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The association between malaria and non-typhoid Salmonella bacteraemia in children in sub-Saharan Africa: a literature review.
[typhoid]
Plasmodium
falciparum
malaria
and
non-
typhoid
Salmonella
(
NTS
)
bacteraemia
are
both
major
causes
of
morbidity
and
mortality
in
children
in
sub-
Saharan
Africa
.
Co
-infections
are
expected
to
occur
because
of
their
overlapping
geographical
distribution
,
but
accumulating
evidence
indicates
that
malaria
is
a
risk
factor
for
NTS
bacteraemia
.
A
literature
review
was
undertaken
to
provide
an
overview
of
the
evidence
available
for
this
association
,
the
epidemiology
of
malaria
-
NTS
co
-infection
(
including
the
highest
risk
groups
)
,
the
underlying
mechanisms
,
and
the
clinical
consequences
of
this
association
,
in
children
in
sub-
Saharan
Africa
.
The
burden
of
malaria
-
NTS
co
-infection
is
highest
in
young
children
(
especially
those
less
than
three
years
old
)
.
Malaria
is
one
of
the
risk
factors
for
NTS
bacteraemia
in
children
,
and
the
risk
is
higher
with
severe
malaria
,
especially
severe
malarial
anaemia
.
There
is
insufficient
evidence
to
determine
whether
asymptomatic
parasitaemia
is
a
risk
factor
for
NTS
bacteraemia
.
Many
mechanisms
have
been
proposed
to
explain
how
malaria
causes
susceptibility
to
NTS
,
ranging
from
macrophage
dysfunction
to
increased
gut
permeability
,
but
the
most
consistent
evidence
is
that
malarial
haemolysis
creates
conditions
which
favour
bacterial
growth
,
by
increasing
iron
availability
and
by
impairing
neutrophil
function
.
Few
discriminatory
clinical
features
have
been
described
for
those
with
malaria
and
NTS
co
-infection
,
except
for
a
higher
risk
of
anaemia
compared
to
those
with
either
infection
alone
.
Children
with
malaria
and
NTS
bacteraemia
co
-infection
have
higher
case
fatality
rates
compared
to
those
with
malaria
alone
,
and
similar
to
those
with
bacteraemia
alone
.
Antimicrobial
resistance
is
becoming
widespread
in
invasive
NTS
serotypes
,
making
empirical
treatment
problematic
,
and
increasing
the
need
for
prevention
measures
.
Observational
studies
indicate
that
interventions
to
reduce
malaria
transmission
might
also
have
a
substantial
impact
on
decreasing
the
incidence
of
NTS
bacteraemia
.
Diseases
Validation
Diseases presenting
"severe malaria"
symptom
alpha-thalassemia
typhoid
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