Beyond Malaria - Causes of Fever in Outpatient Tanzanian Children
Beyond Malaria - Causes of Fever in Outpatient Tanzanian Children
复制标题
DOI：
10.1056/nejmoa1214482
复制
发表时间：
2014-02-27
影响因子：
158.5
通讯作者：
Genton, Blaise
中科院分区：
文献类型：
--
作者：
D'Acremont, Valerie;Kilowoko, Mary;Genton, Blaise
背景随着疟疾发病率的下降，更好地了解非疟疾性发热对于有效地管理儿童疾病非常重要。在这项研究中，我们探讨了频谱的原因发热在African children.MethodsWe招募的儿童年龄小于10岁，温度为38摄氏度或更高的两个门诊部一个农村和一个城市在坦桑尼亚。通过系统程序获得病史并进行临床检查。采集血液和鼻咽部标本，进行快速诊断试验、血清学试验、培养和分子检测，以检测引起急性发热的潜在病原体。最终的诊断确定与使用的算法和一组预先指定的criteris. ResultsAnalysis的数据来自临床表现和25,743实验室调查产生了1232诊断。在1005名儿童（其中22.6%有多个诊断）中，62.2%有急性呼吸道感染;这些感染中有5.0%是放射学确诊的肺炎。在13.3%的儿童中发现了除疟疾或伤寒以外的全身性细菌、病毒或寄生虫感染，（无呼吸道症状或体征）11.9%，疟疾10.5%，胃肠炎10.3%，尿路感染5.9%，伤寒3.7%，皮肤或粘膜感染1.5%，脑膜炎占0.2%。3.2%的患儿发热原因不明。共有70.5%的儿童有病毒性疾病，22.0%有细菌性疾病，和10.9%有寄生虫diseases.ConclusionsThese结果提供了一个描述的众多原因在非洲儿童发热在两个有代表性的设置。病毒过程的证据比细菌或寄生虫过程的证据更常见。（由瑞士国家科学基金会和其他机构资助。随着疟疾在撒哈拉以南非洲地区得到控制，发热性疾病的病因正在发生变化。在这份关于坦桑尼亚发热儿童的报告中，确定了一系列可能的病原体，并根据表现的综合征进行了分层。随着非洲许多地区疟疾传播的减少，（1），（2）人们越来越认识到，大多数急性发热事件是由其他传染病引起的，其中一些是危及生命的，必须加以识别和适当治疗。(3)（4）世界卫生组织（世卫组织）的指导方针建议对疟疾流行地区的所有发热性疾病患者进行疟疾检测。(5)疟疾即时快速诊断检测的出现为卫生保健提供者提出了一个新的艰巨挑战：需要确定发热性疾病的原因，以及在治疗检测结果为阴性的儿童时采取适当的行动。
BackgroundAs the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children.MethodsWe recruited children younger than 10 years of age with a temperature of 38 degrees C or higher at two outpatient clinics one rural and one urban in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria.ResultsAnalyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease.ConclusionsThese results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. (Funded by the Swiss National Science Foundation and others.)As malaria is controlled in regions of sub-Saharan Africa, the causes of febrile illness are changing. In this report on febrile children in Tanzania, a broad array of possible pathogens are identified and stratified by presenting syndrome. With malaria transmission declining in many parts of Africa,(1),(2) there is increasing awareness that most acute febrile episodes are due to other infectious diseases some of which are life-threatening that must be identified and treated appropriately.(3),(4) World Health Organization (WHO) guidelines recommend malaria testing for all patients with febrile illness in areas where malaria is endemic.(5) The advent of point-of-care rapid diagnostic tests for malaria presents health care providers with a new and daunting challenge: the need to determine the causes of febrile illness and the appropriate course of action when treating children who test negative ...