How can supposedly treatable bacterial infections be such dominant causes of death, even in settings where antibiotics are readily available? From over 10 years of experience researching infectious disease diagnostics and disease burden at the University Teaching Hospital, Lusaka, Zambia, at HerpeZ we are interested in undertaking research that helps us understand what the causes of this problem are, and ultimately to gather the evidence that will inform on life-saving interventions.

We postulate that there are three highly probable and non-mutually exclusive factors that likely contribute to the high burden of mortality due to bacterial infections:

Late Referral: Even in cities like Lusaka, Zambia, that have a comprehensive network of community clinics and a good referral system, there are large poor communities where, due to lack of education and/or resources, parents might present their children very late to the health system.

Co-infection: In high disease burden settings, pneumonia, sepsis and meningitis are primarily diagnosed clinically, and treated empirically with antibiotics. This strategy is simple and affordable, but inadequate, and overlooks possible co-morbidity with viral, mycobacterial and fungal pathogens that also infect the lower respiratory tract.

Antibiotic resistance: Widespread misuse of antibiotics has led to high levels of antibiotic resistance [4] and so some deaths may be due to drug resistant bacteria. All three factors highlight the need for a better understanding of the underlying aetiology of these diseases, and improved diagnostic tools and strategies to better manage these large and neglected patient groups. The relative contribution of non-bacterial causes of pneumonia, sepsis and meningitis needs to be better understood, to guide vaccine, diagnostic and drug development, and to permit more rationale microbiologically informed use of antibiotics.