Malaria and salmonella infection: relationship or casuality?

Introduction: In Sub-Saharan Africa, non-Typhoid Salmonella (NTS) bacteriemia is a common and often fatal complication of Plasmodium falciparum malaria. Thus WHO protocols recommend to treat children with severe malaria also with broad-spectrum antibiotics. Case report: We describe the case of a four year old boy, born in Italy, admitted to our Department for severe Plasmodium falciparum malaria after visiting relatives in Burkina Faso. The child presented high fever, diarrhea and vomiting. Intravenous quinine therapy was promptly administrated with improvement of the conditions and decrease of fever after 24 hours. During the third day of hospitalization the temperature abruptly raised and child's conditions worsened. Laboratory testing showed increased CRP level (280 mg/L) and decreased total White Blood Cells count (6940/mm3). Blood smear examination was negative for Plasmodia while blood culture resulted positive for Salmonella enteritidis. The patient was treated with parenteral ceftriaxone for 10 days and oral quinine for one week with a complete recovery. Discussion: Recent studies in mice (Cunnington et al.,2012) showed that the increased risk for developing NTS bacteriemia during malaria is caused by the hemolysis of red cells infected by Plasmodium. Intravascular hemolysis releases heme which induces heme oxigenase-1 leading to reduced macrophage antimicrobial activity and consequently impaired resistance to NTS with increased bacterial replication. Conclusion: Concurrent malaria and salmonella infections are frequently described in endemic areas. This vulnerability to NTS in malaria infection is being assessed in literature. In Medicine coexisting pathologies are rarely explained by casuality.