Abstract
The replacement of “presumptive treatment for malaria” by “test before treat” strategies for the management of febrile illness is raising awareness of the importance of knowing more about the causes of illness in children who are suspected to have malaria but return a negative parasitological test. The most common cause of non-malarial febrile illness (NMFI) in African children is respiratory tract inflection. Whilst the bacterial causes of NMFI are well known, the increasing use of sensitive techniques such as polymerase chain reaction (PCR) tests is revealing large numbers of viruses that are potential respiratory pathogens. However, many of these organisms are commonly present in the respiratory tract of healthy children so causality and risk factors for pneumonia remain poorly understood. Inflection with a combination of viral and bacterial pathogens is increasingly recognised as important in the pathogenesis of pneumonia. Similarly, blood stream inflections with organisms typically grown by aerobic culture are well known but a growing number of organisms that can be identified only by PCR, viral culture, or serology are now recognised to be common pathogens in African children. The high mortality of hospitalised children on the first or second day of admission suggests that, unless results are rapidly available, diagnostic tests to identify specific causes of illness will still be of limited use in guiding the potentially life saving decisions relating to initial treatment of children admitted to district hospitals in Africa with severe febrile illness and a negative test for malaria. Malaria control and the introduction of vaccines against Haemophilus influenzae type b and pneumococcal disease are contributing to improved child survival in Africa. However, increased parasitological testing for malaria is associated with increased use of antbiotics to which resistance is already high.
Highlights
