Acute respiratory infection and bacteraemia as causes of non-malarial febrile illness in African children: a narrative review

Abstract

The replacement of “presumptive treatment for malaria” by “test before treat” strategies for the management of febrile illness is raising awareness of the importance of knowing more about the causes of illness in children who are suspected to have malaria but return a negative parasitological test. The most common cause of non-malarial febrile illness (NMFI) in African children is respiratory tract infection. Whilst the bacterial causes of NMFI are well known, the increasing use of sensitive techniques such as polymerase chain reaction (PCR) tests is revealing large numbers of viruses that are potential respiratory pathogens. However, many of these organisms are commonly present in the respiratory tract of healthy children so causality and risk factors for pneumonia remain poorly understood. Infection with a combination of viral and bacterial pathogens is increasingly recognised as important in the pathogenesis of pneumonia. Similarly, blood stream infections with organisms typically grown by aerobic culture are well known but a growing number of organisms that can be identified only by PCR, viral culture, or serology are now recognised to be common pathogens in African children. The high mortality of hospitalised children on the first or second day of admission suggests that, unless results are rapidly available, diagnostic tests to identify specific causes of illness will still be of limited use in guiding the potentially life saving decisions relating to initial treatment of children admitted to district hospitals in Africa with severe febrile illness and a negative test for malaria. Malaria control and the introduction of vaccines against Haemophilus influenzae type b and pneumococcal disease are contributing to improved child survival in Africa. However, increased parasitological testing for malaria is associated with increased use of antibiotics to which resistance is already high.

Causes of fever in Gabonese children: a cross-sectional hospital-based study

“…Furthermore, one of the two fatalities that occurred in our study was caused by respiratory failure. Lower respiratory tract infections (LRTI) were the main cause of febrile illness in children, as found in similar studies 14 . These results stress the need for fast and correct malaria diagnosis and radiology in resource-limited areas.…”

Prevalence and Clinical Management of Non-malarial Febrile Illnesses among Outpatients in the Era of Universal Malaria Testing in Malawi

“…Studies in children in sub-Saharan Africa have similarly found RTIs to be the most common cause of acute febrile illness. 10,[12][13][14]24 However, our results also suggest that some of the clinical diagnoses made by the health workers in patients with NMFIs were likely inaccurate. Sepsis was diagnosed in almost one-third of cases; however, etiological studies in adults or children in similar settings have shown that only a very small proportion of outpatient fevers, ranging from 1.3% to 4.2%, are caused by bloodstream infections.…”

RespiDisk: a point-of-care platform for fully automated detection of respiratory tract infection pathogens in clinical samples

“…14,15 In such occasions, the epidemiological landscape becomes even more complicated, requiring accurate diagnosis of the RTI-causative pathogen for proper management of patients with comorbidities. 16 In this context, nucleic acid amplification testing (NAAT) 17-19 is a promising candidate to overcome the aforementioned challenges and offer high sensitivity and specific pathogen identification that can contribute to a reliable downstream patient management. Especially when conducted on an automated platform, NAAT offers the potential for shifting the diagnosis to the patient side.…”