{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:22:50Z","timestamp":1793719370078,"version":"4.6.1"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Malaria remains the leading cause of acute febrile illness (AFI) in Africa despite successful control measures and programs. Acute febrile illnesses can be misdiagnosed as malaria as a result of the overlapping spectrum of nonspecific symptoms or may not be pursued because of limited diagnostic capabilities. This study investigated potential etiologies of AFIs in Ghana and determined the relationship between coinfection between malaria and Q fever, leptospirosis, and culturable bacteria in febrile patients. Participants were enrolled between July 2015 and December 2019 from four Ghanaian military treatment facilities. Of the 399 febrile participants, 222 (55.6%) males and 177 (44.6%) females were enrolled. Malaria was diagnosed in 275 (68.9%) participants. Malaria coinfection occurred with leptospirosis, Q fever, and blood-cultured bacteria in 11\/206 (5.3%), 24\/206 (11.7%), and 6\/164 (3.7%) participants, respectively. Among the 124 malaria-negative samples, the positivity rates were 4.1% (3\/74), 8.1% (6\/74), and 3.6% (2\/56) for leptospirosis, Q fever, and bacterial pathogens isolated from blood culture, respectively. The majority of documented clinical signs and symptoms were not significantly associated with specific diseases. Approximately 10% of malaria-positive participants also had evidence suggesting the presence of a bacterial coinfection. Therefore, even in the case of a positive malaria test, other pathogens contributing to febrile illness should be considered. Understanding the frequency of malaria coinfection and other etiological agents responsible for AFIs will improve diagnosis and treatment and better inform public health knowledge gaps in Ghana.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0099","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T11:38:24Z","timestamp":1695641904000},"page":"1036-1046","source":"Crossref","is-referenced-by-count":11,"title":["Coinfection of Malaria and Bacterial Pathogens among Acute Febrile Patients in Selected Clinics in Ghana"],"prefix":"10.4269","volume":"109","author":[{"given":"Janice N. A.","family":"Tagoe","sequence":"first","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"},{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Yeboah","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"},{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Behene","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"},{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selassie","family":"Kumordjie","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"},{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Nimo-Paintsil","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiki","family":"Attram","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward O.","family":"Nyarko","sequence":"additional","affiliation":[{"name":"37 Military Hospital, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Ayite","family":"Carroll","sequence":"additional","affiliation":[{"name":"2 Garrison Clinics, Sekondi\/Takoradi, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne T.","family":"Fox","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaselynn","family":"Watters","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwadwo","family":"Koram","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham Kwabena","family":"Anang","sequence":"additional","affiliation":[{"name":"Noguchi Memorial Institute for Medical Research, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrel","family":"Sanders","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Letizia","sequence":"additional","affiliation":[{"name":"U.S. Naval Medical Research Unit-2 Detachment, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"BMJ","first-page":"995","article-title":"Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study","volume":"330","author":"Berkley","year":"2005"},{"key":"b2","series-title":"Q J Med","first-page":"591","article-title":"High mortality of infant bacteraemia clinically indistinguishable from severe malaria","volume":"97","author":"Evans","year":"2004"},{"key":"b3","series-title":"Disease Control Priorities, Third Edition (Volume 6): Major Infectious Diseases","first-page":"365","author":"Crump","year":"2017"},{"key":"b4","series-title":"BMJ","first-page":"848","article-title":"WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study","volume":"340","author":"Nadjm","year":"2010"},{"key":"b5","series-title":"Clin Microbiol Infect","first-page":"808","article-title":"The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management","volume":"24","author":"Maze","year":"2018"},{"key":"b6","series-title":"eLife","first-page":"1","article-title":"Quantifying the contribution of Plasmodium falciparum malaria to febrile illness amongst African children","volume":"6","author":"Dalrymple","year":"2017"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"1838","article-title":"Malaria coinfections in febrile pediatric inpatients: a hospital-based study from Ghana","volume":"66","author":"Hogan","year":"2018"},{"key":"b8","series-title":"Emerg Infect Dis","first-page":"344","article-title":"Q fever in young children, Ghana","volume":"14","author":"Kobbe","year":"2008"},{"key":"b9","series-title":"J Immunoassay Immunochem","first-page":"152","article-title":"Serological evidence of Coxiella burnetii infection in slaughtered sheep and goats at Kumasi Abattoir, Ghana","volume":"41","author":"Folitse","year":"2019"},{"key":"b10","series-title":"Vet Med Sci","first-page":"402","article-title":"Seroprevalence of Q fever in cattle, sheep and goats in the Volta region of Ghana","volume":"5","author":"Johnson","year":"2019"},{"key":"b11","series-title":"Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health","first-page":"137","author":"Herlihy","year":"2016"},{"key":"b12"},{"key":"b13"},{"key":"b14","series-title":"J Clin Microbiol","first-page":"10","article-title":"Use of the API 20E system to identify veterinary Enterobacteriaceae","volume":"12","author":"Swanson","year":"1980"},{"key":"b15","series-title":"Ann N Y Acad Sci","first-page":"563","article-title":"Evaluation of a real-time PCR assay to detect Coxiella burnetii","volume":"1078","author":"Klee","year":"2006"},{"key":"b16","series-title":"Mol Cell Probes","first-page":"111","article-title":"Evaluation of lig-based conventional and real time PCR for the detection of pathogenic leptospires","volume":"19","author":"Palaniappan","year":"2005"},{"key":"b17","year":"2019"},{"key":"b18","series-title":"PLoS One","first-page":"e0127962","article-title":"Etiology of severe febrile illness in low- and middle-income countries: a systematic review","volume":"10","author":"Prasad","year":"2015"},{"key":"b19","series-title":"BMC Med","first-page":"1","article-title":"Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review","volume":"12","author":"Church","year":"2014"},{"key":"b20","series-title":"Trop Med Int Health","first-page":"612","article-title":"Seroprevalence of Q-fever in febrile individuals in Mali","volume":"10","author":"Steinmann","year":"2005"},{"key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e2787","article-title":"Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review","volume":"8","author":"Vanderburg","year":"2014"},{"key":"b22","series-title":"Int J Infect Dis","first-page":"50","article-title":"Seroepidemiology of leptospirosis among febrile patients in a rapidly growing suburban slum and a flood-vulnerable rural district in Mozambique, 2012\u20132014: implications for the management of fever","volume":"64","author":"Ribeiro","year":"2017"},{"key":"b23","series-title":"Int J Infect Dis","first-page":"47","article-title":"Leptospirosis in Sub-Saharan Africa: a systematic review","volume":"28","author":"de Vries","year":"2014"},{"key":"b24","article-title":"Leptospirosis-current risk factors connected with human activity and the environment","author":"Wasinski","year":"2013"},{"key":"b25","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Diagnosis and management of Q fever - United States, 2013: recommendations from CDC and the Q Fever Working Group","volume":"62","author":"Anderson","year":"2013"},{"key":"b26","series-title":"Clin Vaccine Immunol","first-page":"286","article-title":"Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever","volume":"17","author":"Schneeberger","year":"2010"},{"key":"b27","series-title":"Trop Med Health","first-page":"3","article-title":"Prevalence and characterization of Salmonella among humans in Ghana","volume":"45","author":"Andoh","year":"2017"},{"key":"b28","series-title":"BMC Infect Dis","first-page":"288","article-title":"A cross-sectional study of enteric fever among febrile patients at Ambo Hospital: prevalence, risk factors, comparison of Widal test and stool culture and antimicrobials susceptibility pattern of isolates","volume":"19","author":"Deksissa","year":"2019"},{"key":"b29","series-title":"Asian Pac J Trop Med","first-page":"137","article-title":"Salmonella typhi infection in a tertiary institution in Nasarawa State, Nigeria","volume":"4","author":"Ishaleku","year":"2011"},{"key":"b30","series-title":"BMC Infect Dis","first-page":"1","article-title":"Salmonella blood stream infections in a tertiary care setting in Ghana","volume":"14","author":"Labi","year":"2014"},{"key":"b31","series-title":"BMC Infect Dis","first-page":"1","article-title":"Characterization of methicillin-susceptible and -resistant staphylococci in the clinical setting: a multicentre study in Nigeria","volume":"12","author":"Shittu","year":"2012"},{"key":"b32","series-title":"Frontiers in Staphylococcus aureus","author":"Youssef"},{"key":"b33","series-title":"BMC Infect Dis","first-page":"720","article-title":"Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana","volume":"16","author":"Dekker","year":"2016"},{"key":"b34","series-title":"Clin Microbiol Rev","first-page":"382","article-title":"Bacillus cereus, a volatile human pathogen","volume":"23","author":"Bottone","year":"2010"},{"key":"b35","series-title":"Ann Clin Microbiol Antimicrob","first-page":"43","article-title":"Clinical characteristics and antimicrobial susceptibility of Bacillus cereus blood stream infections","volume":"14","author":"Ikeda","year":"2015"},{"key":"b36","series-title":"PLoS Negl Trop Dis","first-page":"e0007792","article-title":"Global knowledge gaps in acute febrile illness etiologic investigations: a scoping review","volume":"13","author":"Rhee","year":"2019"},{"key":"b37","series-title":"PLoS Negl Trop Dis","first-page":"e0004040","article-title":"Estimating the burden of febrile illnesses","volume":"9","author":"Crump","year":"2015"},{"key":"b38","series-title":"PLoS One","first-page":"30220371","article-title":"Quantifying the incidence of severe-febrile- illness hospital admissions in sub-Saharan Africa","volume":"14","author":"Roddy","year":"2019"},{"key":"b39","series-title":"Clin Microbiol Infect","first-page":"808","article-title":"The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management","volume":"24","author":"Maze","year":"2019"},{"key":"b40","series-title":"BMC Infect Dis","first-page":"244","article-title":"Febrile patients admitted to remote hospitals in Northeastern Kenya: seroprevalence, risk factors and a clinical prediction tool for Q-Fever","volume":"16","author":"Njeru","year":"2016"},{"key":"b41","series-title":"Lancet Infect Dis","first-page":"e27","article-title":"Zoonotic causes of febrile illness in malaria endemic countries: a systematic review","volume":"20","author":"Halliday","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/5\/article-p1036.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/109\/5\/article-p1036.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/109\/5\/article-p1036.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T13:46:55Z","timestamp":1698846415000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/5\/article-p1036.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":41,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0099","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}