Common Cause Of Febrile Illness Research Articles

Socio-Demographic Factors Affecting the Prevalence of Typhoid Fever Among Febrile Patients in Kebbi State, Nigeria

Typhoid fever is a life-threatening public health disease caused by the bacterium Salmonella Typhi. The disease is a significant health concern in underdeveloped and most developing countries, especially in Asia and Africa (including Nigeria). The study was aimed at determining the prevalence and sociodemographic factors associated with typhoid fever among febrile patients attending three selected hospitals in Kebbi State, Nigeria. A hospital based cross sectional study was carried out among 406 febrile patients suspected of typhoid fever aged 1-70 years (mean age 34 years) in three selected health facilities of Kebbi State, Nigeria from February2021 to October, 2021. Approximately 20 ml and 10 ml of venous blood was collected from adults and children respectively. Blood culture and biochemical tests were carried out. Patients were administered structured questionnaires to evaluate the level of knowledge and practice toward the disease. Data obtained from respondents was analysed by descriptive statistics. In this study, the culture identified Salmonella Typhi prevalence of typhoid fever among febrile study subjects in Kebbi State was 6.4%. A higher prevalence was recorded among males (7.5%) than in females (5.0%) participants. Patients within the age range of 11- 20 years had the highest prevalence (14.8%), those with informal education recorded 11.2%. It was observed that rural area dwellers had higher prevalence (9.4%). Out of 26 isolates, 25 were susceptible to cefotaxime, 11 isolates were resistant to cotrimoxazole and amoxicillin-clavulanate antibiotics. Salmonella enterica serovar Typhi is an important and common cause of febrile illness in our population. Lack of good quality drinking water in rural areas has a greater impact on the burden of typhoid fever among study participants. Cefotaxime and ciprofloxacin therapy are suitable treatments for typhoid fever. The identification of sociodemographic characteristics associated with the disease are of great importance in providing holistic preventive approach and control strategies of the disease.

Predominance of multidrug-resistant Salmonella Typhi genotype 4.3.1 with low-level ciprofloxacin resistance in Zanzibar.

Typhoid fever is a common cause of febrile illness in low- and middle-income countries. While multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) has spread globally, fluoroquinolone resistance has mainly affected Asia. Consecutively, 1038 blood cultures were obtained from patients of all age groups with fever and/or suspicion of serious systemic infection admitted at Mnazi Mmoja Hospital, Zanzibar in 2015-2016. S. Typhi were analyzed with antimicrobial susceptibility testing and with short read (61 strains) and long read (9 strains) whole genome sequencing, including three S. Typhi strains isolated in a pilot study 2012-2013. Sixty-three S. Typhi isolates (98%) were MDR carrying blaTEM-1B, sul1 and sul2, dfrA7 and catA1 genes. Low-level ciprofloxacin resistance was detected in 69% (43/62), with a single gyrase mutation gyrA-D87G in 41 strains, and a single gyrA-S83F mutation in the non-MDR strain. All isolates were susceptible to ceftriaxone and azithromycin. All MDR isolates belonged to genotype 4.3.1 lineage I (4.3.1.1), with the antimicrobial resistance determinants located on a composite transposon integrated into the chromosome. Phylogenetically, the MDR subgroup with ciprofloxacin resistance clusters together with two external isolates. We report a high rate of MDR and low-level ciprofloxacin resistant S. Typhi circulating in Zanzibar, belonging to genotype 4.3.1.1, which is widespread in Southeast Asia and African countries and associated with low-level ciprofloxacin resistance. Few therapeutic options are available for treatment of typhoid fever in the study setting. Surveillance of the prevalence, spread and antimicrobial susceptibility of S. Typhi can guide treatment and control efforts.

Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016-2017.

In northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community. Febrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4-fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated. Of 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16-41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38-4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08-23.50). Acute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.

Expanding the roles of community health workers to sustain programmes during malaria elimination: a meeting report on operational research in Southeast Asia.

In Southeast Asia malaria elimination is targeted by 2030. Cambodia aims to achieve this by 2025, driven in large part by the urgent need to control the spread of artemisinin-resistant falciparum malaria infections. Rapid elimination depends on sustaining early access to diagnosis and effective treatment. In much of Cambodia, rapid elimination will rely on a village malaria worker (VMW) network. Yet as malaria declines and is no longer a common cause of febrile illness, VMWs may become less popular with febrile patients, as VMWs do not diagnose or treat other conditions at present. There is a risk that VMWs become inactive and malaria rebounds before the complete interruption of transmission is achieved.During 2021-23 a large-scale operational research study was conducted in western Cambodia to explore how a VMW network could be sustained by including health activities that cover non-malarial illnesses to encourage febrile patients to continue to attend. 105 VMWs received new rapid diagnostic tests (including dengue antigen-antibody and combined malaria/C-reactive protein tests), were trained in electronic data collection, and attended health education packages on hygiene and sanitation, disease surveillance and first aid, management of mild illness, and vaccination and antenatal care.In August 2023 the National Malaria Control Programme of Cambodia convened a stakeholder meeting in Battambang, Cambodia. Findings from the study were reviewed in the context of current malaria elimination strategies. The discussions informed policy options to sustain the relevance of the VMW network in Cambodia, and the potential for its integration with other health worker networks. This expansion could ensure VMWs remain active and relevant until malaria elimination is accomplished.

1384. Verbal Autopsy as a Tool to Identify Probable Cause of Death in People with Acute Febrile Illness in Zambia — January 2020-December 2022

Abstract Background Acute febrile illness (AFI) surveillance improves a country’s understanding of what diseases are circulating. However, fever as an entry point for patient identification casts a wide net that will likely capture non-infectious causes of AFI. We used mortality surveillance data to examine probable causes of death (CoD) potentially associated with AFI to expand our understanding of febrile illness in Zambia. Methods The Zambian Ministry of Health provided verbal autopsy (VA) data from 27 (of 117) districts representing ∼50% of Zambia’s population. The World Health Organization’s standardized tool for VA was used by hospital staff to interview relatives or close associates of deceased persons of all ages on clinical presentation and circumstances prior to death. The InterVA-5 validated computer algorithm provided a CoD. Using questionnaire data, we applied an AFI case definition based on common global AFI surveillance criteria: a febrile person with a fever duration of < 1-14 days and a mild, moderate, or severe fever classification (in lieu of a temperature cutoff). We analyzed the CoDs and SARS-CoV-2 infections among those that met our AFI case definition in R. Results From January 2020 to December 2022, 51,751 VAs were conducted on people over 28 days old–14,503 (28%) reported fever prior to death, of which 12,071 (23%) met our AFI case definition. Broadly, we found that 64% of those that met our AFI case definition had an infectious CoD, 32% had a non-communicable CoD, and 4% had other CoDs. Specifically, the most reported CoDs were acute respiratory infection (14%), diarrheal disease (11%), and HIV/AIDS (10%). A positive SARS-CoV-2 test was reported in 965 (8%) persons with AFI versus 1,876 (5%) without AFI (p< 0.001). Conclusion AFI-associated deaths were primarily attributable to infectious disease, as identified through VA. AFI is one approach for multi-pathogen surveillance that provides valuable insight into circulating diseases, including SARS-CoV-2, but findings are limited by which pathogens are targeted for testing. Mortality surveillance is a valuable supplementary data source when attempting to understand inconclusive findings in AFI surveillance and aids in a country’s understanding of common causes of febrile illness not captured through AFI surveillance diagnostics. Disclosures All Authors: No reported disclosures

Prospective Observational study of Etiological Spectrum of Febrile Illinessess in Pregnancy and Association with Outcomes

