Beyond Malaria - Causes of Fever in Outpatient Tanzanian Children

BackgroundAs the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children. MethodsWe recruited children younger than 10 years of age with a temperature of 38 degrees C or higher at two outpatient clinics one rural and one urban in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria. ResultsAnalyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease. ConclusionsThese results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. (Funded by the Swiss National Science Foundation and others.) As malaria is controlled in regions of sub-Saharan Africa, the causes of febrile illness are changing. In this report on febrile children in Tanzania, a broad array of possible pathogens are identified and stratified by presenting syndrome. With malaria transmission declining in many parts of Africa,(1),(2) there is increasing awareness that most acute febrile episodes are due to other infectious diseases some of which are life-threatening that must be identified and treated appropriately.(3),(4) World Health Organization (WHO) guidelines recommend malaria testing for all patients with febrile illness in areas where malaria is endemic.(5) The advent of point-of-care rapid diagnostic tests for malaria presents health care providers with a new and daunting challenge: the need to determine the causes of febrile illness and the appropriate course of action when treating children who test negative ...