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Causes of non‐malarial febrile illness in outpatients in T anzania
Author(s) -
Hildenwall Helena,
Amos Ben,
Mtove George,
Muro Florida,
Cederlund Kerstin,
Reyburn Hugh
Publication year - 2016
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12635
Subject(s) - medicine , pneumonia , malaria , blood culture , pediatrics , outpatient clinic , bacteremia , antibiotics , immunology , microbiology and biotechnology , biology
Abstract Objective In sub‐ S aharan A frica, the use of malaria rapid diagnostic tests (m RDT ) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of m RDT ‐negative fever aetiologies among children and adults in T anzania. Methods A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative m RDT were enrolled from a T anzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology. Results Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X‐rayed children meeting WHO pneumonia criteria, 47.4% had a normal X‐ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2–14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively). Conclusion Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying A frican children in need of antibiotics among the majority who do not.