Background:- Fever in pregnancy is a common clinical problem worldwide. The risk to the mother and fetus is significantly increased in pregnancy complicated by infection and fever. Aim and objective:- To determine etiological spectrum of febrile illnesses in pregnancy and its association with maternal & fetal outcomes. Methodology :- Prospective observational study was conducted in the Department of obstetrics and gynecology in a tertiary care center in western Maharashtra. A total 105 pregnant women reported with fever during the study periods, out of which 37 were followed up longitudinally till delivery and were included in the study analysis. Results:- In the present study, Fever of unknown origin(32.43%), Dengue(24.32%), COVID-19 (24.32%), Urinary tract infections(16.21%) Malaria(2.7%) were the common cause of febrile illness. Out of 37 pregnant women with febrile illness, 31 (83.8%) had live births, 5 (13.5%) had intrauterine death (IUD) and there was one case of abortion. In 10 (27%) patients, there was a requirement for NICU admission. It was observed that more is the number of febrile episodes higher is the chance of neonatal morbidity and mortality. Conclusion :- High grade fever with multiple febrile episodes due to any underlying etiology in pregnancy is harmful to the fetal-maternal health.

A CASE REPORT ON HEPATOGASTRIC FISTULA IN A CASE OF LIVER ABSCESS

Liver abscess is a common cause of febrile illness in India. It usually presents with fever and right upper quadrant abdominal pain. Upper gastrointestinal bleeding is not a commonly described clinical presentation of liver abscess. In liver abscess, upper gastrointestinal bleeding would usually be attributed to nonsteroidal anti-inflammatory druginduced esophagitis, erosive mucosal disease, or duodenal or gastric ulcer, as would be expected in any febrile illness. I present a case report of a patient who presented with febrile illness and upper gastrointestinal bleed due to a ruptured liver abscess perforating into the stomach.

Aetiology of hospitalized fever and risk of death at Arua and Mubende tertiary care hospitals in Uganda from August 2019 to August 2020

BackgroundEpidemiology of febrile illness in Uganda is shifting due to increased HIV treatment access, emerging viruses, and increased surveillance. We investigated the aetiology and outcomes of acute febrile illness in adults presenting to hospital using a standardized testing algorithm of available assays in at Arua and Mubende tertiary care hospitals in Uganda.MethodsWe recruited adults with a ≥ 38.0 °C temperature or history of fever within 48 h of presentation from August 2019 to August 2020. Medical history, demographics, and vital signs were recorded. Testing performed included a complete blood count, renal and liver function, malaria smears, blood culture, and human immunodeficiency virus (HIV). When HIV positive, testing included cryptococcal antigen, CD4 count, and urine lateral flow lipoarabinomannan assay for tuberculosis. Participants were followed during hospitalization and at a 1-month visit. A Cox proportional hazard regression was performed to evaluate for baseline clinical features and risk of death.ResultsOf 132 participants, the median age was 33.5 years (IQR 24 to 46) and 58.3% (n = 77) were female. Overall, 73 (55.3%) of 132 had a positive microbiologic result. Among those living with HIV, 31 (68.9%) of 45 had at least one positive assay; 16 (35.6%) had malaria, 14 (31.1%) tuberculosis, and 4 (8.9%) cryptococcal antigenemia. The majority (65.9%) were HIV-negative; 42 (48.3%) of 87 had at least one diagnostic assay positive; 24 (27.6%) had positive malaria smears and 1 was Xpert MTB/RIF Ultra positive. Overall, 16 (12.1%) of 132 died; 9 (56.3%) of 16 were HIV-negative, 6 died after discharge. High respiratory rate (≥ 22 breaths per minute) (hazard ratio [HR] 8.05; 95% CI 1.81 to 35.69) and low (i.e., < 92%) oxygen saturation (HR 4.33; 95% CI 1.38 to 13.61) were identified to be associated with increased risk of death.ConclusionIn those with hospitalized fever, malaria and tuberculosis were common causes of febrile illness, but most deaths were non-malarial, and most HIV-negative participants did not have a positive diagnostic result. Those with respiratory failure had a high risk of death.

Risk Factors Associated with Passengers with Imported Dengue Fever at International Airports in Taiwan.

