Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
Programa de Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
BMC Med. 2020 Sep 21;18(1):294. doi: 10.1186/s12916-020-01746-z.
In malaria-endemic countries, febrile episodes caused by diseases other than malaria are a growing concern. However, limited knowledge of the prevalent etiologic agents and their geographic distributions restrict the ability of health services to address non-malarial morbidity and mortality through effective case management. Here, we review the etiology of fever in Latin America (LA) between 1980 and 2015 and map significant pathogens commonly implicated in febrile infectious diseases.
A literature search was conducted, without language restrictions, in three distinct databases in order to identify fever etiology studies that report laboratory-confirmed fever-causing pathogens that were isolated from usually sterile body sites. Data analyses and mapping was conducted with Tableau Desktop (version 2018.2.3).
Inclusion criteria were met by 625 publications corresponding to data relative to 34 countries. Studies using serology (n = 339) predominated for viral infections, culture (n = 131) for bacteria, and microscopy (n = 62) for fungi and parasites. The pathogen groups most frequently reported were viral infections (n = 277), bacterial infections (n = 265), parasitic infections (n = 59), fungal infections (n = 47), and more than one pathogen group (n = 24). The most frequently reported virus was dengue virus (n = 171), followed by other arboviruses (n = 55), and hantavirus (n = 18). For bacteria, Staphylococcus spp. (n = 82), Rickettsia spp. (n = 70), and Leptospira spp. (n = 55) were frequently reported. Areas with biggest gaps on etiology of fever were apparent.
This review provides a landscape of pathogens causing febrile illness other than malaria in LA for over 30 years. Our findings highlight the need to standardize protocols and report guidelines for fever etiology studies for better comparability of results and improved interpretation. Lastly, we should improve existing national laboratory surveillance systems, especially from low- to middle-income countries, to inform global fever policy priorities and timely identify emerging infections threats.
PROSPERO systematic review registration number: CRD42016049281.
在疟疾流行的国家，由疟疾以外的疾病引起的发热病例日益受到关注。然而，由于对常见病原体及其地理分布的了解有限，卫生服务机构难以通过有效的病例管理来解决非疟疾发病率和死亡率问题。在此，我们回顾了 1980 年至 2015 年拉丁美洲（LA）发热的病因，并绘制了常见引起发热性传染病的病原体的地理分布。
我们在三个不同的数据库中进行了无语言限制的文献检索，以确定报告从通常无菌部位分离出的经实验室确认的引起发热的病原体的发热病因研究。使用 Tableau Desktop（版本 2018.2.3）进行数据分析和绘图。
符合纳入标准的出版物有 625 篇，对应于 34 个国家的数据。血清学研究（n=339）居多，用于病毒感染；培养（n=131）用于细菌感染；显微镜检查（n=62）用于真菌感染和寄生虫感染。最常报告的病原体组为病毒感染（n=277）、细菌感染（n=265）、寄生虫感染（n=59）、真菌感染（n=47）和多种病原体组感染（n=24）。最常报告的病毒是登革热病毒（n=171），其次是其他虫媒病毒（n=55）和汉坦病毒（n=18）。对于细菌，金黄色葡萄球菌（n=82）、立克次体（n=70）和钩端螺旋体（n=55）常被报告。发热病因方面，仍存在明显的知识空白。
本综述提供了过去 30 多年来拉丁美洲地区引起发热的除疟疾以外的病原体全景图。我们的研究结果强调需要标准化协议和报告发热病因研究的指南，以提高结果的可比性和更好地进行解释。最后，我们应该改进现有的国家实验室监测系统，特别是从中低收入国家，为全球发热政策重点提供信息，并及时发现新出现的感染威胁。
PROSPERO 系统评价注册编号：CRD42016049281。
