Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study
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. We prospecti...
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| Veröffentlicht in: | PLoS neglected tropical diseases 2013-07, Vol.7 (7), p.e2324-e2324 |
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| creator | 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 |
| description | 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.
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.
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. |
| doi_str_mv | 10.1371/journal.pntd.0002324 |
| format | Article |
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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.
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.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0002324</identifier><identifier>PMID: 23875053</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteria - classification ; Bacteria - isolation & purification ; Bacterial Infections - epidemiology ; Child ; Child, Preschool ; Cohort Studies ; Female ; Fever of Unknown Origin - epidemiology ; Fever of Unknown Origin - etiology ; Fungi - classification ; Fungi - isolation & purification ; Health risk assessment ; Hospitalization ; Hospitals ; Humans ; Illnesses ; Infant ; Infections ; Leptospira ; Male ; Medicine ; Middle Aged ; Mortality ; Mycoses - epidemiology ; Prospective Studies ; Studies ; Tanzania - epidemiology ; Viral infections ; Virus Diseases - epidemiology ; Viruses - classification ; Viruses - isolation & purification ; Young Adult</subject><ispartof>PLoS neglected tropical diseases, 2013-07, Vol.7 (7), p.e2324-e2324</ispartof><rights>2013</rights><rights>2013 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Citation: Crump JA, Morrissey AB, Nicholson WL, Massung RF, Stoddard RA, et al. (2013) Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study. PLoS Negl Trop Dis 7(7): e2324. doi:10.1371/journal.pntd.0002324</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c597t-b4bbc8bfd02de1661a4ef5899997a4ccbc1b9251f159b2deae268aafcf3389ab3</citedby><cites>FETCH-LOGICAL-c597t-b4bbc8bfd02de1661a4ef5899997a4ccbc1b9251f159b2deae268aafcf3389ab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715424/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715424/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23875053$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Picardeau, Mathieu</contributor><creatorcontrib>Crump, John A</creatorcontrib><creatorcontrib>Morrissey, Anne B</creatorcontrib><creatorcontrib>Nicholson, William L</creatorcontrib><creatorcontrib>Massung, Robert F</creatorcontrib><creatorcontrib>Stoddard, Robyn A</creatorcontrib><creatorcontrib>Galloway, Renee L</creatorcontrib><creatorcontrib>Ooi, Eng Eong</creatorcontrib><creatorcontrib>Maro, Venance P</creatorcontrib><creatorcontrib>Saganda, Wilbrod</creatorcontrib><creatorcontrib>Kinabo, Grace D</creatorcontrib><creatorcontrib>Muiruri, Charles</creatorcontrib><creatorcontrib>Bartlett, John A</creatorcontrib><title>Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>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.
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.
Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. 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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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c597t-b4bbc8bfd02de1661a4ef5899997a4ccbc1b9251f159b2deae268aafcf3389ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacteria - classification</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - epidemiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fever of Unknown Origin - epidemiology</topic><topic>Fever of Unknown Origin - etiology</topic><topic>Fungi - classification</topic><topic>Fungi - isolation & purification</topic><topic>Health risk assessment</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Infant</topic><topic>Infections</topic><topic>Leptospira</topic><topic>Male</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mycoses - epidemiology</topic><topic>Prospective Studies</topic><topic>Studies</topic><topic>Tanzania - epidemiology</topic><topic>Viral infections</topic><topic>Virus Diseases - epidemiology</topic><topic>Viruses - classification</topic><topic>Viruses - isolation & purification</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Crump, John A</creatorcontrib><creatorcontrib>Morrissey, Anne B</creatorcontrib><creatorcontrib>Nicholson, William L</creatorcontrib><creatorcontrib>Massung, Robert F</creatorcontrib><creatorcontrib>Stoddard, Robyn A</creatorcontrib><creatorcontrib>Galloway, Renee L</creatorcontrib><creatorcontrib>Ooi, Eng Eong</creatorcontrib><creatorcontrib>Maro, Venance P</creatorcontrib><creatorcontrib>Saganda, Wilbrod</creatorcontrib><creatorcontrib>Kinabo, Grace D</creatorcontrib><creatorcontrib>Muiruri, Charles</creatorcontrib><creatorcontrib>Bartlett, John A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Crump, John A</au><au>Morrissey, Anne B</au><au>Nicholson, William L</au><au>Massung, Robert F</au><au>Stoddard, Robyn A</au><au>Galloway, Renee L</au><au>Ooi, Eng Eong</au><au>Maro, Venance P</au><au>Saganda, Wilbrod</au><au>Kinabo, Grace D</au><au>Muiruri, Charles</au><au>Bartlett, John A</au><au>Picardeau, Mathieu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2013-07-18</date><risdate>2013</risdate><volume>7</volume><issue>7</issue><spage>e2324</spage><epage>e2324</epage><pages>e2324-e2324</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23875053</pmid><doi>10.1371/journal.pntd.0002324</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Bacteria - classification Bacteria - isolation & purification Bacterial Infections - epidemiology Child Child, Preschool Cohort Studies Female Fever of Unknown Origin - epidemiology Fever of Unknown Origin - etiology Fungi - classification Fungi - isolation & purification Health risk assessment Hospitalization Hospitals Humans Illnesses Infant Infections Leptospira Male Medicine Middle Aged Mortality Mycoses - epidemiology Prospective Studies Studies Tanzania - epidemiology Viral infections Virus Diseases - epidemiology Viruses - classification Viruses - isolation & purification Young Adult |
| title | Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study |
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