Abstract:
:Severe febrile illness is a major cause of adult hospital admission in Africa. Studies of non-malarial fever come largely from children or from high HIV prevalence settings. This prospective study of adult admissions with severe febrile illness in a malaria-endemic area with moderate/low HIV prevalence investigated admission diagnosis as well as final diagnosis based on results of investigations. Severe malaria was the admission diagnosis in 148/198 (74.7%) cases. Plasmodium falciparum was identified in 38/188 (20.2%) admissions and 26/198 (13.1%) were bacteraemic, with 13/25 (52%) prescribed empirical antibiotics. HIV was equally common among those with (16/37; 43.2%) and without P. falciparum (50/138; 36.2%) (p=0.44). In 6/22 (27.3%) deaths, blood cultures were positive for a pathogen, with Streptococcus pneumoniae, Escherichia coli and non-Typhi Salmonella predominating. Chest radiography was suspicious for bacterial/mycobacterial disease in 5/22 additional deaths. Systemic inflammatory response syndrome criteria were more sensitive but less specific than WHO severe malaria criteria for predicting mortality. Malaria is overdiagnosed in adults with severe febrile illness and was not associated with mortality in the absence of co-infection in this high-incidence setting. Adults with severe febrile illness should be tested for malaria and HIV using rapid, sensitive tests. Early antibiotic use should be promoted. Improved diagnostics for invasive bacterial disease are needed.
journal_name
Trans R Soc Trop Med Hygauthors
Nadjm B,Mtove G,Amos B,Walker NF,Diefendal H,Reyburn H,Whitty CJdoi
10.1016/j.trstmh.2012.08.006subject
Has Abstractpub_date
2012-11-01 00:00:00pages
688-95issue
11eissn
0035-9203issn
1878-3503pii
S0035-9203(12)00173-3journal_volume
106pub_type
杂志文章,评审abstract::When cross-sectional surveys are used to evaluate malaria intervention programmes in the community, the prevalence of morbidity is difficult to assess because of the fluctuating nature of malarial fever. We have therefore investigated the impact of bed net usage on 2 surrogate markers of malarial morbidity: (i) elevat...
journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
pub_type: 杂志文章
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
pub_type: 杂志文章
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journal_title:Transactions of the Royal Society of Tropical Medicine and Hygiene
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