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The Changing Face of Fever in Tanzanian Children

Summary and Comment |
February 26, 2014

The Changing Face of Fever in Tanzanian Children

  1. Larry M. Baddour, MD

The majority of infections were caused by viruses.

  1. Larry M. Baddour, MD

The etiology of nonmalarial fever is becoming more important in malaria-endemic areas where incidence of that disease is decreasing. Improved understanding is needed to optimize care and decrease inappropriate antibiotic use.

To determine the causes of nonmalarial fever, researchers conducted a prospective survey of consecutive children aged 2 months to 10 years presenting with an axillary temperature of ≥38°C at one of two outpatient clinics in Tanzania in 2008. One clinic was rural and one was urban; both were in areas of low malarial endemicity. The researchers used standardized procedures to obtain medical histories and perform clinical examinations; they also collected blood and nasopharyngeal specimens for laboratory testing.

Overall, 1232 diagnoses were established in 1005 children; multiple conditions were diagnosed in 227 (22.6%). The proportions of children with viral, bacterial, and parasitic diseases were 70.5%, 22.0%, and 10.9%, respectively. At both clinics, fever was the main complaint in most of the children. Acute respiratory infection was seen in 62.2%, and malaria in only 10.4%. No infectious cause of fever could be found in 3.2% of the children.

Comment

At least two factors have emerged in recent years that have affected fever management in malaria-endemic areas. First, the incidence of malaria has decreased in some regions due to enhanced preventive measures. Second, new laboratory diagnostic tools that provide rapid results to identify colonizing or infecting pathogens have become available. These changes have prompted a reevaluation of the wholesale use of antimalarial and antimicrobial therapies, with an effort to be more selective in their administration — as is espoused in an accompanying editorial.

  • Disclosures for Larry M. Baddour, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Heart Association (Chairman, Rheumatic Fever, Endocarditis, Kawasaki Disease Committee)

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