Centre for International Health, University of Otago, New Zealand; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Pg. Lluís Companys 23, Barcelona, Spain; Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.
Clin Microbiol Infect. 2018 Aug;24(8):808-814. doi: 10.1016/j.cmi.2018.02.011. Epub 2018 Feb 15.
Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies.
To summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria.
A narrative literature review by searching the MEDLINE database, and recent conference abstracts.
Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum β-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important.
Understanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens.
发热是非洲居民最常见的症状之一，由于各种潜在病因的临床表现相似，临床医生面临着巨大的挑战。
总结目前撒哈拉以南非洲发热病因的研究情况，重点关注疟疾以外的病因。
通过检索 MEDLINE 数据库和最近的会议摘要进行叙述性文献回顾。
针对多种潜在发热病因的研究较为匮乏，对于许多患者而言，致病病原体仍未明确，或者可能存在多种混合感染微生物，明确病因具有一定难度。在门诊患者中，自限性虫媒病毒感染和病毒性上呼吸道感染较为常见，高达 60%的就诊于卫生中心的儿童会出现此类感染。在住院患者中，存在许多致死风险高的感染，需要进行特定治疗。血流感染细菌和动物源性细菌感染是发热的主要病因。近年来，细菌分离株的抗生素耐药性有所增加，尤其是产超广谱β-内酰胺酶的肠杆菌科细菌和氟喹诺酮耐药的肠炎沙门氏菌。在人类免疫缺陷病毒（HIV）感染者中，多达 34.8%的败血症患者中证实存在结核分枝杆菌菌血症，而隐球菌病和组织胞浆菌病等真菌感染仍然很重要。
了解发热病因的当地流行病学情况，以及包括疟疾和 HIV 快速诊断检测在内的诊断方法，可指导临床医生对发热患者进行管理。目前临床医生面临的挑战包括评估哪些门诊患者需要使用抗菌药物，以及确定感染了对经验性抗菌方案不敏感的病原体的住院患者。
