The Prevalence of Malaria and Bacteremia Co-Infections among Febrile Patients: A Systematic Review and Meta-Analysis

Polrat Wilairatana; Wanida Mala; Frederick Ramirez Masangkay; Kwuntida Uthaisar Kotepui; Manas Kotepui

doi:10.3390/tropicalmed7090243

The Prevalence of Malaria and Bacteremia Co-Infections among Febrile Patients: A Systematic Review and Meta-Analysis

Trop Med Infect Dis. 2022 Sep 13;7(9):243. doi: 10.3390/tropicalmed7090243.

Authors

Polrat Wilairatana¹, Wanida Mala^{2

3}, Frederick Ramirez Masangkay⁴, Kwuntida Uthaisar Kotepui², Manas Kotepui²

Affiliations

¹ Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
² Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand.
³ Center of Excellence Research for Melioidosis and Microorganisms, Walailak University, Nakhon Si Thammarat 80160, Thailand.
⁴ Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila 1008, Philippines.

Abstract

Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the co-existence of malaria and bacteremia in the literature to provide evidence-based information for future studies investigating the clinical significance of this co-infection. The study protocol was registered at PROSPERO (ID: CRD42021287971). Relevant studies were identified from PubMed, Web of Science, and Scopus. The pooled prevalence of (1) co-existent malaria and bacteremia among febrile patients, (2) the pooled prevalence of bacteremia among patients with malaria, (3) the probability of co-infection, and (4) the pooled prevalence of deaths were estimated by the random-effects model. Fifty-one studies involving 1583 cases of co-infection were included in the analyses. Typhoidal Salmonella spp. and Staphylococcus aureus were the most common Gram-negative and Gram-positive bacteria, respectively. The prevalence of co-existent malaria and bacteremia among febrile patients was 1.9% (95% confidence interval (CI) = 1.5-2.2%, I² = 96.64%, 31 studies). The prevalence of bacteremia among patients with malaria was 7.6% (95% CI = 6.7-8.7%, and I² = 96.68%, 43 studies). Co-infection by malaria and bacteremia did not occur by chance (p = 0.024, odds ratio = 0.64, 95% CI = 0.43-0.94, and I² = 95.7%, 29 studies). The pooled prevalence of deaths among patients with co-infection was 15.0% (95% CI = 8.0-23.0%, I² = 75.23%, 8 studies). On the basis of this study, we conclude that although the prevalence of co-infection was low, patients with malaria appear at greater risk of bacteremia and death.

Keywords: bacteremia; co-infection; concomitant infection; malaria; meta-analysis.

Publication types

Review

Grants and funding

This research was financially supported by the New Strategic Research Project (P2P) fiscal year 2022, Walailak University, Thailand. The funders played no role in the collection, analysis, or interpretation of the data.