Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008–2010

Abstract

BackgroundFebrile jaundice results clinically in generalized yellow coloration of the teguments and mucous membranes due to excess plasma bilirubin, accompanied by fever. Two types are found: conjugated and unconjugated bilirubin jaundice. Jaundice is a sign in several diseases due to viruses (viral hepatitis and arbovirus), parasites (malaria) and bacteria (leptospirosis). In the Central African Republic (CAR), only yellow fever is included on the list of diseases for surveillance. The aim of this study was to identify the other pathogens that can cause febrile jaundice, for better management of patients.MethodsBetween 2008 and 2010, 198 sera negative for yellow fever IgM were randomly selected from 2177 samples collected during yellow fever surveillance. Laboratory analyses targeted four groups of pathogens: hepatitis B, C, delta and E viruses; dengue, chikungunya, Zika, Crimean–Congo haemorrhagic fever, West Nile and Rift Valley arboviruses; malaria parasites; and bacteria (leptospirosis).ResultsOverall, 30.9% sera were positive for hepatitis B, 20.2% for hepatitis E, 12.3% for hepatitis C and 8.2% for malaria. The majority of positive sera (40.4%) were from people aged 16–30 years. Co-infection with at least two of these pathogens was also found.ConclusionThese findings suggest that a systematic investigation should be undertaken of infectious agents that cause febrile jaundice in the CAR.

Prevalence of and risk factors for Plasmodium spp. co-infection with hepatitis B virus: a systematic review and meta-analysis

“…The main characteristics of the 22 included studies [ 8 – 11 , 14 – 17 , 23 – 36 ] are presented in Table 1 . Of the 22 included studies, 13 studies [ 9 – 11 , 14 , 16 , 17 , 24 , 26 , 28 , 31 , 32 , 34 , 35 ] were conducted before 2015, while three studies [ 23 , 29 , 30 ] were conducted in or after 2015. One study was conducted during 2013–2015, while five studies [ 8 , 15 , 27 , 33 , 36 ] did not specify the year of study conducted.…”

“…The full texts of 102 articles that met the inclusion criteria were screened. Finally, 9 studies [8][9][10][23][24][25][26][27][28] were included in the quantitative synthesis. Thirteen additional studies [11,[14][15][16][17][29][30][31][32][33][34][35][36] were identified and included after reviewing the references of the nine included studies and additional searches of other databases.…”

Characterization of occult hepatitis B in high-risk populations in Kenya

“…Africa is an intermediate endemic region for hepatitis B infection, with an estimated prevalence of 6.1% [6]. An increased probability of infection is associated with certain populations at high risk, such as female sex workers [31], MSM [32,33], or patients presenting for medical care with jaundice [19,34,35]. The findings of this study describe the high prevalence of HBsAg positivity in MSM-SW at 10.1%, and provide the first description of OBI in Kenya.…”

Evidence of human leptospirosis cases in a cohort of febrile patients in Bangui, Central African Republic: a retrospective study, 2012–2015

“…In addition to hepatitis viruses as demonstrated by Gadia et al [ 1 ], Leptospira may also be responsible for some of the unexplained cases of febrile jaundice disease identified in the country and would deserve to be investigated within a differential diagnostic strategy, for example within the national surveillance program of YFV.…”

“…Their retrospective study highlighted that almost half of the 198 samples tested were positive for at least one pathogen other than YFV [ 1 ]. This informative article showed that hepatitis viruses are predominant in YFV-negative Yellow Fever suspicions.…”