Details:

Alternative Title:
PLoS Negl Trop Dis
Personal Author:
Crump, John A. ; Morrissey, Anne B. ; Nicholson, William L. ; Massung, Robert F. ; Stoddard, Robyn A. ; ... More +
Crump, John A. ; Morrissey, Anne B. ; Nicholson, William L. ; Massung, Robert F. ; Stoddard, Robyn A. ; Galloway, Renee L. ; Ooi, Eng Eong ; Maro, Venance P. ; Saganda, Wilbrod ; Kinabo, Grace D. ; Muiruri, Charles ; Bartlett, John A. Less -
Description:
Introduction

The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes.

Methods and Findings

We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis.

Conclusions

Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts.


Subjects:
[+]
Adolescent Adult Aged Aged, 80 And Over Bacteria Bacterial Infections Child Child, Preschool Cohort Studies Female Fever Of Unknown Origin Fungi Hospitalization Humans Infant Male Middle Aged Mycoses Prospective Studies Virus Diseases Viruses Young Adult
Source:
PLoS Negl Trop Dis. 2013; 7(7).
Document Type:
Journal Article
Place as Subject:
Tanzania
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:68be1082891d4e8a55f3b59b781ffbb317f28345b6700f17dc760544863e1297
Download URL:
https://stacks.cdc.gov/view/cdc/19597/cdc_19597_DS1.pdf
File Type:

Supporting Files

• 	pntd.0002324.t001.jpg	jpeg
  	license.txt	txt
  	pntd.0002324.g001.gif	gif
  	pntd.0002324.g001.jpg	jpeg
  	pntd.0002324.g002.gif	gif
  	pntd.0002324.g002.jpg	jpeg
  	pntd.0002324.nxml	txt
  	pntd.0002324.s001.doc	doc
  	pntd.0002324.t001.gif	gif

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