Etiology of severe non-malaria febrile illness in Northern Tanzania: A prospective cohort study
Autor(es): 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
Resumo: 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, - patients without malaria have poor outcomes. We prospectively studied a cohort of 870 pediatric - adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional st-ard 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, - fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), - 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, - 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. Malaria was uncommon - over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses - 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 - to rationally target disease control efforts.
Imprenta: PLoS Neglected Tropical Diseases, v. 7, n. 7, p. e2324, 2013
Identificador do objeto digital: 10.1371/journal.pntd.0002324
Descritores: Chikungunya virus - Arbovirus ; Chikungunya virus - Pathogenesis ; Chikungunya virus - Infectious diseases ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemiology ; Chikungunya virus - Public health
Data de publicação: 2013
