Malaria and typhoid fever coinfection among patients presenting with febrile illnesses in Ga West Municipality, Ghana

Abstract

AbstractBackgroundMalaria and typhoid fever coinfection presents major public health problems especially in the tropics and sub-tropics where malaria and typhoid fever are co-endemic. Clinicians often treat both infections concurrently without laboratory confirmation. However, concurrent treatment has public health implications as irrational use of antibiotics or anti-malarials may lead to the emergence of drug resistance, unnecessary cost and exposure of patients to unnecessary side effects. This study determined the proportion of febrile conditions attributable to either malaria and/or typhoid fever and the susceptibility patterns of Salmonella spp. isolates to commonly used antimicrobial agents in Ghana.MethodsOne hundred and fifty-seven (157) febrile patients attending the Ga West Municipal Hospital, Ghana, from February to May 2017 were sampled. Blood samples were collected for cultivation of pathogenic bacteria and the susceptibility of the Salmonella isolates to antimicrobial agents was performed using the Kirby-Bauer disk diffusion method with antibiotic discs on Müller Hinton agar plates. For each sample, conventional Widal tests for the detection of Salmonella spp were done as well as blood film preparation for detection of Plasmodium spp. Data on the socio-demographic and clinical characteristics of the study participants were collected using an android technology software kobo-collect by interview. Data were analyzed using Stata version 13 statistical Software. Logistic regression models were run to determine odds ratio (OR) and the direction of association between dependent and independent variables, setting p-value at <0.05 for statistical significance.ResultsOf the total number of patients aged 2–37 years (median age = 6 years, IQR 3–11), 82 (52.2%) were females. The proportion of febrile patients with falciparum malaria were 57/157 (36.3%), while Salmonella typhi O and H antigens were detected in 23/157 (14.6%) of the samples. The detection rate of Salmonella spp in febrile patients was 10/157 (6.4%). Malaria and typhoid fever coinfection using Widal test and blood culture was 9 (5.7%) and 3 (1.9%), respectively. The isolates were highly susceptible to cefotaxime, ceftriaxone, ciprofloxacin, and amikacin but resistant to ampicillin, tetracycline, co-trimoxazole, gentamicin, cefuroxime, chloramphenicol, and meropenem.ConclusionPlasmodium falciparum and Salmonella spp coinfections were only up to 1.9%, while malaria and typhoid fever, individually, were responsible for 36.3% and 6.4%, respectively. Treatment of febrile conditions must be based on laboratory findings in order not to expose patients to unnecessary side effects of antibiotics and reduce the emergence and spread of drug resistance against antibiotics.