Laboratory investigations in the diagnosis of septicaemia and malaria.

During a three month prospective study, 229 in-patients with fever, admitted to St. Mary's Hospital, Mumias, were examined for bacterial and malarial causes of fever. Blood cultures taken from patients appeared to contain true pathogens in 51 (22%) cases. Nine different bacterial species were identified from positive blood cultures of which four predominated: Salmonella typhi (46%), Streptococcus pneumoniae (19%), Salmonella enteritidis (12%), Salmonella typhimurium (8%). S. enteritidis and S. typhimurium isolates were mostly multi-antibiotic resistant, compared to S. typhi isolates which were relatively susceptible to the antibiotics used in the hospital. Only 70% of the S. pneumoniae isolates were susceptible to penicillin. Among 227 patients in whom a thick blood-film for malaria parasites and HIV serology were performed, only 25 (11%) revealed malaria parasites. HIV-1 antibodies were detected in 51 (22%) patients. Without appropriate laboratory examinations, the majority of the diagnoses would have been missed and no optimal treatment would have been administered. This may increase resistance to antimalarials and antibiotics.