Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Africa, 1980–2015

Abstract

Background The availability of reliable point-of-care tests for malaria has heralded a paradigm shift in the management of febrile illnesses away from presumptive antimalarial therapy. In the absence of a definitive diagnosis, health care providers are more likely to prescribe empirical antimicrobials to those who test negative for malaria. To improve management and guide further test development, better understanding is needed of the true causative agents and their geographic variability. Methods A systematic review of published literature was undertaken to characterise the spectrum of pathogens causing non-malaria febrile illness in Africa (1980–2015). Literature searches were conducted in English and French languages in six databases: MEDLINE, EMBASE, Global Health (CABI), WHO Global Health Library, PASCAL, and Bulletin de la Société Française de Parasitologie (BDSP). Selection criteria included reporting on an infection or infections with a confirmed diagnosis, defined as pathogens detected in or cultured from samples from normally sterile sites, or serological evidence of current or past infection. A number of published articles (rather than incidence or prevalence) reporting a given pathogen were presented. Results A total of 16,523 records from 48 African countries were screened, of which 1065 (6.4%) met selection criteria. Bacterial infections were reported in 564 (53.0%) records, viral infections in 374 (35.1%), parasitic infections in 47 (4.4%), fungal infections in nine (0.8%), and 71 (6.7%) publications reported more than one pathogen group. Age range of the study population was not specified in 233 (21.9%) publications. Staphylococcus aureus (18.2%), non-typhoidal Salmonella (17.3%), and Escherichia coli (15.4%) were the commonly reported bacterial infections whereas Rift Valley fever virus (7.4%), yellow fever virus (7.0%), and Ebola virus (6.7%) were the most commonly reported viral infections. Dengue virus infection, previously not thought to be widespread in Africa, was reported in 54 (5.1%) of articles. Conclusions This review summarises the published reports of non-malaria pathogens that may cause febrile illness in Africa. As the threat of antimicrobial resistance looms, knowledge of the distribution of infectious agents causing fever should facilitate priority setting in the development of new diagnostic tools and improved antimicrobial stewardship. Trial registration PROSPERO, CRD42016049281

Mosquito-Associated Viruses and Their Related Mosquitoes in West Africa

“…In this new context, it should be recommended to formulate an alternative calculation of dengue risk indices in Africa. Moreover, particular attention should be drawn on febrile illnesses in West Africa as arboviral infections are often recorded or misdiagnosed as malaria [ 205 , 206 , 207 ]. Therefore, it should be important to “deconstruct malaria-industrial complex [ 24 , 208 ]” by performing additional tests to check the presence of an arbovirus among acute fever cases in inpatients and outpatients in the local hospitals [ 24 , 208 , 209 , 210 , 211 , 212 , 213 ].…”

Febrile illness mapping—much of the world without data and without evidence-based treatments

“…Of these, 4099 (2410 in Asia, 1065 in Africa, 624 in Latin America) met selection criteria. A wide diversity of pathogens and their distribution are described (see [5] in press, [7] in press, [10] in press).…”

“…Febrile illness mapping-much of the world without data and without evidencebased treatments Paul N. Newton 1,2,3,4* and Philippe J. Guerin 1,5…”

The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents

“…Pneumonia, diarrhoea and fevers persist as frequent reasons for seeking healthcare in low- and middle-income countries, particularly among children [ 1 – 5 ]. Sub-Saharan Africa (SSA) bears a disproportionately high burden of morbidity and mortality due to such common infections [ 6 – 8 ].…”

“…It is less frequently assessed at the syndrome level, as it can have a multitude of infectious causes and therefore requires broad diagnostics [ 1 , 17 ]. A recent systematic review identified Staphylococcus aureus , non-typhoidal Salmonella and Escherichia coli to be the most commonly reported bacterial causes, and arboviruses to be among the most common viral causes of AFDUC in SSA [ 5 ]. This review highlighted the lack of data from rural areas, which tends to be neglected by surveillance efforts.…”