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FältnamnIndikatorerMetadata
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001oai:DiVA.org:uu-277254
003SwePub
008160218s2016 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:132921929
009oai:gup.ub.gu.se/232935
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2772542 URI
0247 a https://doi.org/10.1371/journal.pone.01460542 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1329219292 URI
0247 a https://gup.ub.gu.se/publication/2329352 URI
040 a (SwePub)uud (SwePub)kid (SwePub)gu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Elfving, Kristinau Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Biomedicine, Department of Infectious Medicine,Institute of Clinical Sciences, Department of Pediatrics4 aut0 (Swepub:gu)xelfkr
2451 0a Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar :b Aetiologies, Antibiotic Treatment and Outcome
264 c 2016-01-28
264 1b Public Library of Science (PLoS),c 2016
338 a electronic2 rdacarrier
520 a 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.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Pediatrik0 (SwePub)302212 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Pediatrics0 (SwePub)302212 hsv//eng
7001 a Shakely, Deleru Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Andersson, Maria,d 1976u Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Biomedicine, Department of Infectious Medicine4 aut0 (Swepub:gu)xamarz
7001 a Baltzell, Kimberlyu Department of Family Health Care Nursing, University of California San Francisco, USA4 aut
7001 a Ali, Abdullah Su Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania4 aut
7001 a Bachelard, Marcu Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics4 aut
7001 a Falk, Kerstin Iu Karolinska Institutet4 aut
7001 a Ljung, Annikau Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Biomedicine, Department of Infectious Medicine4 aut0 (Swepub:gu)xljanp
7001 a Msellem, Mwinyi Iu Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania4 aut
7001 a Omar, Rahila Su Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania4 aut
7001 a Parola, Philippeu Aix Marseille University, UM63, WHO collaborative centre for rickettsioses and other arthropod borne bacterial diseases, Faculté de Médecine, Marseille, France4 aut
7001 a Xu, Weipingu Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Petzold, Max,d 1973u Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri,Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics4 aut0 (Swepub:gu)xpemax
7001 a Trollfors, Birger,d 1947u Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics4 aut0 (Swepub:gu)xtrobi
7001 a Björkman, Andersu Karolinska Institutet4 aut
7001 a Lindh, Magnus,d 1960u Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Biomedicine, Department of Infectious Medicine4 aut0 (Swepub:gu)xlmagr
7001 a Mårtensson, Andreas,d 1963-u Karolinska Institutet,Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Centrum för klinisk forskning i Sörmland (CKFD),Internationell barnhälsa och nutrition/Mårtensson4 aut0 (Swepub:uu)andma331
7102 a Göteborgs universitetb Institutionen för biomedicin, avdelningen för infektionssjukdomar4 org
7730 t PLOS ONEd : Public Library of Science (PLoS)g 11:1q 11:1x 1932-6203
8564 u https://uu.diva-portal.org/smash/get/diva2:904145/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 u https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0146054&type=printable
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-277254
8564 8u https://doi.org/10.1371/journal.pone.0146054
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:132921929
8564 8u https://gup.ub.gu.se/publication/232935

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