About: Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar – Aetiologies, Antibiotic Treatment and Outcome

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar – Aetiologies, Antibiotic Treatment and Outcome
Creator	Parola, Philippe Falk, Kerstin Lindh, Magnus Björkman, Anders Andersson, Maria Bachelard, Marc Baltzell, Kimberly Elfving, Kristina Ljung, Annika Mårtensson, Andreas Petzold, Max Shakely, Deler Trollfors, Birger Xu, Weiping Francisco, San Ali, Abdullah Msellem, Mwinyi Omar, Rahila
source	Medline; PMC
abstract	BACKGROUND: Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. METHODS: We prospectively studied the aetiology of febrile illness in 677 children aged 2–59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. FINDINGS: NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98%) and 153/164 (93%) of patients and 158/166 (95%) and 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) and group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection retrospectively considered to require antibiotics. Clinical outcome was generally good. However, two children died. Only 68 (11%) patients remained febrile on day 3 and three of them had verified fever on day 14. An additional 29 (4.5%) children had fever relapse on day 14. Regression analysis determined C-reactive Protein (CRP) as the only independent variable significantly associated with CXR-confirmed pneumonia. CONCLUSIONS: This is the first study on uncomplicated febrile illness in African children that both applied a comprehensive laboratory panel and a healthy control group. A majority of patients had viral respiratory tract infection. Pathogens were frequently detected by qPCR also in asymptomatic children, demonstrating the importance of incorporating controls in fever aetiology studies. The precision of IMCI for identifying infections requiring antibiotics was low.
has issue date	2016-01-28(xsd:dateTime)
bibo:doi	10.1371/journal.pone.0146054
bibo:pmid	26821179
has license	cc-by
sha1sum (hex)	5bb362d1be223686ad4467e317cf5abb8383ab3e
schema:url	https://doi.org/10.1371/journal.pone.0146054
resource representing a document's title	Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar – Aetiologies, Antibiotic Treatment and Outcome
has PubMed Central identifier	PMC4731140
has PubMed identifier	26821179
schema:publication	PLoS One
resource representing a document's body	covid:5bb362d1be223686ad4467e317cf5abb8383ab3e#body_text
is schema:about of	named entity 'studies' named entity 'Africa' named entity 'large' named entity 'areas' named entity 'ACUTE' named entity 'MONTHS' named entity 'RECENTLY' named entity 'LOW' named entity 'CHILDHOOD' named entity 'MALARIA TRANSMISSION' named entity 'PROPORTION' named entity 'CAUSES' named entity 'LIKE' named entity 'LARGE' named entity 'ANTIBIOTIC TREATMENT' named entity 'UNCOMPLICATED' named entity 'FEBRILE ILLNESS' named entity 'AGED' named entity 'OUTCOME' named entity 'CHILDREN' named entity 'ZANZIBAR' named entity 'PRESENT' named entity 'AFRICA' named entity 'HAVE' named entity 'HEALTH CARE FACILITIES' named entity 'HIGH' named entity 'UNCOMPLICATED' named entity 'ZANZIBAR' named entity 'FEVER' named entity 'CHILDREN' named entity 'PRIMARY HEALTH CARE' named entity 'FACT' named entity 'STUDIES' named entity 'LEVEL OF CARE' named entity 'STUDY' named entity 'FEBRILE ILLNESS' named entity 'CHANGE' named entity 'AREAS' named entity 'malaria' named entity 'level' named entity 'primary health care' named entity 'febrile illness' named entity 'Aetiologies' named entity 'facilities' named entity 'malaria' named entity 'CXR' named entity 'malaria' named entity 'follow-up' named entity 'fever' named entity 'point-of-care tests' named entity 'pathogens' named entity 'Tanzania' named entity 'health care centre' named entity 'febrile' named entity 'antibiotic' named entity 'health care centre' named entity 'CXR' named entity 'CRP' named entity 'rapid breathing' named entity 'regression analysis' named entity 'Fisher's exact test' named entity 'aetiology' named entity 'Regression analysis' named entity 'pathogens'

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