Mourembou Gaël, Nzondo Sydney Maghendji, Ndjoyi-Mbiguino Angélique, Lekana-Douki Jean Bernard, Kouna Lady Charlène, Matsiegui Pierre Blaise, Manego Rella Zoleko, Moukandja Irene Pegha, Keïta Alpha Kabinet, Tissot-Dupont Hervé, Fenollar Florence, Raoult Didier
Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE), Aix Marseille Université, Marseille, France. Ecole Doctorale Régionale d'Afrique Centrale, Franceville, Gabon.
Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.
Am J Trop Med Hyg. 2016 Jul 6;95(1):123-32. doi: 10.4269/ajtmh.15-0751. Epub 2016 Apr 25.
Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bacteremias exist but are under assessed. This study aimed to assess bacteremias and malaria in children from urban and rural areas in Gabon. DNA extracts from blood samples of 410 febrile and 60 afebrile children were analyzed using quantitative polymerase chain reaction. Plasmodium spp. was the microorganism most frequently detected in febrile (78.8%, 323/410) and afebrile (13.3%, 8/60) children, (P < 0.001). DNA from one or several bacteria were detected in 15 febrile patients (3.7%) but not in the controls (P = 0.1). This DNA was more frequently detected as co-infections among febrile children tested positive for Plasmodium (4.6%, 15/323) than in those tested negative for Plasmodium (0%, 0/87; P = 0.04). The bacteria detected were Streptococcus pneumoniae 2.4% (10/410), Staphylococcus aureus 1.7% (7/410), Salmonella spp. 0.7% (3/410), Streptococcus pyogenes 0.2% (1/410) and Tropheryma whipplei 0.2% (1/410) only in febrile children. Coxiella burnetii, Borrelia spp., Bartonella spp., Leptospira spp., and Mycobacterium tuberculosis were not observed. This paper reports the first detection of bacteremia related to T. whipplei in Gabon and shows that malaria decreases in urban areas but not in rural areas. Co-infections in febrile patients are common, highlighting the need to improve fever management strategies in Gabon.
疟疾被认为是撒哈拉以南非洲地区发热最常见的病因,而菌血症虽存在但评估不足。本研究旨在评估加蓬城乡儿童的菌血症和疟疾情况。使用定量聚合酶链反应分析了410名发热儿童和60名无发热儿童血样的DNA提取物。疟原虫属是在发热儿童(78.8%,323/410)和无发热儿童(13.3%,8/60)中最常检测到的微生物,(P < 0.001)。在15名发热患者(3.7%)中检测到一种或几种细菌的DNA,但在对照组中未检测到(P = 0.1)。与疟原虫检测呈阳性的发热儿童相比,这种DNA作为共感染在疟原虫检测呈阴性的发热儿童中更频繁被检测到(4.6%,15/323对0%,0/87;P = 0.04)。检测到的细菌有肺炎链球菌2.4%(10/410)、金黄色葡萄球菌1.7%(7/410)、沙门氏菌属0.7%(3/410)、化脓性链球菌0.2%(1/410)和惠普尔嗜组织细胞菌0.2%(1/410),仅在发热儿童中检测到。未观察到伯氏考克斯体、疏螺旋体属、巴尔通体属、钩端螺旋体属和结核分枝杆菌。本文报道了加蓬首次检测到与惠普尔嗜组织细胞菌相关的菌血症,并表明疟疾在城市地区减少,但在农村地区没有。发热患者中的共感染很常见,凸显了加蓬改善发热管理策略的必要性。