the study (collection, management, analysis, and interpretation of the data and preparation, review, or approval of the manuscript). All data generated and material used during this study are included in this published article and its supplementary information. This study was approved by the Gabon National Committee for Research Ethics (CNER) (No. 0020/2015/SG/CNE).

Figures

Figure 1.
Figure 1.
Current and previous study areas. The area marked with a black arrow is our study area. Circles represent zones having been studied for fever causes. Triangles display areas that have been studied for malaria prevalence only.
Figure 2.
Figure 2.
Prevalence of detected microorganisms among 428 febrile children (black bars) versus 88 afebrile children (gray bars).
Figure 3.
Figure 3.
Means of Cycle threshold values for Plasmodium falciparum based on specific quantitative PCR targeting PfEMP1 gene in both febrile and afebrile children.
Figure 4.
Figure 4.
Coinfections between Plasmodium falciparum, Plasmodium malariae, and Plasmodium ovale among 298 febrile children (A) and 28 afebrile children (B).
Figure 5.
Figure 5.
Discrepancies between retrospective molecular diagnostic and treatment previously prescribed at the hospital by a physician. (A) Discrepancy between retrospective molecular diagnosis of malaria and prescribed antimalarial treatment. (B) Discrepancy between retrospective molecular diagnosis of bacteremia and prescribed antibiotic treatment.
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