Dengue fever (DF) is a mosquito-borne disease prevalent in the tropics (e.g., sub-Saharan Africa, Asia, and Central and South America) and a common cause of febrile illness in travelers. The high incidence of imported DF in Taiwan has led to a domestic outbreak. This study explored the risk factors associated with individuals given diagnoses of imported DF at international airports in Taiwan. The results may serve as a reference for DF prevention. In this retrospective study, data from the symptom notification system database of the Taiwan Centers for Disease Control (TCDC) were used. These data concerned travelers who returned to Taiwan from DF-endemic areas with suspected DF symptoms. The epidemiological characteristics of the cases were analyzed, and 28 variables related to DF infection were included in the multivariate logistic regression analysis. In 2018–2019, there were 8656 cases (451 positive and 8205 negative cases). The results revealed DF symptoms and a 16–30-day stay in endemic areas to be independent risk factors and the presence of three respiratory symptoms and <10 days of short-term travel to be protective factors. These results may enable the accurate assessment of symptoms in travelers with DF as well as the risk factors associated with imported DF, lowering the risk of indigenous DF outbreaks caused by imported DF.

The Association Between Vitamin D and Urinary Tract Infection in Children: A Case-Control Study.

Background and objectiveUrinary tract infection (UTI) is one of the common causes of febrile illness in young children. Vitamin D influences the levels of endogenous cathelicidin, an antimicrobial peptide, which improves bladder wall immunity and prevents UTIs. In light of this, we conducted this study to determine the association between vitamin D deficiency and UTIs in children and to identify whether vitamin D deficiency is one of the risk factors for UTIs.Materials and methodsThis was a case-control study of children aged between one to five years. Eighty-two children with the first episode of febrile culture-proven UTI as cases and 82 healthy children as a control group were included in this study. The sera were analyzed for 25-hydroxy vitamin D levels and classified as vitamin-D deficient if their level was below 30 ng/mL. Descriptive statistics were presented as numbers and percentages. Continuous data were expressed as means and standard deviations (SD). Pearson's chi-square test was used to test the significance of the differences in variables between the two groups. Multiple logistic regression equation methods were used to predict the relationship between the dependent and independent variables.ResultsThe mean age of the study and the control group was 2.36 ±1.42 years and 2.57 ±1.26 years, respectively. The mean serum 25-hydroxy vitamin D levels in the patients and controls were 24.27 ±9.70 ng/mL and 31.97 ±10.7 ng/mL (p<0.001), respectively. Vitamin D deficiency was present in 34 (41.5%) patients and 10 (2.2%) in the control group (p<0.001).ConclusionBased on our findings, vitamin D deficiency might be one of the risk factors for UTIs in children. Vitamin D deficiency is significantly associated with febrile UTIs in children between one to five years of age.

Urinary tract infection in children: preventing the havoc in India

Urinary tract infection (UTI) remains one of the most common causes of febrile illness in paediatric practice ranking next to gastrointestinal and respiratory tract infections as the third most common bacterial infection in children in the developing countries. According to World Health Organization (WHO) in developed countries, UTI is diagnosed in 1% of boys and 3-8% of girls. In the first year of life, UTI is more prevalent in boys with rates of 2.7% compared with 0.7% in girls. Most infection in boys occur in the first 3 months of life but by school age, the rate has decreased in boys and increased in girls. Several studies have been conducted to determine UTI prevalence in developing countries and have shown a higher UTI prevalence of 8-35% in malnourished children with the risk of bacteriuria increasing significantly with the severity of malnutrition.

High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015.

BackgroundBrucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya.MethodsBetween February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population.ResultsWe enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months– 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28–53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence.ConclusionWe report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community.

Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study.

