Severe malaria-bacterial sepsis co-infection among critically ill children admitted to pediatric emergency departments in Kinshasa

Why clinicians should know about it

• Picked for Pediatrics and Child Health (paper of the day, 26 August 2026): Severe malaria-bacterial sepsis co-infection frequency in critically ill children

Abstract

BACKGROUND: Severe malaria remains a major cause of pediatric critical illness and early mortality in sub-Saharan Africa. In pediatric emergency settings, concomitant bacterial sepsis is often under-recognized because of overlapping clinical manifestations, which may delay appropriate antimicrobial therapy and worsen outcomes. Data on severe malaria-bacterial sepsis co-infection among critically ill children in Kinshasa remain limited. AIM: To determine the frequency of severe malaria-bacterial sepsis co-infection and identify the associated clinical and biological factors among critically ill children. METHODS: This prospective multicenter observational study was conducted from September 2014 to September 2015 in four pediatric emergency departments in Kinshasa, Democratic Republic of Congo. Children aged 6 months to 15 years admitted with life-threatening conditions and confirmed severe malaria were included. Bacterial sepsis was defined by a positive blood culture for a pathogenic organism. Clinical and laboratory variables were compared using Fisher's exact test and the Mann-Whitney U test. Multivariable logistic regression was performed to identify factors independently associated with co-infection. RESULTS: Among 138 children admitted with life-threatening conditions, 96 (69.6%) had confirmed severe malaria. Severe malaria-bacterial sepsis co-infection was identified in 11 children, representing 11.5% of severe malaria cases. In univariate analysis, respiratory distress, splenomegaly, and hypoglycemia were more frequent among co-infected children. In multivariable analysis, respiratory distress remained independently associated with bacterial co-infection. Early mortality in the emergency department was higher among co-infected children than among those without co-infection. Gram-negative bacteria, predominantly Enterobacteriaceae, accounted for most bloodstream isolates. CONCLUSION: Severe malaria-bacterial sepsis co-infection is relatively frequent among critically ill children in Kinshasa and is associated with poorer early outcomes. Early and systematic assessment for sepsis at admission may help improve the initial management of children in pediatric emergency settings.

Abstract as published, via PubMed.