Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study.
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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.
Aged, 80 and over
Fever of Unknown Origin
Published Version (Please cite this version)10.1371/journal.pntd.0002324
Publication InfoBartlett, John A; Crump, John Andrew; Galloway, RL; Kinabo, GD; Maro, Venance P; Massung, RF; ... Stoddard, RA (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.
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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
Medical Instructor in the Department of Population Health Sciences
Dr. Muiruri is a health services researcher, Medical Instructor 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. Prior to joining Duke faculty, Charles worked in various Global Health operations and leadership roles within the Duke for over 10 years.Broadly, his research seeks to improve the quality of healthcare and reduce dispa
Alphabetical list of authors with Scholars@Duke profiles.