Causes of fever in Gabonese children: a cross-sectional hospital-based study

José Francisco Fernandes,Jürgen May,Sélidji Todagbé Agnandji,Benjamin Mordmüller,Abel Ben Adande,Bertrand Lell,Albert Lalremruata,Daniel Eibach,Meral Esen,Beate Henrichfreise,Isabella Eckerle,Maradona Daouda Agbanrin,Cosme Kokou,Benedikt Hogan,Jana Held,Peter G Kremsner ,Martin P Grobusch ,Ayôla Akim Adegnika ,Magdalena Dorn,Abraham Alabi,Frieder Schaumburg

doi:10.1038/s41598-020-58204-2

Abstract

The causes of infections in pediatric populations differ between age groups and settings, particularly in the tropics. Such differences in epidemiology may lead to misdiagnosis and ineffective empirical treatment. Here, we investigated the current spectrum of pathogens causing febrile diseases leading to pediatric hospitalization in Lambaréné, Gabon. From August 2015 to March 2016, we conducted a prospective, cross-sectional, hospital-based study in a provincial hospital. Patients were children ≤ 15 years with fever ≥ 38 °C and required hospitalization. A total of 600 febrile patients were enrolled. Malaria was the main diagnosis found in 52% (311/600) patients. Blood cultures revealed septicemia in 3% (17/593), among them four cases of typhoid fever. The other causes of fever were heterogeneously distributed between both bacteria and viruses. Severe infections identified by Lambaréné Organ Dysfunction Score (LODS) were also most often caused by malaria, but children with danger signs did not have more coinfections than others. In 6% (35/600) of patients, no pathogen was isolated. In Gabon, malaria is still the major cause of fever in children, followed by a bacterial and viral disease. Guidelines for both diagnosis and management should be tailored to the spectrum of pathogens and resources available locally.

Highlights

The causes of infections in pediatric populations differ between age groups and settings, in the tropics
A landmark study conducted in Tanzania showed that due to a change in epidemiology, a broad spectrum of pathogens replaced P. falciparum malaria as the most common cause of disease in children in this area[1]
Vaccination coverage of the expanded program on immunization (EPI) vaccines was above 80% for scheduled doses of BCG, poliomyelitis and pentavalent vaccines, and 54% and 55% for measles and yellow fever vaccines, respectively (Supplementary Fig. S1)

Summary

Introduction

The causes of infections in pediatric populations differ between age groups and settings, in the tropics. The evolution of the main clinical and biological parameters among study patients in relation to both infections malaria and H. influenza are described in Supplementary Table S3. Laboratory results showed that anemia was not associated with H. influenzae infection, whilst the alanine aminotransferase was lower than in uninfected patients by factor 2 (18.9 IU/L versus 41.8 IU/L; p < 0.001) (Supplementary Table S3).

Results

Conclusion