Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar.
Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar.
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DOI：
10.1371/journal.pntd.0006642
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发表时间：
2018-07
影响因子：
3.8
通讯作者：
Héraud JM
中科院分区：
文献类型：
--
作者：
Guillebaud J;Bernardson B;Randriambolamanantsoa TH;Randrianasolo L;Randriamampionona JL;Marino CA;Rasolofo V;Randrianarivelojosia M;Vigan-Womas I;Stivaktas V;Venter M;Piola P;Héraud JM
越来越多地使用疟疾诊断测试表明，有发烧但没有疟疾的患者比例越来越大。低收入国家的临床医生和卫生保健工作者几乎没有诊断疟疾以外的发热原因的检测方法，尽管有几种疾病有共同的症状。我们在此建议评估马达加斯加的发热病因，以最终改善发热病例的管理。2014年4月至2015年9月，在马达加斯加选定的21个哨点招募了6个月及以上的发热门诊患者。进行了标准的临床检查，并采集了血液和上呼吸道标本，以便对36种与马达加斯加的公共卫生有关的病原体进行快速诊断测试和分子分析，无论临床状况如何。共纳入682例发热患者。40.5%（276/682）的患者至少检出一种病原菌，6.2%（42/682）的患者同时感染。在所有检测的患者中，26.5%（181/682）存在至少一种病毒感染，17.0%（116/682）存在疟疾，1.0%（7/682）存在细菌或分枝杆菌感染。在本研究中没有或很少检测到东非和亚洲高度流行的传染原，例如人畜共患细菌或虫媒病毒感染。这些结果提出了关于马达加斯加社区发热病因的问题。然而，我们注意到，病毒感染和疟疾仍然在发热性疾病的病因中占很大比例。有趣的是，我们的研究不仅发现了与公共卫生有关的病原体，如裂谷热病毒，而且还发现了马达加斯加首例经实验室确认的钩端螺旋体病感染病例。发热性疾病有许多起因，但传染因子是最重要的原因。病毒和细菌等病原体可引起各种疾病，但相关的体征和症状通常是非特异性的，并且可能在疾病之间重叠。传染病的治疗依赖于病原体的诊断，但在资源有限的情况下，实验室能力往往缺乏。因此，卫生保健工作者通常遵循临床管理指南，而这些指南很少得到有关当地感染流行情况的信息的支持。我们研究的主要目的是描述在马达加斯加门诊保健中心出现的个人发烧的常见原因。呼吸道病毒、疟疾和血液病毒感染是主要的感染源。实施新的诊断工具，如床边测试（护理点测试）可以帮助卫生保健工作者改善对发热患者的诊断和护理。发现其他病原体，如乙型肝炎病毒、人类免疫缺陷病毒（艾滋病毒）或导致结核病的病原体，加强了扩大预防、监测和发现这些感染的必要性。有趣的是，我们的研究报告了钩端螺旋体病和裂谷热病毒感染病例，这是高度关注公共卫生的病原体。
The increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases. Consenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status. A total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections. These results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar. Febrile illnesses have many origins, but infectious agents are the most important cause. Pathogens such as viruses and bacteria can cause various diseases, but associated signs and symptoms are generally non-specific and can overlap between diseases. Treatments of infectious diseases rely on the diagnostic of the causative agent however laboratory capacities are often lacking in resources-limited settings. Thus, health care workers generally follow clinical management guidelines that are rarely supported by information on the prevalence of local infections. The main objective of our study was to describe the common causes of fever in individuals presenting at outpatient healthcare center in Madagascar. Respiratory viruses, malaria and viral infection in the blood were the main infectious agents detected. Implementation of new diagnostic tools such as bedside testing (Point of Care Testing) could help health care workers to improve diagnosis and care of febrile patients. Detection of other pathogens such as hepatitis B virus, human immunodeficiency virus (HIV) or agent responsible for tuberculosis enhances the need for extended prevention, surveillance and detection of these infections. Interestingly, our study reported cases of leptospirosis and Rift Valley Fever virus infection that are pathogens of high public health concern.
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影响因子：
9.4
作者：
Fuehrer, Hans-Peter;Stadler, Marie-Therese;Noedl, Harald
通讯作者：
Noedl, Harald
DOI：
10.4269/ajtmh.2012.11-0409
发表时间：
2012-02-01
影响因子：
3.3
作者：
Kasper, Matthew R.;Blair, Patrick J.;Putnam, Shannon D.
通讯作者：
Putnam, Shannon D.
影响因子：
4.4
作者：
Desvars A;Michault A;Bourhy P
通讯作者：
Bourhy P
影响因子：
11.8
作者：
Marks, Florian;Rabehanta, Nathalie;Rakotozandrindrainy, Raphael
通讯作者：
Rakotozandrindrainy, Raphael
影响因子：
3.3
作者：
Mayxay, Mayfong;Sengvilaipaseuth, Onanong;Newton, Paul N.
通讯作者：
Newton, Paul N.