Integrated diagnostic and therapeutic approaches for bacterial co-infections in severe malaria

Background: Severe Malaria is medical emergency. Approximately 1 to 20 % of adults hospitalized with severe malaria across the globe are also have bacteraemia. Several guidelines for paediatric populations recommend the use of broad-spectrum antibiotics in addition to parenteral artesunate as incidence of bacteraemia and mortality is higher compared to adult population. However for adult populations it’s unsure, some recommend use of Empirical antibiotics other do not. Objectives: Our aim was to review literature in patients admitted with severe malaria with bacteraemia and form recommendations for diagnosis as well as treatment. Methods: Collection of data on severe malaria in adult patients on PUBMED using key words like Severe malaria, Incidence, prevalence of co infections, bacterial infections, Diagnosis, management and outcome of bacterial infections in severe malaria. Data collection and recommendations covering the years 2010–2023 done. Results: The prevalence of concomitant bacteraemia in adults with severe malaria is approximately 1 to 20 %. Early identification of patients with severe malaria with high mortality using biomarkers like Procalcitonin, CRP, Microscopy (Parasitemia) and administration of empirical antibiotics, in addition to artesunate reduces mortality. Empirical antibiotic therapy is warranted in the patients whom diagnosis is unclear and immediate diagnostic modalities are unavailable or Suspicion of bacterial sepsis with organ dysfunctions and small subgroup of patients with very high parasitemia’s and emphasizing the importance of quantitative blood smear microscopy assessment. Conclusions: Use of new diagnostic methods like haptoglobin, lipocalin-2 levels to identify the patients at higher risk of bacterial infections and Early Blood cultures and PCR based methods help in identify, initiate, tailor antibiotic therapy in patients with secondary bacteraemia and improve outcomes.