Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study
Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study
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DOI：
10.1371/journal.pntd.0002324
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发表时间：
2013-07-01
影响因子：
3.8
通讯作者：
Bartlett, John A.
中科院分区：
文献类型：
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作者：
Crump, John A.;Morrissey, Anne B.;Bartlett, John A.
在资源匮乏地区，发热综合征是求医者的常见主诉，但公共卫生界尚未以全面的方式处理发热问题。在许多地区，疟疾被过度诊断，没有疟疾的患者预后很差。方法和研究结果：我们前瞻性地研究了坦桑尼亚北部两家医院一年内入院的870名儿童和成人发热患者，使用常规标准诊断测试来确定发热病因。528例（60.7%）临床诊断为疟疾，但仅14例（1.6%）为发热的实际原因。相比之下，细菌、分枝杆菌和真菌血液感染分别占85例（9.8%）、14例（1.6%）和25例（2.9%）发热入院。在118例（26.2%）发热入院患者中发现急性细菌性人畜共患病；布氏菌病16例（13.6%），钩端螺旋体病40例（33.9%），Q热24例（20.3%），斑疹热组立克次体病36例（30.5%），斑疹伤寒组立克次体病2例（1.8%）。此外，55名（7.9%）参与者确诊急性虫媒病毒感染，均由基孔肯雅热引起。没有患者有细菌性人畜共患病或虫媒病毒感染纳入入院鉴别诊断。结论：疟疾罕见且诊断过度，侵袭性感染未得到充分重视。细菌性人畜共患病和虫媒病毒感染非常普遍，但却被忽视。需要对资源有限地区的发热综合征采取综合方法，以改善患者预后并合理定位疾病控制工作。
Introduction: The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes.Methods and Findings: We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis.Conclusions: Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts.