Relative contribution of bacteraemia and malaria to acute fever without localizing signs of infection in under-five children.

Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever of acute onset, without localizing signs of infection, were prospectively recruited over 1 year. Sixty-three per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria and bacteraemia. Neither infection was identified in 27 per cent. Malaria was the predominant infection irrespective of season, temperature on presentation, or age (except under 6 months). Although Gram-negative bacteraemia was overall commoner than Gram-positive bacteraemia, Staphylococcus aureus was the commonest single organism (43 per cent) in bacteraemic patients. The prevalence of malaria increased with age while that of bacteraemia decreased with age (P < 0.0005). The prevalence of an identifiable infection increased with the temperature on presentation (P < 0.025). It is concluded that although malaria is the predominant infection in previously healthy under-5 children with acute fever without specific localizing signs of infection, bacteraemia (alone or associated with malaria) occur with an importantly high frequency. It is recommended that while presumptive treatment for malaria is justified in such children, evaluation for bacteraemia should be given consideration.