Management of adolescents and adults with febrile illness in resource limited areas

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Overlap in the clinical features of febrile illnesses and limited laboratory services make the management of febrile patients in resource limited settings challenging. WHO guidelines for managing febrile adolescents and adults in resource limited settings are available for first level health facilities and are forthcoming for district hospitals. First level health facility guidelines recommend antimalarials for those with a positive malaria diagnostic test, antibacterials for those with signs of severe illness or specific bacterial infections, and hospital referral of those with severe illness or no apparent diagnosis. Management guidelines should be validated, locally adapted, and improved on the basis of local or national surveillance data and sentinel hospital studies. Malaria, tuberculosis, and HIV diagnostic tests can enhance management by ruling out a specific illness or by directing towards a particular diagnosis. Clinical trials of empirical treatment strategies and advocacy for better clinical laboratory services could help improve management guidelines and patient outcomes.






Crump, J. A., S. Gove, et al. (2011). "Management of adolescents and adults with febrile illness in resource limited areas." BMJ 343.

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Crump, John A, Sandy Gove and Christopher M Parry (2011). Management of adolescents and adults with febrile illness in resource limited areas. 10.1136/bmj.d4847 Retrieved from

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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 transmission of HIV, and infectious diseases diagnostics. In addition, I am a medical epidemiologist with the US Centers for Disease Control and Prevention (CDC). My CDC work focuses on enteric infection epidemiology and prevention in developing countries, particularly invasive salmonelloses.

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