Clinical presentations, diagnostics, treatments and treatment costs of children and adults with febrile illness in a tertiary referral hospital in south-eastern Guinea: a retrospective longitudinal cohort study.
Abstract Background Febrile illness is frequent among patients in the tropics. It is caused by a wide variety of common diseases such as malaria or gastrointestinal infections but also by less common but highly contagious pathogens with epidemic potential. This study describes the clinical features of adult and paediatric patients with febrile illness in in the largest tertiary referral hospital in south-eastern Guinea, a region at high risk for viral haemorrhagic fever outbreaks. The study further compares their diagnostic characteristics, treatments and outcomes with non-febrile patients in order to contribute to the local epidemiology of febrile illness. Methods We used retrospective data collection to record demographic and clinical data of all incoming patients during a study period of three months. For the follow-up study of inpatients, we retrospectively reviewed patient charts for diagnostic characteristics, diagnoses and outcomes. Results Of the 4317 patients admitted during the study period, 9.5% had a febrile illness. The majority of febrile adults (73.8%) and children (92.1%) were hospitalized after admission. By far, the most used diagnostic measures to identify causative agents in febrile patients were point-of-care tests. Treatments of febrile patients were mainly a combination of paracetamol and/or antibiotics. Most common discharge diagnoses for febrile inpatients were malaria (9.6% adults, 56.7% children), salmonella gastroenteritis/typhoid (10.6% adults, 7.8% children) and respiratory infection/pneumonia (5.3% adults, 18.7% children). Inpatient mortality for children was significantly higher in febrile than non-febrile children (18.5% vs. 5.1%, p < 0.001) and considerably higher in febrile than non-febrile adults (29.8% vs. 25.0%, p = 0.404). Conclusions The wide use of rapid diagnostic tests to identify causes of febrile illness highlights the low reliance on basic serological and advanced laboratory testing to research causative agents of febrile illness other than malaria or salmonella gastroenteritis/typhoid. This not only risks to over- or under-diagnose certain infectious diseases but also leaves the possibility of highly infectious diseases in febrile patients unexplored. Furthermore, healthcare facilities in south-eastern Guinea would benefit from antimicrobial stewardship due to their heavy reliance on antibiotics for treating febrile patients.