Causes of fever in Tanzanian adults attending outpatient clinics: a prospective cohort study.

Details

Serval ID
serval:BIB_0FB152432E2F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Causes of fever in Tanzanian adults attending outpatient clinics: a prospective cohort study.
Journal
Clinical microbiology and infection
Author(s)
Boillat-Blanco N., Mbarack Z., Samaka J., Mlaganile T., Kazimoto T., Mamin A., Genton B., Kaiser L., D'Acremont V.
ISSN
1469-0691 (Electronic)
ISSN-L
1198-743X
Publication state
Published
Issued date
06/2021
Peer-reviewed
Oui
Volume
27
Number
6
Pages
913.e1-913.e7
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Exploring fever aetiologies improves patient management. Most febrile adults are outpatients, but all previous studies were conducted in inpatients. This study describes the spectrum of diseases in adults attending outpatient clinics in urban Tanzania.
We recruited consecutive adults with temperature ≥38°C in a prospective cohort study. We collected medical history and performed a clinical examination. We performed 27 364 microbiological diagnostic tests (rapid tests, serologies, cultures and molecular analyses) for a large range of pathogens on blood and nasopharyngeal samples. We based our diagnosis on predefined clinical and microbiological criteria.
Of 519 individuals, 469 (89%) had a clinically or microbiologically documented infection and 128 (25%) were human immunodeficiency virus (HIV) -infected. We identified 643 diagnoses: 264 (41%) acute respiratory infections (36 (5.6%) pneumonia, 39 (6.1%) tuberculosis), 71 (11%) infections with another focus (31 (4.8%) gastrointestinal, 26 (4.0%) urogenital, 8 (1.2%) central nervous system) and 252 (39%) infections without focus (134 (21%) dengue, 30 (4.7%) malaria, 28 (4.4%) typhoid). Of the 519 individuals, 318 (61%), 179 (34%), 30 (6%) and 15 (3%), respectively, had a viral, bacterial, parasitic and fungal acute infection. HIV-infected individuals had more bacterial infections than HIV-negative (80/122 (66%) versus 100/391 (26%); p < 0.001). Patients with advanced HIV disease had a higher proportion of bacterial infections (55/76 (72%) if CD4 ≤200 cells/mm <sup>3</sup> and 25/52 (48%) if CD4 >200 cells/mm <sup>3</sup> , p 0.02).
Viral diseases caused most febrile episodes in adults attending outpatient clinics except in HIV-infected patients. HIV status and a low CD4 level strongly determined the need for antibiotics. Systematic HIV screening is essential to appropriately manage febrile patients.
Keywords
Aetiologies of fever, Dengue, Human immunodeficiency virus, Outbreak, Sub-Saharan Africa
Pubmed
Web of science
Open Access
Yes
Create date
09/09/2020 17:20
Last modification date
19/06/2021 5:33
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