.Scrub typhus and spotted fever group rickettsioses are thought to be common causes of febrile illness in India, whereas they rarely test for murine typhus. This cross-sectional study explored the risk factors associated with scrub typhus, tick-borne spotted fever, and murine typhus seropositivity in three different geographical settings, urban, rural, and hill villages in Tamil Nadu, South India. We enrolled 1,353 participants living in 48 clusters. The study included a questionnaire survey and blood sampling. Blood was tested for Orientia tsutsugamushi (scrub typhus), Rickettsia typhi (murine typhus), and spotted fever group Rickettsia IgG using ELISA. The seroprevalence of scrub typhus, spotted fever, and murine typhus were 20.4%, 10.4%, and 5.4%, respectively. Scrub typhus had the highest prevalence in rural areas (28.1%), and spotted fever was most common in peri-forested areas (14.9%). Murine typhus was more common in rural (8.7%) than urban areas (5.4%) and absent in peri-forested hill areas. Agricultural workers had a higher relative risk for scrub typhus, especially in urban areas. For murine typhus, proximity to a waterbody and owning a dog were found to be major risk factors. The main risk factors for spotted fever were agricultural work and living in proximity to a forest. Urban, rural plains, and hill settings display distinct epidemiological pattern of Orientia and rickettsial infections. Although scrub typhus and spotted fever were associated with known risk factors in this study, the findings suggest a different ecology of murine typhus transmission compared with other studies conducted in Asia.

Study of the prevalence of urinary tract infection in febrile children attending paediatric OPD in Government medical college and general hospital, Srikakulam, Andhra Pradesh, India

Background: Children with fever comprise a major proportion of our practice in outpatient department of Paediatric. Among the fever cases Urinary tract infection is the third most common cause of febrile illness in children. The emphasis on identification of urinary tract infections in febrile children is minimal. Very often, children receive antibiotics empirically, without any adequate evaluation for urinary tract infection. The objective of our study is to determine the prevalence of urinary tract infection in all febrile children from 1months to 5 years of age.Methods: A prospective study was undertaken in the department of Pediatrics, Government medical college, Srikakulam. Urine was collected from enrolled febrile patients and sent for routine microscopic examination as well as for culture and sensitivity.Results: The study included 500 children. Females were 256(51.2%) and males were 244(48.8%). The total prevalence of UTI cases were 6%. The incidence in &lt;1 year was 7.05%, 1-2 years was 5.97 % and &gt;2 years was 5.35%. The prevalence of UTI was higher among females (7.68%) than males (4.68%). Apart from fever, the commonest symptoms were dysuria, abdominal pain, vomiting, chills and rigors and loss of appetite. Urine culture shows E. coli followed by Klebsiella were found to contribute the maximum number of cases.Conclusions: Possibility of Urinary Tract Infection must be considered in all febrile children and urine culture specimen must be collected as a part of diagnostic evaluation.

Oropouche orthobunyavirus: Genetic characterization of full-length genomes and development of molecular methods to discriminate natural reassortments

Oropouche orthobunyavirus (OROV) has significant impact in public health in Amazon region. This arbovirus is one of the most common causes of febrile illness in Brazil, and is responsible for several epidemics since 1960's. In this study, we sequenced and characterized the complete coding sequences (S-, M- and L-RNA) of 35 OROV isolates from Brazil. Here, we classified 20 strains in genotype I from Pará and Maranhão states, nine as genotype II from Pará and Rondônia states confirmed, four classified into genotype III from Acre, Maranhão, Minas Gerais and Rondônia states and two genotype IV from Amazonas State. Also, we did not observe reassortment events involving the OROV isolates. In addition, we developed novel RT-PCR tools to identify reassortment events among OROV strains. These data will be useful to better understand the molecular epidemiology and diagnostic of OROV infections.

Prevalence of urinary tract infection among children

Urinary tract infection is the third most common cause of febrile illness among children. UTI carries a considerable morbidity among this vulnerable age group because of its potential complications (e.g. hypertension and renal failure). Because diagnosis of UTI among the pediatric age group is challenging if solely based on clinical setting, knowledge of the actual prevalence rates of UTI among children is essential for pediatricians to determine the cost benefit effect of requesting investigations for suspected cases. Infants and children with UTI often present with fever with or without urinary symptoms. During assessment of a febrile child, pediatricians should be aware of the prevalence and risk factors for UTI in febrile children that necessitate further investigations. Prevalence of UTI among children is highly variable among different studies and the variability is attributed to multiple factors. This article aims at reviewing the prevalence of UTI in children reported among various literature studies and discussing factors influencing this prevalence.

