Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Clin Microbiol Infect. 2021 Apr;27(4):590-596. doi: 10.1016/j.cmi.2020.05.029. Epub 2020 Jun 4.
Areas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso.
In a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens.
A total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases.
Viral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.
在撒哈拉以南非洲疟疾传播率下降的地区，儿童急性发热性疾病（AFI）的病因最近发生了重要变化。我们描述了布基纳法索农村一个高疟疾传播地区的 AFI 病因。
在一项前瞻性基于医院的诊断研究中，招募了年龄在 3 个月至 15 岁之间患有 AFI 的儿童，并使用系统的诊断方案进行评估，包括血培养、针对选择的细菌病原体的全血 PCR、疟疾诊断以及针对 21 种病毒和 4 种细菌呼吸道病原体的鼻咽拭子多重 PCR。
共纳入了 589 例患有 AFI 的儿童，其中 575 例考虑了传染病。急性呼吸道感染、疟疾和侵袭性细菌感染（IBI）分别占 AFI 病例的 179 例（31.1%）、175 例（30.4%）和 75 例（13%）；16 例（21.3%）的 IBI 病例也存在疟原虫血症。有呼吸道症状的 157 例儿童（90.7%）从鼻咽部检测到病毒病原体。所有患有病毒性呼吸道感染的儿童中，154 例（92.4%）接受了抗生素治疗，而在 13 例（17%）的 IBI 病例中没有提供抗生素。
病毒性呼吸道感染是高疟疾传播地区儿童 AFI 的常见病因，仅次于疟疾和 IBI。这些发现强调了干预措施以改善针对微生物的靶向治疗的重要性。大多数患有病毒感染的患者不必要地使用了抗生素，而相当数量的 IBI 患者未接受抗生素治疗。
