A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone

Abstract

Introduction Sierra Leone has one of the highest burdens of febrile illnesses in the world. As the incidence of malaria diminishes, a better understanding of the spectrum of etiological agents was important for accurate diagnosis and empirical treatment of febrile illness. Methods Blood, nasopharyngeal, and fecal specimens were collected from febrile patients for serological, molecular detection, and microbiologic culture to identify potential pathogens. Results For this prospective study, 142 febrile patients were enrolled. The prevalence of malaria was higher in children aged 5–15 years old ( P = 0.185) and adults ( P = 0.018). Acute respiratory infection (ARI) presented more commonly in the under 5 years old group ( P = 0.009). For diarrhea, all children groups ( P = 0.024) were predominant. A total of 22.5% of the febrile patients had malaria infection, 19.7% had typhoid infection, and 2.8% were coinfected with malaria and typhoid. ARI was the most common causes of fever, accounting for 31.7% of patients, influenza A virus, Mycoplasma pneumoniae , and five other respiratory pathogens were found. Diarrhea accounted for 16.2%, and seven kinds of diarrhea bacteria were isolated. Hepatitis B accounted for 8.5%, including five cases of spontaneous bacterial peritonitis, and ascites smear staining were both Gram-negative bacteria. Tuberculous encephalitis, parasitic diseases (ascaris and filariasis), and skin infection caused by Staphylococcus aureus accounted for 0.7%, 2.1%, and 0.7%, respectively. Conclusions Evidence of a wide spectrum of febrile etiological agents other than malaria was identified. The spread of malaria rapid diagnostic tests (RDTs) out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. Antibiotics against Gram-negative bacteria are helpful for empirical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00474-y.

Management of febrile illness in rural Guinea over a seven-year period: A retrospective study

“…The few studies that investigated in depth the etiologies of febrile illness in sub-Saharan Africa (almost exclusively East Africa) have demonstrated that most respiratory infections are due to viruses in children (like what is observed in Western countries) [33,35,36]. Similarly, while most gastrointestinal infections are due to bacteria in the tropics, they are almost always selflimiting and require hydration and symptomatic care.…”

Prevalence and Burden of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: Evidence from a 25-Year Systematic Review and Meta-Analysis

“…The latest Sierra Leone Demographic Health Survey (2019) reported an infant mortality rate of 75 per 1,000 live births, maternal mortality of 717 deaths per 100,000 live births and adult mortality rate of 5.14 per 1,000 [22]. Despite these health indicators, the health expenditure per capita has remained low (i.e., 8.75% of the gross national product in 2020 [19], and over 60% of healthcare costs are financed by end-users through out-of-pocket payments [21].…”

“…Sierra Leone is a country in West Africa with an estimated population of 8.14 million and a gross domestic product per capita of 516 United States in 2021 [19]. Since 2017, the country has been divided into 5 administrative regions, namely, the Northern, North West, Southern, and Eastern Provinces and the Western Area.…”

“…Using a random-effects model, the crude pooled prevalence of chronic HBV in Sierra Leone was 13.0% (95% CI 10.0-16.0) in a pooled sample of 107,186 individuals (I 2 = 99%, pheterogeneity < 0.01) (Figure 2). Using the 2021 national population estimate of 8.14 million [19] yielded an estimated national chronic HBV burden of 1.06 million infected people (95% uncertainty interval 0.81-1.30). In sensitivity analysis, we removed the study with the highest seroprevalence of HBV (Koroma et al, 2013) to ensure stability of the crude prevalence estimates.…”

Recent advances in the diagnosis and management of typhoid fever in Africa: A review

“…The bone marrow and blood specimens are undertaken through invasive techniques that are painful in human nature 12–14 . After the specimen is processed and investigated in the laboratory, the feedback form is filled for the results 15 . Also, the widal test is a serology test on which the result depends on whether an agglutination reaction has occurred or not or whether the serology test is reactive or non‐reactive 12–15 .…”