Pathogens That Cause Acute Febrile Illness Among Children and Adolescents in Burkina Faso, Madagascar, and Sudan

Abstract

Background The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood. Methods Blood samples taken from study participants with acute fever (≥37.5°C) or a history of fever and recruited into the previous Typhoid-Fever-Surveillance-in-Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral and parasitic pathogens. Clinical metadata were also assessed. Results A total of 615 blood samples available for analysis originated from Burkina Faso (n=53), Madagascar (n=364) and Sudan (n=198) and were taken from participants ranging from 0-19 years of age. Most individuals [86.4% (531/615)] presenting at healthcare facilities were outpatient adolescents (11-19 years-old). Leading clinical diagnoses were respiratory tract infections [45.9% (282/615)], malaria [27.3% (168/615)], and gastrointestinal tract infections [10.7% (66/615)]. Through the TaqMan-Array Card, at least one pathogen was detected in 62% (33/53), 24% (86/364), and 60% (118/198) of specimens, from Burkina Faso, Madagascar and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25/53), 2.2% (8/364) and 45% (90/198) of AFI at respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357/516) of patients with clinical diagnoses of malaria, respiratory, or gastrointestinal infections were prescribed a WHO-guideline-recommended empiric antibiotic,whereas only 45% (106/237) of patients with pathogens detected were treated with an antibiotic exerting likely activity. Conclusions A PCR-approach for identifying multiple bacterial, viral and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome.

Concurrent malaria and dengue fever in (sub-Saharan) Africa: a systematic review and meta-analysis

“…In our meta-analysis (Figure 5), cross-sectional studies in Cameroon [30, 45], and Kenya [22] revealed significantly lower odds of co-infection in contrast with the absence of acute dengue infections (OR: 0.60; 95% CI, 0.42 – 0.87). Cross-sectional studies in Nigeria [16, 18, 20, 25, 32, 33, 35], Tanzania [17], Sierra Leone [23], Democratic Republic of Congo (DRC) [34], Cameroon [31], Sudan [40, 42], and Senegal [21] indicated no significant odds of co-infection in comparison with acute dengue negatives (OR = 1.07; 95% CI = 0.58, 1.94). Studies in Ethiopia [44], Nigeria [29], Tanzania [36], Cameroon [43], and Kenya [39], on the other hand, indicated significantly higher odds of concurrent infection to acute dengue negatives (OR = 4.56; 95% CI = 3.29, 6.33).…”

“…Sudan [40,42], and Senegal [21] indicated no significant odds of co-infection in comparison with acute dengue negatives (OR = 1.07; 95% CI = 0.58, 1.94). Studies in Ethiopia [44], Nigeria [29],…”

“…Tanzania [17], Sierra Leone [23], DRC [34], Cameroon [31], Sudan [40,42], and Senegal [21] ; however, showed no notable odds of acute dengue infection in the presence of malaria when compared to the absence of malaria (OR = 1.07, 95% CI, 0.58 -1.94). On the contrary, crosssectional studies in Ethiopia [44], Nigeria [16,29], Tanzania [36], and Cameroon [43] indicated higher odds of acute dengue infection in the presence of malaria than in its absence (OR = 6.98, 95% CI, 2.89 -16.85).…”

“…, Tanzania25 , Sierra Leone 31 , Democratic Republic of Congo (DRC)42 , Cameroon 39 , Sudan48,50 , and Senegal29 …”

Etiology of acute febrile illnesses in Southern China: Findings from a two-year sentinel surveillance project, 2017–2019

“…As a result, many of these AFI patients are treated according to clinical presentation [8]. The reliance on clinical presentation alone can lead to the misuse of antimicrobials [9] as well as poor patient outcomes. This is particularly the case for Zika virus, which like many other causes of AFI, is difficult to diagnose [10] and may clinically mimic other infections such as Salmonella enterica, Listeria spp., and Brucella spp.…”