This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features!
Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

NIH NLM Logo
Log in
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul 18;7(7):e2324.
doi: 10.1371/journal.pntd.0002324. Print 2013.

Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study

Affiliations

Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study

John A Crump et al. PLoS Negl Trop Dis. .

Abstract

Introduction: The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes.

Methods and findings: We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis.

Conclusions: Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Study flow diagram.
KCMC: Kilimanjaro Christian Medical Centre; MRH: Mawenzi Regional Hospital; MAT: microagglutination test; IFA: immunoflouresence assay; NAAT: nucleic acid amplification test.
Figure 2
Figure 2. Laboratory confirmed causes of febrile illness among infants and children (panel A) and adolescents and adults (panel B) hospitalized in northern Tanzania, 2007–8*.
*In instances that diagnostic test results were not available for all participants, the proportion positive from Table 1 was applied to the whole study population. Pie graphs do not account for concurrent infections. A complete listing of specific bacterial, mycobacterial, and fungal bloodstream infections is available elsewhere , .

References

    1. Petit PL, van Ginneken JK (1995) Analysis of hospital records in four African countries, 1975–1990, with emphasis on infectious diseases. J Trop Med Hyg 98: 217–227. - PubMed
    1. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, et al. (2011) The burden of common infectious syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya. PLoS ONE 6: e16085. - PMC - PubMed
    1. Murray CJ, Rosenfeld LC, Lim SS, Andrews KG, Foreman KJ, et al. (2012) Global malaria mortality between 1980 and 2010: a systematic analysis. Lancet 379: 413–431. - PubMed
    1. Reddy EA, Shaw AV, Crump JA (2010) Community acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417–432. - PMC - PubMed
    1. Nadjm B, Amos B, Mtove G, Ostermann J, Chonya S, et al. (2010) WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study. BMJ 340: c1350. - PMC - PubMed

Publication types

MeSH terms

Full text links
Public Library of Science full text link Public Library of Science Free PMC article
Cite

AltStyle によって変換されたページ (->オリジナル) /