Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study.
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.
Type
Journal articleSubject
AdolescentAdult
Aged
Aged, 80 and over
Bacteria
Bacterial Infections
Child
Child, Preschool
Cohort Studies
Female
Fever of Unknown Origin
Fungi
Hospitalization
Humans
Infant
Male
Middle Aged
Mycoses
Prospective Studies
Tanzania
Virus Diseases
Viruses
Young Adult
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https://hdl.handle.net/10161/13779Published Version (Please cite this version)
10.1371/journal.pntd.0002324Publication Info
Crump, John A; Morrissey, Anne B; Nicholson, William L; Massung, Robert F; Stoddard,
Robyn A; Galloway, Renee L; ... Bartlett, John A (2013). Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective
cohort study. PLoS Negl Trop Dis, 7(7). pp. e2324. 10.1371/journal.pntd.0002324. Retrieved from https://hdl.handle.net/10161/13779.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Alexander Bartlett
Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection
and its complicastions, especially in resource-limited settings. Key Words: HIV infection,
AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr
Charles Muiruri
Assistant Professor of Population Health Sciences
Dr. Muiruri is a health services researcher, Assistant Professor in the Duke Department
of Population Health Sciences, Assistant Research Professor in the Global Health Institute,
and Adjunct lecturer at the Kilimanjaro Christian Medical University College, Moshi
Tanzania. Broadly, his research seeks to improve the quality of healthcare and reduce
disparities for persons with multiple chronic conditions both in and outside the United
States. His current work focuses on prevention of non
Alphabetical list of authors with Scholars@Duke profiles.

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