Acute uncomplicated febrile illness in children aged 2-59 months in Zanzibar - aetiologies, antibiotic treatment and outcome
Autor(es): Elfving Kristina, Shakely Deler, Andersson Maria, Baltzell Kimberly, Ali Abdullah S, Bachelard Marc, Falk Kerstin I, Ljung Annika, Msellem Mwinyi I, Omar Rahila S, Parola Philippe, Xu Weiping, Petzold Max, Trollfors Birger, Björkman Anders, Lindh Magnus, Mårtensson Andreas
Resumo: Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. We prospectively studied the aetiology of febrile illness in 677 children aged 2-59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, - multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) - rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH - GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical - laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. NPH-qPCR - GE-qPCR detected ?1 pathogen in 657/672 (98%) - 153/164 (93%) of patients - 158/166 (95%) - 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) - group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral - bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever - West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection retrospectively considered to require antibiotics. Clinical outcome was generally good. However, two children died. Only 68 (11%) patients remained febrile on day 3 - three of them had verified fever on day 14. An additional 29 (4.5%) children had fever relapse on day 14. Regression analysis determined C-reactive Protein (CRP) as the only independent variable significantly associated with CXR-confirmed pneumonia. This is the first study on uncomplicated febrile illness in African children that both applied a comprehensive laboratory panel - a healthy control group. A majority of patients had viral respiratory tract infection. Pathogens were frequently detected by qPCR also in asymptomatic children, demonstrating the importance of incorporating controls in fever aetiology studies. The precision of IMCI for identifying infections requiring antibiotics was low.
Imprenta: PloS One, v. 11, n. 1, p. e0146054, 2016
Identificador do objeto digital: 10.1371/journal.pone.0146054
Descritores: Chikungunya virus - Cell ; Chikungunya virus - Infectious diseases ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Transmission ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Dengue
Data de publicação: 2016
