Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March–July 2005

Ari, Mary D.; Guracha, Argata; Fadeel, Moustafa Abdel; Njuguna, Charles; Njenga, M. Kariuki; Kalani, Rosalia; Abdi, Hossein; Warfu, Osman; Omballa, Victor; Tetteh, Christopher; Breiman, Robert F.; Pimentel, Guillermo; Feikin, Daniel R.

doi:10.4269/ajtmh.2011.11-0030

Cited by 29 publications

(38 citation statements)

References 18 publications

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“…61,62 However, we did find that participants with brucellosis were more likely to have other bacterial zoonoses compared with participants without brucellosis. Although this may be caused by serologic cross-reactivity, prior studies have also shown co-infections with other zoonoses among patients with brucellosis, 37,63 suggesting shared risk factors for these infections.…”

Section: Discussionmentioning

confidence: 93%

“…However, it is notable that no association between brucellosis and rural residence, weekly expenditures, or paternal tribe was identified. Brucellosis has been well documented among nomadic pastoralists in sub-Saharan Africa, 16,22,37,38 and these populations are generally thought to be at increased risk for contracting brucellosis because of their close contact with livestock. 22 However, some studies have suggested a recent shift in the epidemiology of brucellosis from rural to urban settings, possibly related to unpasteurized milk consumption in urban environments.…”

Section: Discussionmentioning

confidence: 99%

“…44,[64][65][66] The third limitation is that our study catchment population may not have captured the full agro-ecologic diversity of northern Tanzania. In particular, nomadic pastoralists, a group at particular risk for brucellosis, 16,22,37,38 may have been underrepresented among KCMC or MRH inpatients. Finally, case definitions biased our study toward the detection of acute brucellosis, whereas those with chronic brucellosis may contribute greatly to the burden of illness and death.…”

Section: Discussionmentioning

confidence: 99%

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Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

Bouley

Biggs²,

Stoddard³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

Bouley

Biggs²,

Stoddard³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…The first human cases were reported in 1977, 16 and in 2011 a study investigating acute febrile illnesses in northern Kenya reported cases of leptospirosis. 17 This study examined slaughterhouse workers in western Kenya for serological evidence of exposure to Leptospira spp. and identified risk factors associated with seropositivity in this population.…”

Section: What This Paper Addsmentioning

confidence: 99%

Risk factors for leptospirosis seropositivity in slaughterhouse workers in western Kenya

et al. 2016

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ObjectivesLeptospirosis has been documented in slaughterhouse workers around the world. Risk factors include smoking and drinking at work, and performing tasks such as cleaning offal. This paper examined risk factors for leptospirosis seropositivity in slaughterhouse workers in western Kenya.MethodsThe study was conducted between May 2011 and October 2012. Questionnaires were used to collect information from workers on demographic data, health and hygiene practices in the slaughterhouse. A commercial ELISA detected antibodies to Leptospira spp. in serum samples and multilevel logistic regression analysis identified factors associated with leptospirosis seropositivity.ResultsA total of 737 workers from 142 slaughterhouses were recruited. The seroprevalence of antibodies to Leptospira spp. was 13.4% (95% CI 11.1% to 16.1%). Risk factors included: having wounds (OR 3.1; 95% CI 1.5 to 6.1); smoking (OR 1.8; 95% CI 1.1 to 2.9); eating at work (OR 2.1; 95% CI 1.2 to 3.6); cleaning the offal (OR 5.1; 95% CI 1.8 to 15.0); and having a borehole for personal water use (OR 2.3; 95% CI 1.1 to 4.7). At the slaughterhouse level, risk factors included having a roof (OR 2.6; 95% CI 1.2 to 5.6) and drawing water from a well (OR 2.2; 95% CI 1.2 to 4.0). Protective factors included working in slaughterhouses where antemortem inspection was conducted (OR 0.6; 95% CI 0.4 to 1.0) and where workers wore protective aprons (OR 0.4; 95% CI 0.2 to 0.7).ConclusionsThis is the first report of leptospirosis seropositivity in slaughterhouse workers in Kenya. Potential risk factors were identified and this information can be used to educate workers regarding their disease risks and ways to prevent or reduce transmission.

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“…This province was selected because public health support and disease surveillance have been extremely limited and outbreaks of re-emerging diseases have been reported [15], [19], [20]. The study design was described in detail elsewhere [12].…”

Section: Methodsmentioning

confidence: 99%

Serological evidence of Francisella tularensis in febrile patients seeking treatment at remote hospitals, northeastern Kenya, 2014–2015

Njeru

Tomaso

Mertens

et al. 2017

New Microbes and New Infections

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Tularaemia is a highly contagious infectious zoonosis caused by the bacterial agent Francisella tularensis. The aim of this study was to investigate the presence of antibodies to F. tularensis in febrile patients in northeastern Kenya. During 2014–2015, 730 patients were screened for anti-F. tularensis antibodies using a combination of ELISA and Western blot. Twenty-seven (3.7%) individuals were positive for F. tularensis. Tularaemia was not suspected by the treating clinicians in any of them. Our results suggest that tularaemia may be present in Kenya but remain unreported, and emphasizes the need for local clinicians to broaden their diagnostic repertoire when evaluating patients with undifferentiated febrile illness.

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Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March–July 2005

Abstract: Acknowledgments: We thank the Ministry Of Health, Provincial Medical Office, Northeastern Province Kenya and Liboi area community leaders who assisted in this investigation.

Cited by 29 publications

References 18 publications

Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

Risk factors for leptospirosis seropositivity in slaughterhouse workers in western Kenya

Serological evidence of Francisella tularensis in febrile patients seeking treatment at remote hospitals, northeastern Kenya, 2014–2015

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