Commentary

Commentary

English

Improper diagnosis and management of febrile patients results in the persistence of malaria and other conditions with similar symptoms. The algorithm established here with Rapid Diagnostic Tests (RDTs) will help in the follow-up and treatment of fever patients according to the guidelines on Integrated Management of Childhood Illness (IMCI). This study aimed at determining the causes of fever in children and at valorizing the use of RDTs for the diagnosis of febrile diseases. Fifty children with fever, aged between 0 and 5 years, were recruited in a cross-sectional study at the Ekounou Baptist Clinic in Yaounde. RDTs were used to assess for the four common causes of febrile illness in the area. Microscopy was done and the Plasmodium species were confirmed by nested Polymerase Chain Reaction (PCR). Of the 50 febrile children, none was rubella seropositive, while 8% had malaria, 22% had toxoplasmosis infection, 8% had Salmonella typhi, 14% had a malaria-typhoid fever co-infection, 4% had a malaria-toxoplasmosis co-infection, 6% had a malaria-toxoplasmosis-typhoid fever co-infection, and 38% were negative for all the suspected common causes of fever in the health district. The overall frequencies of occurrence attributed 32% to malaria, 32% to toxoplasmosis and 28% to typhoid fever. Among all the positive malaria cases (n=16 (32%)) Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale were identified by nested PCR. Malaria RDT results agreed significantly with the microscopy (kappa=0.81; p&lt;0.0001) and PCR (kappa=0.84; p&lt;0.0001) results; and the microscopy results also concurred significantly with the PCR results (kappa=0.77; p&lt;0.0001). Malaria was not the exclusive cause of fever. Toxoplasmosis was found to occur in the same proportion as malaria (32%) in the study population. S. typhi was the third most important infection. Therefore RDTs are appropriate tools for the management of childhood febrile diseases. Key words: Fever, malaria, toxoplasmosis, typhoid, rubella, rapid diagnostic test (RDT), Cameroon.

The prevalence of urinary tract infection in children with severe acute malnutrition: a narrative review.

This article aims to review the current evidence which shows that the prevalence of urinary tract infection (UTI) has been increasing in children with severe acute malnutrition (SAM). UTI remains one of the most common causes of febrile illness in pediatric practice. Most studies conducted among hospitalized children with complicated SAM have reported high prevalence rates of UTI. Clearly, the knowledge of baseline risk of UTI can help clinicians to make informed diagnostic and therapeutic decisions in these children. From the global reports reviewed in this article, UTI prevalence rates range from as low as 6% to as high as 37% in developing countries, while the most common bacterial isolates from urine cultures are Gram-negative coliform organisms such as Escherichia coli and Klebsiella species. These findings form the basis for the current diagnostic and therapeutic guidelines for clinicians managing children with complicated SAM. With the reported high prevalence of UTI among these children and concerns over antibiotic resistance, more extensive data are required using standardized microbiological methods. Thus, the assessment of the performance of urine dipsticks and microscopy against the gold standard urine culture is an important step toward strengthening the evidence for the therapeutic guidelines for UTI in children with SAM.

Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study.

SummaryBackgroundScrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease in endemic countries. Laos is representative of vast economically poor rural areas in Asia with little medical information to guide public health policy. We assessed whether these pathogens are important causes of CNS infections in Laos.MethodsBetween Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with CNS symptoms or signs requiring a lumbar puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations (culture, PCR, and serology) targeted so-called conventional bacterial infections (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups.Findings1051 (95%) of 1112 patients who presented had CSF available for analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi, R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051 [4%]; p<0·0001) by use of conservative diagnostic definitions. CNS infections had a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional bacterial infections (p=0·076).InterpretationOur data suggest that R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp infections are important causes of CNS infections in Laos. Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of CNS infections. These severely neglected infections represent a potentially large proportion of treatable CNS disease burden across vast endemic areas and need more attention.FundingWellcome Trust UK.