Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar

Autor: Tsiry Hasina Randriambolamanantsoa, Julia Guillebaud, Marietjie Venter, Voahangy Rasolofo, Jane Léa Randriamampionona, Cesare Augusto Marino, Barivola Bernardson, Laurence Randrianasolo, Milijaona Randrianarivelojosia, Inès Vigan-Womas, Voula Stivaktas, Patrice Piola, Jean-Michel Heraud
Přispěvatelé: Unité de Virologie [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Unité d'Epidémiologie [Antananarivo, Madagascar] (IPM), Ministère de la Santé Publique [Antananarivo, Madagascar], Unité des Mycobactéries [Antananarivo, Madagascar] (IPM), Réseau International des Instituts Pasteur (RIIP), Unité d'immunologie des maladies infectieuses [Antananarivo, Madagascar] (IPM), University of Pretoria [South Africa], This work was supported by the US Agency for International Development (USAID) (Grant No. AID-687-G-13-00003), and the US Centers for Disease Control and Prevention (Grant No. 5U51IP000812-02).
Jazyk: angličtina
Rok vydání: 2018
Předmět:
RNA viruses
Male
Pulmonology
Fevers
Pathology and Laboratory Medicine
Geographical Locations
0302 clinical medicine
MESH: Child
Bunyaviruses
Health care
Medicine and Health Sciences
MESH: Community Health Centers/statistics & numerical data
Medicine
Prospective Studies
030212 general & internal medicine
MESH: Public Health/statistics & numerical data
Young adult
Child
Prospective cohort study
Pathogen
MESH: Aged
MESH: Virus Diseases/epidemiology
MESH: Middle Aged
MESH: Bacterial Infections/epidemiology
lcsh:Public aspects of medicine
Bacterial Infections
Middle Aged
Leptospirosis
3. Good health
MESH: Malaria/diagnosis
Infectious Diseases
Medical Microbiology
Virus Diseases
MESH: Young Adult
Viral Pathogens
Child
Preschool
Viruses
Female
Public Health
Pathogens
MESH: Malaria/epidemiology
Research Article
Adult
MESH: Madagascar/epidemiology
MESH: Fever/diagnosis
Herpesviruses
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
Adolescent
Fever
lcsh:RC955-962
030231 tropical medicine
Microbiology
Young Adult
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
Internal medicine
parasitic diseases
Parasitic Diseases
Madagascar
Epstein-Barr virus
Humans
Microbial Pathogens
Aged
MESH: Adolescent
MESH: Fever/epidemiology
MESH: Humans
business.industry
Public health
MESH: Child
Preschool
Organisms
Public Health
Environmental and Occupational Health
Biology and Life Sciences
lcsh:RA1-1270
MESH: Adult
Community Health Centers
Tropical Diseases
Rift Valley fever virus
medicine.disease
MESH: Male
MESH: Prospective Studies
MESH: Virus Diseases/diagnosis
Malaria
Respiratory Infections
People and Places
Africa
MESH: Bacterial Infections/diagnosis
Etiology
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
DNA viruses
business
MESH: Female
Zdroj: PLoS Neglected Tropical Diseases
PLoS Neglected Tropical Diseases, Public Library of Science, 2018, 12 (7), pp.e0006642. ⟨10.1371/journal.pntd.0006642⟩
PLoS Neglected Tropical Diseases, Vol 12, Iss 7, p e0006642 (2018)
ISSN: 1935-2727
1935-2735
Popis: Background The increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases. Methodology Consenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status. Principal findings A total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections. Conclusions These results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar.
Author summary Febrile illnesses have many origins, but infectious agents are the most important cause. Pathogens such as viruses and bacteria can cause various diseases, but associated signs and symptoms are generally non-specific and can overlap between diseases. Treatments of infectious diseases rely on the diagnostic of the causative agent however laboratory capacities are often lacking in resources-limited settings. Thus, health care workers generally follow clinical management guidelines that are rarely supported by information on the prevalence of local infections. The main objective of our study was to describe the common causes of fever in individuals presenting at outpatient healthcare center in Madagascar. Respiratory viruses, malaria and viral infection in the blood were the main infectious agents detected. Implementation of new diagnostic tools such as bedside testing (Point of Care Testing) could help health care workers to improve diagnosis and care of febrile patients. Detection of other pathogens such as hepatitis B virus, human immunodeficiency virus (HIV) or agent responsible for tuberculosis enhances the need for extended prevention, surveillance and detection of these infections. Interestingly, our study reported cases of leptospirosis and Rift Valley Fever virus infection that are pathogens of high public health concern.
Databáze: OpenAIRE
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