The burden of invasive bacterial infections in Pemba, Zanzibar

• Published in: PloS one Vol. 7; no. 2; p. e30350
• Main Authors: Thriemer, Kamala, Ley, Benedikt, Ame, Shaali, von Seidlein, Lorenz, Pak, Gi Deok, Chang, Na Yoon, Hashim, Ramadhan, Schmied, Wolfgang Hellmut, Busch, Clara Jana-Lui, Nixon, Shanette, Morrissey, Anne, Puri, Mahesh K, Ali, Mohammad, Ochiai, R Leon, Wierzba, Thomas, Jiddawi, Mohammad S, Clemens, John D, Ali, Said M, Deen, Jaqueline L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17-02-2012; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age; Age Distribution; AIDS; Ampicillin; Anti-Bacterial Agents - pharmacology; Antibacterial agents; Antimicrobial agents; Bacteremia; Bacteremia - complications; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteria; Bacteria - drug effects; Bacterial infections; Bacterial Infections - complications; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Biology; Blood; Blood culture; Blood tests; Care and treatment; Child; Child, Preschool; Chloramphenicol; Collaboration; Contaminants; Cotrimoxazole; Culture; Diagnostic systems; Disease transmission; Fever; Fungal infections; Geography; Haplotypes; Health aspects; Health surveillance; HIV; Hospitals; Hospitals - statistics & numerical data; Human immunodeficiency virus; Humans; Incidence; Infections; Laboratories; Malaria; Malaria - complications; Malaria - epidemiology; Medical research; Medicine; Microbial drug resistance; Microbial Sensitivity Tests; Multidrug resistance; Multidrug resistant organisms; Patients; Pneumonia; Population; Primary care; Progress reports; Public health; Salmonella; Salmonella Typhimurium; Sepsis; Streptococcus infections; Streptococcus pneumoniae; Tanzania - epidemiology; Tetanus; Tropical diseases; Typhoid; Vaccination; Vaccines; Vector-borne diseases; Tanzania; South Korea; Zanzibar
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0030350

We conducted a surveillance study to determine the leading causes of bloodstream infection in febrile patients seeking treatment at three district hospitals in Pemba Island, Zanzibar, Tanzania, an area with low malaria transmission.
All patients above two months of age presenting to hospital with fever were screened, and blood was collected for microbiologic culture and malaria testing. Bacterial sepsis and malaria crude incidence rates were calculated for a one-year period and were adjusted for study participation and diagnostic sensitivity of blood culture.
Blood culture was performed on 2,209 patients. Among them, 166 (8%) samples yielded bacterial growth; 87 (4%) were considered as likely contaminants; and 79 (4%) as pathogenic bacteria. The most frequent pathogenic bacteria isolated were Salmonella Typhi (n = 46; 58%), followed by Streptococcus pneumoniae (n = 12; 15%). The crude bacteremia rate was 6/100,000 but when adjusted for potentially missed cases the rate may be as high as 163/100,000. Crude and adjusted rates for S. Typhi infections and malaria were 4 and 110/100,000 and 4 and 47/100,000, respectively. Twenty three (51%), 22 (49%) and 22 (49%) of the S. Typhi isolates were found to be resistant toward ampicillin, chloramphenicol and cotrimoxazole, respectively. Multidrug resistance (MDR) against the three antimicrobials was detected in 42% of the isolates.
In the presence of very low malaria incidence we found high rates of S. Typhi and S. pneumoniae infections on Pemba Island, Zanzibar. Preventive measures such as vaccination could reduce the febrile disease burden.