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

Abstract

The causes of infections in pediatric populations differ between age groups and settings, particularly in the tropics. Such differences in epidemiology may lead to misdiagnosis and ineffective empirical treatment. Here, we investigated the current spectrum of pathogens causing febrile diseases leading to pediatric hospitalization in Lambaréné, Gabon. From August 2015 to March 2016, we conducted a prospective, cross-sectional, hospital-based study in a provincial hospital. Patients were children ≤ 15 years with fever ≥ 38 °C and required hospitalization. A total of 600 febrile patients were enrolled. Malaria was the main diagnosis found in 52% (311/600) patients. Blood cultures revealed septicemia in 3% (17/593), among them four cases of typhoid fever. The other causes of fever were heterogeneously distributed between both bacteria and viruses. Severe infections identified by Lambaréné Organ Dysfunction Score (LODS) were also most often caused by malaria, but children with danger signs did not have more coinfections than others. In 6% (35/600) of patients, no pathogen was isolated. In Gabon, malaria is still the major cause of fever in children, followed by a bacterial and viral disease. Guidelines for both diagnosis and management should be tailored to the spectrum of pathogens and resources available locally.Causes of fever in African pediatric populations are more diverse than previously thought. A landmark study conducted in Tanzania showed that due to a change in epidemiology, a broad spectrum of pathogens replaced P. falciparum malaria as the most common cause of disease in children in this area 1 . However, a few years later, P. falciparum malaria, is still seen to be the main cause of febrile illnesses in Ghana, West Africa 2 . When unaware, these differences in epidemiology might lead to misdiagnosis as well as inefficient treatment by the medical personnel. The process of medical diagnosis includes the joint interpretation of symptoms, clinical signs and laboratory findings. Careful selection and prioritization of a diagnostic setup are informed by a priori knowledge of the seasonal, local and worldwide frequency and distribution of a given disease 3,4 .Our study describes the distribution of infections, co-infections, and co-morbidities in children hospitalized for febrile illnesses at the Albert Schweitzer Hospital (HAS) in Lambaréné, Gabon, as an example for a hospital in a semiurban Central African region. In addition, we present the current spectrum of pathogens causing severe disease identified by Lambaréné Organ Dysfunction Score (LODS) in these children. ResultsStudy patients. A total of 600 febrile patients ≤ 15 years were enrolled in our study. Of these, 280 (47%) were females; 69% (415/600) patients were < 5 years, and median (IQR) age was 29 [12-68] months (Table 1). Seven percent (40/549, NA = 51) had at least one known chronic medical condition prior to admission, among the main ones: 4% (23/600) patients had homozygous sickle cell disease; 1% (6/600) were HIV positive. Vaccination coverage...

Unbiased metagenomic next-generation sequencing of blood from hospitalized febrile children in Gabon

“…Indeed, except for HPgV-1, all RNA and DNA viruses reported by our mUNGS analysis represent commonly recognized viral aetiologies of febrile illness in both paediatric and adult populations across all continents. Among viruses known to cause outbreaks in this part of the world, by mUNGS we did not detect any flavivirus or alphavirus sequences, which confirms the PCR results previously reported [5]. Using an unbiased approach such as mUNGS in specific populations, according also to the epidemiological season, will help to characterize viruses causing fever, and provides a surveillance tool for emerging viral diseases.…”

“…In conclusion, our mUNGS investigations support evidence that febrile disease of viral origin among children in Sub-Saharan Africa are frequently associated with "common" viruses. The mUNGS data are concordant with the PCR screening results from a previous study [5] that reported the detection of Human herpesvirus type 6 in the blood of 33% of a subset of 89 patients, Enterovirus and Human rhinovirus in throat swabs of 1.6% of 191 patients each, as well as Rotavirus (11.3% of patients) and Mamastrovirus 1 (4.8% of patients) in stools. Interestingly in the previous study, Human herpesvirus type 6 was detected by PCR in patients without exanthema which suggested past infections or acute infections without apparent skin lesions.…”

“…rectal or axillary temperature ≥38°C), without any exclusion criteria, at the Albert Schweitzer Hospital in Lambaréné, Gabon, between August 2015 to March 2016. A total of 405 samples were collected as part of a previous study [5], of which 385 had a sufficient leftover volume. Of these samples, 360 were randomly selected and were grouped in 18 pools of 20 samples each (6 ul of each of the 20 sera samples per pool were used, corresponding to a volume of 120 ul/pool) according to four age subgroups [6].…”

Virosaurus A Reference to Explore and Capture Virus Genetic Diversity

“…Moreover, the database has been used in a pilot study to characterize viruses causing fever, and provides a surveillance tool for emerging viral diseases in Gabon [26]. The results are concordant with the PCR screening results from a previous study [27].…”

Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial

“…Recent work in LMICs has focused on unravelling the diverse aetiologies of acute febrile illnesses especially in children [7][8][9][10][11][12][13]. Data from outpatient settings are scarce, with a small number of studies describing the relative distribution of bacterial, parasitic and viral agents among acutely febrile patients [7].…”