Aetiology of acute febrile illness in children in a high malaria transmission area in West Africa

Abstract

Objectives: Areas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso. Methods: In a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens. Results: A total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases. Conclusions: Viral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.

Nasopharyngeal colonisation dynamics of bacterial pathogens in patients with fever in rural Burkina Faso: an observational study

“…This study was designed as a side project to the PALUBAC study, which was set up to test and optimise an algorithm to distinguish malaria from bacterial infections in acutely ill febrile patients. Inclusion and exclusion criteria of the PALUBAC study and a complete report on which data were collected have been published previously [ 21 – 23 ]. Briefly, participants were enrolled between March 2016 and June 2017 at the Centre Médical avec Antenne Chirurgicale (CMA) Saint Camille de Nanoro, Burkina Faso.…”

“…From March until November 2016, only hospitalised patients were enrolled. Thereafter, until the end of the study in June 2017, non-hospitalised patients were also enrolled because of insufficient study recruitment [ 23 ].…”

“…qPCR for Salmonella spp., S. pneumoniae , H. influenzae and S. aureus was performed on blood samples of patients with negative blood cultures. qPCR methods for the detection of bacterial pathogens in blood samples were described in a previous publication [ 23 ]. The detection limit was 75 copies of DNA per ml of blood.…”

Magnitude of Malaria-Typhoid Fever Coinfection in Febrile Patients at Arba Minch General Hospital in Southern Ethiopia

“…Acute febrile illness is de ned as a rise in body temperature above the normal range of 36.5-37.5 °C [2,[6][7][8]. Malaria and typhoid fever are caused by quite distinct organisms, protozoa, and Gram-negative bacilli, respectively, and are spread by separate routes [9,10].…”

The position of geochemical variables as causal co-factors of diseases of unknown aetiology

“…Acrocyanosis Acrocyanosis is a peripheral vascular disorder which presents as a persistent bluish or cyanotic discolouration of the extremities, most commonly occurring in the hands Geographical locale (latitude; urban versus rural setting) uncertain—[ 23 ] Chronic As toxicity—[ 23 – 27 ] Cold climate—[ 28 , 29 ]; Cold environments—[ 30 , 31 ] According to Kurklinsky et al—[ 23 ] the diagnosis of acrocyanosis remains mostly clinical; and the variegated nature of pathological mechanisms suggests that the disease is unlikely to be a single entity 2. Acute Febrile Illness Acute Febrile Illness (AFI) is characterised by malaise, myalgia (pain in muscle or group of muscles) and a raised temperature that could be interpreted as a nonspecific manifestation of infectious diseases in the tropics—[ 32 ] Sub-Saharan Africa; Tropics and Sub-Tropics Viral respiratory tract infections—[ 33 , 34 ]; Significantly lower serum Zn levels in febrile seizure group than in the afebrile group—[ 35 ]; No significant relationship observed between fabrile convulsion and the elements: Fe, Zn, Mg and Ca—[ 36 ] Clear seasonal trend observed—[ 37 ] Further research is warranted on trace element metabolism in relation to the development of AFI—See: [ 36 ] 3. Acute Severe Asthma Asthma is characterised by chronic airway inflammation, resulting in periodic wheeze, cough and breathlessness (See: [ 38 ]) Worldwide prevalence.…”