Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Pathology and Biochemistry, State University of Zanzibar, Zanzibar, Tanzania.
J Community Health. 2020 Oct;45(5):1073-1080. doi: 10.1007/s10900-020-00832-w.
Fever of unknown origin (FUO) remains an important public health problem. With malaria transmission declining in some parts of Africa, the evidence suggests other infectious agents now account for most FUO. The purpose of this study was to identify the etiologic agents of FUO in a cross-section of patients at the Mnazi Mmoja hospital in Zanzibar, Tanzania.
A multiplex TaqMan gene expression Array Card (TAC) and plates were used for detection and classification of different pathogens in blood samples obtained from patients with FUO. Logistic regression analyses was performed using pathogens detected and sociodemographic characteristics as outcome and exposure variables respectively. Odd ratios and 95% confidence interval were calculated and statistical significance was set at P < .05.
Thirty-three different pathogens were detected in 27 patient blood samples. The following pathogens were detected in decreasing order of prevalence; Dengue virus, Plasmodium species, Rickettsia, Brucella species, Salmonella typhi, and less than 1% for each of Bartonella, Coxiella burnetii, Salmonella species, and Leptospira. Co-infections of Plasmodium with Dengue and S. typhi were also detected, including one case with three different pathogens-Plasmodium, Rickettsia and Brucella. There was no association between the etiologic agents of FUO and demographic or clinical characteristics.
Zoonotic and arboviral etiological agents of fever of unknown origin are present among patients at the Mnazi Mmoja hospital in Zanzibar, Tanzania. There is a need to develop a baseline of standardized diagnostic approaches particularly within the hospital setting. In areas with low malaria prevalence like Zanzibar, Dengue, Rickettsia, Coxiella burnetii, Brucellosis should be considered by clinicians in the differential diagnoses of FUO.
不明原因发热（FUO）仍然是一个重要的公共卫生问题。随着非洲部分地区疟疾传播的减少，有证据表明，现在大多数 FUO 是由其他感染性病原体引起的。本研究的目的是确定坦桑尼亚桑给巴尔 Mnazi Mmoja 医院 FUO 患者的病原体。
使用多重 TaqMan 基因表达阵列卡（TAC）和板来检测和分类从 FUO 患者血液样本中获得的不同病原体。使用检测到的病原体和社会人口统计学特征分别作为结果和暴露变量进行逻辑回归分析。计算比值比和 95%置信区间，并设置 P<0.05 为统计学意义。
在 27 名患者的血液样本中检测到 33 种不同的病原体。按流行率降低的顺序依次为：登革热病毒、疟原虫、立克次体、布鲁氏菌、伤寒沙门氏菌，而巴尔通体、柯克斯体、沙门氏菌和钩端螺旋体的检出率均小于 1%。还检测到疟原虫与登革热和伤寒沙门氏菌的合并感染，包括一例合并三种病原体-疟原虫、立克次体和布鲁氏菌。FUO 的病原体与人口统计学或临床特征之间没有关联。
坦桑尼亚桑给巴尔 Mnazi Mmoja 医院的 FUO 患者存在动物源和虫媒病毒病原体。需要制定一个标准化诊断方法的基线，特别是在医院环境中。在疟疾流行率低的地区，如桑给巴尔，临床医生在 FUO 的鉴别诊断中应考虑登革热、立克次体、柯克斯体、布鲁氏菌病。
