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The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management.

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Maze, Michael J, Bassat, Quique, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405, Mandomando, Inácio, Musicha, Patrick and Crump, John A (2018) 'The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management.'. Clinical Microbiology and Infection, Vol 24, Issue 8, pp. 808-814.

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Abstract

BACKGROUND
Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies.

AIM
To summarise recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria.

SOURCES
A narrative literature review by searching the MEDLINE database, and recent conference abstracts.

CONTENT
Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalised patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection, and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum betalactamase-producing Enterobacteriaceae and fluoroquinolone resistant Salmonella enterica. Among those with HIV infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important.

IMPLICATIONS
Understanding the local epidemiology of fever aetiology, and use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalised patients infected with organisms that are not susceptible to empiric antibacterial regimens.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WL Nervous System > WL 300 General works (Include works on brain alone)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.cmi.2018.02.011
Depositing User: Stacy Murtagh
Date Deposited: 05 Mar 2018 16:27
Last Modified: 15 Feb 2019 02:02
URI: http://archive.lstmed.ac.uk/id/eprint/8320

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