The burden of invasive bacterial infections in Pemba, Zanzibar

Kamala Thriemer, Benedikt Ley, Shaali Ame, Lorenz von Seidlein, Giok de Pak, Na Yoon Chang, Ramadhan Hashim, Wolfgang Hellmut Schmied, Clara Jana Lui BuschClara, Shanette Nixon, Anne Morrissey, Mahesh K. Puri, Mohammad Ali, R. Leon Ochiai, Thomas Wierzba, Mohammad S. Jiddawi, John D. Clemens, Said M. Ali, Jaqueline L. Deen

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Article numbere30350
JournalPLoS One
Volume7
Issue number2
DOIs
StatePublished - Feb 17 2012

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Indian Ocean Islands
Zanzibar
Tanzania
bacterial infections
Bacterial Infections
malaria
Malaria
Blood
Salmonella Typhi
Salmonella typhi
Bacteria
fever
Streptococcus pneumoniae
Fever
Patient treatment
Salmonella
Islands
Sulfamethoxazole Drug Combination Trimethoprim
Chloramphenicol
Ampicillin

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Thriemer, K., Ley, B., Ame, S., von Seidlein, L., de Pak, G., Chang, N. Y., ... Deen, J. L. (2012). The burden of invasive bacterial infections in Pemba, Zanzibar. PLoS One, 7(2), [e30350]. https://doi.org/10.1371/journal.pone.0030350

The burden of invasive bacterial infections in Pemba, Zanzibar. / Thriemer, Kamala; Ley, Benedikt; Ame, Shaali; von Seidlein, Lorenz; de Pak, Giok; Chang, Na Yoon; Hashim, Ramadhan; Schmied, Wolfgang Hellmut; BuschClara, 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.

In: PLoS One, Vol. 7, No. 2, e30350, 17.02.2012.

Research output: Contribution to journalArticle

Thriemer, K, Ley, B, Ame, S, von Seidlein, L, de Pak, G, Chang, NY, Hashim, R, Schmied, WH, BuschClara, CJL, Nixon, S, Morrissey, A, Puri, MK, Ali, M, Ochiai, RL, Wierzba, T, Jiddawi, MS, Clemens, JD, Ali, SM & Deen, JL 2012, 'The burden of invasive bacterial infections in Pemba, Zanzibar', PLoS One, vol. 7, no. 2, e30350. https://doi.org/10.1371/journal.pone.0030350
Thriemer K, Ley B, Ame S, von Seidlein L, de Pak G, Chang NY et al. The burden of invasive bacterial infections in Pemba, Zanzibar. PLoS One. 2012 Feb 17;7(2). e30350. https://doi.org/10.1371/journal.pone.0030350
Thriemer, Kamala ; Ley, Benedikt ; Ame, Shaali ; von Seidlein, Lorenz ; de Pak, Giok ; Chang, Na Yoon ; Hashim, Ramadhan ; Schmied, Wolfgang Hellmut ; BuschClara, 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. / The burden of invasive bacterial infections in Pemba, Zanzibar. In: PLoS One. 2012 ; Vol. 7, No. 2.
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AU - Thriemer, Kamala

AU - Ley, Benedikt

AU - Ame, Shaali

AU - von Seidlein, Lorenz

AU - de Pak, Giok

AU - Chang, Na Yoon

AU - Hashim, Ramadhan

AU - Schmied, Wolfgang Hellmut

AU - BuschClara, Clara Jana Lui

AU - Nixon, Shanette

AU - Morrissey, Anne

AU - Puri, Mahesh K.

AU - Ali, Mohammad

AU - Ochiai, R. Leon

AU - Wierzba, Thomas

AU - Jiddawi, Mohammad S.

AU - Clemens, John D.

AU - Ali, Said M.

AU - Deen, Jaqueline L.

PY - 2012/2/17

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N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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