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Etiology of pediatric fever in western Kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis.

Publication ,  Journal Article
O'Meara, WP; Mott, JA; Laktabai, J; Wamburu, K; Fields, B; Armstrong, J; Taylor, SM; MacIntyre, C; Sen, R; Menya, D; Pan, W; Nicholson, BP ...
Published in: Am J Trop Med Hyg
May 2015

In Kenya, more than 10 million episodes of acute febrile illness are treated annually among children under 5 years. Most are clinically managed as malaria without parasitological confirmation. There is an unmet need to describe pathogen-specific etiologies of fever. We enrolled 370 febrile children and 184 healthy controls. We report demographic and clinical characteristics of patients with Plasmodium falciparum, group A streptococcal (GAS) pharyngitis, and respiratory viruses (influenza A and B, respiratory syncytial virus [RSV], parainfluenza [PIV] types 1-3, adenovirus, human metapneumovirus [hMPV]), as well as those with undifferentiated fever. Of febrile children, 79.7% were treated for malaria. However, P. falciparum was detected infrequently in both cases and controls (14/268 [5.2%] versus 3/133 [2.3%], P = 0.165), whereas 41% (117/282) of febrile children had a respiratory viral infection, compared with 24.8% (29/117) of controls (P = 0.002). Only 9/515 (1.7%) children had streptococcal infection. Of febrile children, 22/269 (8.2%) were infected with > 1 pathogen, and 102/275 (37.1%) had fevers of unknown etiology. Respiratory viruses were common in both groups, but only influenza or parainfluenza was more likely to be associated with symptomatic disease (attributable fraction [AF] 67.5% and 59%, respectively). Malaria was overdiagnosed and overtreated. Few children presented to the hospital with GAS pharyngitis. An enhanced understanding of carriage of common pathogens, improved diagnostic capacity, and better-informed clinical algorithms for febrile illness are needed.

Duke Scholars

Dimensions Citation Stats

Published In

Am J Trop Med Hyg

DOI

EISSN

1476-1645

Publication Date

May 2015

Volume

92

Issue

5

Start / End Page

1030 / 1037

Location

United States

Related Subject Headings

  • Tropical Medicine
  • Streptococcus pyogenes
  • Streptococcal Infections
  • Respiratory Tract Infections
  • Respiratory Syncytial Virus Infections
  • Pharyngitis
  • Paramyxoviridae Infections
  • Metapneumovirus
  • Male
  • Malaria, Falciparum
 

Citation

APA
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MLA
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O’Meara, W. P., Mott, J. A., Laktabai, J., Wamburu, K., Fields, B., Armstrong, J., … Holland, T. L. (2015). Etiology of pediatric fever in western Kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis. Am J Trop Med Hyg, 92(5), 1030–1037. https://doi.org/10.4269/ajtmh.14-0560

Published In

Am J Trop Med Hyg

DOI

EISSN

1476-1645

Publication Date

May 2015

Volume

92

Issue

5

Start / End Page

1030 / 1037

Location

United States

Related Subject Headings

  • Tropical Medicine
  • Streptococcus pyogenes
  • Streptococcal Infections
  • Respiratory Tract Infections
  • Respiratory Syncytial Virus Infections
  • Pharyngitis
  • Paramyxoviridae Infections
  • Metapneumovirus
  • Male
  • Malaria, Falciparum