Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

Kasper, Matthew R.; Blair, Patrick J.; Touch, Sok; Sokhal, Buth; Yasuda, Chadwick Y.; Williams, M. C.; Richards, Allen L.; Burgess, Timothy; Wierzba, Thomas F.; Putnam, Shannon D.

doi:10.4269/ajtmh.2012.11-0409

Cited by 102 publications

(105 citation statements)

References 27 publications

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“…Third, we examined a limited set of pathogens in a population that is likely affected by many others. 5,[31][32][33] Further testing of banked samples is ongoing. Finally, our control group was not randomly selected, instead being drawn from patients presenting to the hospital for other reasons.…”

Section: Discussionmentioning

confidence: 99%

Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

O’Meara¹,

Mott²,

Laktabai³

et al. 2015

The American Journal of Tropical Medicine and Hygiene

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Abstract. 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.

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Section: Discussionmentioning

confidence: 99%

Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

O’Meara¹,

Mott²,

Laktabai³

et al. 2015

The American Journal of Tropical Medicine and Hygiene

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“…Such surveillance for respiratory syndromes, including SARI, has been shown to effectively identify influenza cases,9 and several studies have also confirmed influenza infection among hospitalized and non‐hospitalized patients with undifferentiated febrile illness 4, 7. In young children, influenza patients often present for medical treatment with only fever;10 one recent study found that 19% of 106 influenza‐positive hospitalized infants <3 months old had fever but no respiratory symptoms 11…”

Section: Introductionmentioning

confidence: 99%

Sentinel surveillance for influenza among severe acute respiratory infection and acute febrile illness inpatients at three hospitals in Ghana

Jones

Ampofo

Akuffo³

et al. 2016

Influenza Resp Viruses

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BackgroundInfluenza epidemiology in Africa is generally not well understood. Using syndrome definitions to screen patients for laboratory confirmation of infection is an established means to effectively conduct influenza surveillance.MethodsTo compare influenza‐related epidemiologic data, from October 2010 through March 2013, we enrolled hospitalized severe acute respiratory infection (SARI; fever with respiratory symptoms) and acute febrile illness (AFI; fever without respiratory or other localizing symptoms) patients from three referral hospitals in Ghana. Demographic and epidemiologic data were obtained from enrolled patients after which nasopharyngeal and oropharyngeal swabs were collected, and processed by molecular methods for the presence of influenza viruses.ResultsOf 730 SARI patients, 59 (8%) were influenza positive; of 543 AFI patients, 34 (6%) were positive for influenza. Both SARI and AFI surveillance yielded influenza A(H3N2) (3% versus 1%), A(H1N1)pdm09 (2% versus 1%), and influenza B (3% versus 4%) in similar proportions. Data from both syndromes show year‐round influenza transmission but with increased caseloads associated with the rainy seasons.ConclusionsAs an appreciable percentage of influenza cases (37%) presented without defined respiratory symptoms, and thus met the AFI but not the SARI definition, it is important to consider broader screening criteria (i.e., AFI) to identify all laboratory‐confirmed influenza. The identified influenza transmission seasonality has important implications for the timing of related public health interventions.

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“…11,31,32,[42][43][44][45] However, there are other conditions in which information is limited, including co-infections. Recently, a study conducted in Cambodia identified unique co-infections such as dengue and Burkholderia pseudomallei and Salmonella typhi 46 ; through an enhanced surveillance system co-infections could be identified and data could be used to better understand clinical outcomes of patients who were laboratory positive for multiple etiologies. In addition, surveillance and improved knowledge among clinicians of patients' final diagnoses can be useful in improving physicians' clinical diagnosis skills and broadening their differential diagnosis, and assisting public health authorities in prioritizing limited resources.…”

Section: Discussionmentioning

confidence: 99%

Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

Lorenzi

Gregory²,

Santiago³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. BACKGROUND

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Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

Cited by 102 publications

References 27 publications

Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

Sentinel surveillance for influenza among severe acute respiratory infection and acute febrile illness inpatients at three hospitals in Ghana

Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

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