Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Crump, JA; Morrissey, AB; Nicholson, WL; Massung, RF; Stoddard, RA; Galloway, RL; Ooi, EE; Maro, VP; Saganda, W; Kinabo, GD; Muiruri, C; Bartlett, JA

Published Date

  • January 2013

Published In

Volume / Issue

  • 7 / 7

Start / End Page

  • e2324 -

PubMed ID

  • 23875053

Pubmed Central ID

  • 23875053

Electronic International Standard Serial Number (EISSN)

  • 1935-2735

International Standard Serial Number (ISSN)

  • 1935-2727

Digital Object Identifier (DOI)

  • 10.1371/journal.pntd.0002324

Language

  • eng