ƵƚŚŽƌ ĐŽŶƚƌŝďƵƟŽŶƐůů ĂƵƚŚŽƌƐ ŵĞƚ /D: ĂƵƚŚŽƌƐŚŝƉ ĐƌŝƚĞƌŝĂ &D ĂŶĚ ZZ ƵŶĚĞƌƚŽŽŬ ůŝƚĞƌĂƚƵƌĞ ƐĞĂƌĐŚĞƐ ĂŶĚ ĚƌĂŌĞĚ ƚŚĞ ŵĂŶƵƐĐƌŝƉƚ ZZ ĞdžƚƌĂĐƚĞĚ ĚĂƚĂ ĨƌŽŵ ƌĞůĞǀĂŶƚ ƉƵďůŝĐĂƟŽŶƐ,Z ĚĞƐŝŐŶĞĚ ƚŚĞ ƉĂƉĞƌ ĂƐƐŝƐƚĞĚ ǁŝƚŚ ŝĚĞŶƟĨLJŝŶŐ ƉƵďůŝĐĂƟŽŶƐ ĂŶĚ ǁƌŽƚĞ ƚŚĞ ĮŶĂů ǀĞƌƐŝŽŶ ŽĨ ƚŚĞ ŵĂŶƵƐĐƌŝƉƚůů ĂƵƚŚŽƌƐ ĐƌŝƟĐĂůůLJ ƌĞǀŝĞǁĞĚ ƚŚĞ ŵĂŶƵƐĐƌŝƉƚ ĨŽƌ ŝŵƉŽƌƚĂŶƚ ŝŶƚĞůůĞĐƚƵĂů ĐŽŶƚĞŶƚůů ĂƵƚŚŽƌƐ ĂŐƌĞĞĚ ǁŝƚŚ ƚŚĞ ŵĂŶƵƐĐƌŝƉƚ ƌĞƐƵůƚƐ ĂŶĚ ĐŽŶĐůƵƐŝŽŶƐ ZĞĐĞŝǀĞĚ ϮϬ DĂLJ ϮϬϭκ ĐĐĞƉƚĞĚ 13 March 2015; WƵďůŝƐŚĞĚ May 29 2015 ŝƚĂƟŽŶ DƵƌŽ &͕ ZĞLJďƵƌŶ Z ZĞLJďƵƌŶ,͘ ĐƵƚĞ ƌĞƐƉŝƌĂƚŽƌLJ ŝŶĨĞĐƟŽŶ ĂŶĚ ďĂĐƚĞƌĂĞŵŝĂ ĂƐ ĐĂƵƐĞƐ ŽĨ ŶŽŶͲŵĂůĂƌŝĂů ĨĞďƌŝůĞ ŝůůŶĞƐƐ ŝŶ ĨƌŝĐĂŶ ĐŚŝůĚƌĞŶ Ă ŶĂƌƌĂƟǀĞ ƌĞǀŝĞǁpneumonia 2015;6:6–17
'ƌĂŵͲŶĞŐĂƟǀĞ ŝŶĨĞĐƟŽŶƐ ĂŶĚ ŝŶ ƉĂƌƟĐƵůĂƌ Ed^͕ ĂƌĞ associated with malaria and ŵĂŶLJ ŽĨ ƚŚĞƐĞ ƋƵĂůŝĨLJ ĨŽƌ ƚŚĞ t,K ĚĞĮŶŝƟŽŶ ŽĨ ƐĞǀĞƌĞ ƉŶĞƵŵŽŶŝĂtŚŝůĞ ƚŚŝƐ ĚĞĮŶŝƟŽŶ ůĂĐŬƐ ƐƉĞĐŝĮĐŝƚLJƚŚĞƌĞ ŝƐ ĐůĞĂƌ ĞǀŝĚĞŶĐĞ ƚŚĂƚ ƚŚĞƐĞ ŝŶĨĞĐƟŽŶƐ ĂƌĞ ƌĞƐƉŽŶƐŝďůĞ ĨŽƌ ƚƌƵĞ ƉŶĞƵŵŽŶŝĂ ĚĞĮŶĞĚ ďLJ ŝƐŽůĂƟŽŶ ŽĨ ƚŚĞ ŽƌŐĂŶŝƐŵ ĨƌŽŵ ĐŽŶƐŽůŝĚĂƚĞĚ ůƵŶŐ ρϬ͘
Ed ŶŽƚ ƚĞƐƚĞĚ WW ƉŶĞƵŵŽĐLJƐƟƐ ƉŶĞƵŵŽŶŝĂ,ŝď,ĂĞŵŽƉŚŝůƵƐ ŝŶŇƵĞŶnjĂĞ ƚLJƉĞ ď Ds ĐLJƚŽŵĞŐĂůŽǀŝƌƵƐ,/s ŚƵŵĂŶ ŝŵŵƵŶŽĚĞĮĐŝĞŶĐLJ ǀŝƌƵƐ WZ ƉŽůLJŵĞƌĂƐĞ ĐŚĂŝŶ ƌĞĂĐƟŽŶ ĂĐƚĞƌŝĂ Ϯ ƉĂƟĞŶƚƐ ŚĂĚ ŵŝdžĞĚ ŝŶĨĞĐƟŽŶ ǁŝƚŚ S. typhimurium and S. pneumoniae; 1 had S. typhimurium ĨƌŽŵ ďůŽŽĚ ĐƵůƚƵƌĞ ĂŶĚ S. pneumoniae ĨƌŽŵ ďůŽŽĚ WZ ĂŶĚ ĂĚĞŶŽǀŝƌƵƐ ĨƌŽŵ ůƵŶŐ ĂƐƉŝƌĂƚĞ WZϭ ŚĂĚ S. typhimurium ĨƌŽŵ ďůŽŽĚ ĂŶĚ ůƵŶŐ ĂƐƉŝƌĂƚĞ ĐƵůƚƵƌĞ and S. pneumoniae ĨƌŽŵ ůƵŶŐ ĂƐƉŝƌĂƚĞ WZϳ ŚĂĚ S. pneumoniae/adenovirus, 1 had S. pneumoniae/chlamydia, 1 case with S. pneumoniae had Mycobacterium tuberculosis ĐƵůƚƵƌĞĚ ĨƌŽŵ ŶĂƐŽƉŚĂƌLJŶŐĞĂů ĂƐƉŝƌĂƚĞ ĂŌĞƌ ŝŶĚƵĐĞĚ ƐƉƵƚƵŵ WŶĞƵŵŽĐLJƐƟƐϭ ƉĂƟĞŶƚ ŚĂĚ WWͬ,ŝďϭ ƉĂƟĞŶƚ ŚĂĚ WWͬDsϭ ƉĂƟĞŶƚ ŚĂĚ WWͬĂĚĞŶŽǀŝƌƵƐ Viruses: 1 adenovirus/CMV, 1 adenovirus/chlamydia, 1 bocavirus/CMV ZĞƉƌŽĚƵĐĞĚ ĨƌŽŵ ĂƌƌŽů Ğƚ Ăů κϮ
Summary
ZĞĮŶĞĚ ƚŚĞ ǀĂůƵĞ ŽĨ ZZ ďLJ ĂŐĞ ƐƚƌĂƟĮĐĂƟŽŶ ƚŽ хρϬ ĨŽƌ ŝŶĨĂŶƚƐ ĂŶĚ хκϬ ĨŽƌ ĐŚŝůĚƌĞŶ хϭϮ ŵŽŶƚŚƐ. ^ŝŵŽĞƐ ĂŶĚ Mbabane, 362 DĐ'ƌĂƚŚ ϯϮ ^ǁĂnjŝůĂŶĚ yZ ĐŚĞƐƚ ƌĂĚŝŽŐƌĂƉŚ ZZƌĞƐƉŝƌĂƚŽƌLJ ƌĂƚĞ ZĞƉƌŽĚƵĐĞĚ ĨƌŽŵ ^ĐŽƩ Ğƚ Ăů ϯϯ
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
