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Etiology of pediatric Fever in Western kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis

TitleEtiology of pediatric Fever in Western kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis
Publication TypeJournal Article
Year of Publication2015
AuthorsO'Meara, WP, Mott, JA, Laktabai, J, Wamburu, K, Fields, B, Armstrong, J, Taylor, SM, MacIntyre, C, Sen, R, Menya, D, Pan, W, Nicholson, BP, Woods, CW, Holland, TL
JournalAm J Trop Med Hyg
Volume92
Pagination1030-7
Date PublishedMay 6
ISBN Number1476-1645 (Electronic)0002-9637 (Linking)
Accession Number25758648
Abstract

In Kenya, more than 10 million episodes of acute febrile illness are treated annually among children under 5 years. Most are clinically managed as malaria without parasitological confirmation. There is an unmet need to describe pathogen-specific etiologies of fever. We enrolled 370 febrile children and 184 healthy controls. We report demographic and clinical characteristics of patients with Plasmodium falciparum, group A streptococcal (GAS) pharyngitis, and respiratory viruses (influenza A and B, respiratory syncytial virus [RSV], parainfluenza [PIV] types 1-3, adenovirus, human metapneumovirus [hMPV]), as well as those with undifferentiated fever. Of febrile children, 79.7% were treated for malaria. However, P. falciparum was detected infrequently in both cases and controls (14/268 [5.2%] versus 3/133 [2.3%], P = 0.165), whereas 41% (117/282) of febrile children had a respiratory viral infection, compared with 24.8% (29/117) of controls (P = 0.002). Only 9/515 (1.7%) children had streptococcal infection. Of febrile children, 22/269 (8.2%) were infected with > 1 pathogen, and 102/275 (37.1%) had fevers of unknown etiology. Respiratory viruses were common in both groups, but only influenza or parainfluenza was more likely to be associated with symptomatic disease (attributable fraction [AF] 67.5% and 59%, respectively). Malaria was overdiagnosed and overtreated. Few children presented to the hospital with GAS pharyngitis. An enhanced understanding of carriage of common pathogens, improved diagnostic capacity, and better-informed clinical algorithms for febrile illness are needed.

PMCID

PMC4426560