Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens

Details

• Alternative Title:
  Int J Infect Dis
• Personal Author:
  Althaus, Thomas ; Thaipadungpanit, Janjira ; Greer, Rachel C. ; Swe, Myo Maung Maung ; Dittrich, Sabine ; Peerawaranun, Pimnara ; Smit, Pieter W. ; Wangrangsimakul, Tri ; Blacksell, Stuart ; Winchell, Jonas M. ; Diaz, Maureen H. ; Day, Nicholas P.J. ; Smithuis, Frank ; Turner, Paul ; Lubell, Yoel
• Description:
  Objectives
  
  This study investigated causes of fever in the primary levels of care in Southeast Asia, and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens.
  
  Methods
  
  Blood and nasopharyngeal swab specimens were taken from children and adults with fever (>37.5 °C) or history of fever (<14 days) in Thailand and Myanmar.
  
  Results
  
  Of 773 patients with at least one blood or nasopharyngeal swab specimen collected, 227 (29.4%) had a target organism detected. Influenza virus type A was detected in 85/227 cases (37.5%), followed by dengue virus (30 cases, 13.2%), respiratory syncytial virus (24 cases, 10.6%) and Leptospira spp. (nine cases, 4.0%). Clinical outcomes were similar between patients with a bacterial or a viral organism, regardless of antibiotic prescription. CRP was higher among patients with a bacterial organism compared with those with a viral organism (median 18 mg/L, interquartile range [10–49] versus 10 mg/L [≤8–22], p = 0.003), with an area under the curve of 0.65 (95% CI 0.55–0.75).
  
  Conclusions
  
  Serious bacterial infections requiring antibiotics are an exception rather than the rule in the first line of care. CRP testing could assist in ruling out such cases in settings where diagnostic uncertainty is high and routine antibiotic prescription is common.
  
  
• Subjects:
  Antibiotic Prescription Article C-reactive Protein Causes Of Fever Primary Care
• Source:
  Int J Infect Dis. 2020; 96:334-342
• Pubmed ID:
  32437937
• Pubmed Central ID:
  PMC7211754
• Document Type:
  Journal Article
• Place as Subject:
  Asia, Southeastern
• Volume:
  96
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:35ae4d68f509fb8e710b4b2bb0013ed641102acaf7aff526ccead9df2f01554b0bb01734bf6939f9dff06b4a9a194f956fc34a7c68a3e79ca28489db326a20ba
• Download URL:
  https://stacks.cdc.gov/view/cdc/93289/cdc_93289_DS1.pdf
• File Type:
  [PDF - 857.42 KB ]