scholarly journals Rickettsioses and Q Fever in Tanzania: Estimating the Burden of Pervasive and Neglected Causes of Severe Febrile Illness in Sub-Saharan Africa

Author(s):  
Paul W. Blair ◽  
Mohammed Lamorde ◽  
J. Stephen Dumler
Author(s):  
David Ndeereh ◽  
Gerald Muchemi ◽  
Andrew Thaiyah

Many factors contribute to misdiagnosis and underreporting of infectious zoonotic diseases in most sub-Saharan Africa including limited diagnostic capacity and poor knowledge. We assessed the knowledge, practices and attitudes towards spotted fever group rickettsioses (SFGR) and Q fever amongst local residents in Laikipia and Maasai Mara in Kenya. A semistructured questionnaire was administered to a total of 101 respondents including 51 pastoralists, 17 human health providers, 28 wildlife sector personnel and 5 veterinarians. The pastoralists expressed no knowledge about SFGR and Q fever. About 26.7% of the wildlife sector personnel in Laikipia expressed some knowledge about SFGR and none in Maasai Mara. None of these respondents had knowledge about Q fever. About 45.5 and 33.3% of the health providers in Laikipia and Maasai Mara respectively expressed knowledge about SFGR and 9.1% in Laikipia expressed good knowledge on Q fever and none in Maasai Mara. The diseases are not considered amongst potential causes of febrile illnesses in most medical facilities except in one facility in Laikipia. Majority of pastoralists practiced at least one predisposing activity for transmission of the diseases including consumption of raw milk, attending to parturition and sharing living accommodations with livestock. Education efforts to update knowledge on medical personnel and One-Health collaborations should be undertaken for more effective mitigation of zoonotic disease threats. The local communities should be sensitized through a multidisciplinary approach to avoid practices that can predispose them to the diseases.


BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035632 ◽  
Author(s):  
Heidi Hopkins ◽  
Quique Bassat ◽  
Clare IR Chandler ◽  
John A Crump ◽  
Nicholas A Feasey ◽  
...  

IntroductionFever commonly leads to healthcare seeking and hospital admission in sub-Saharan Africa and Asia. There is only limited guidance for clinicians managing non-malarial fevers, which often results in inappropriate treatment for patients. Furthermore, there is little evidence for estimates of disease burden, or to guide empirical therapy, control measures, resource allocation, prioritisation of clinical diagnostics or antimicrobial stewardship. The Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study seeks to address these information gaps.Methods and analysisFIEBRE investigates febrile illness in paediatric and adult outpatients and inpatients using standardised clinical, laboratory and social science protocols over a minimum 12-month period at five sites in sub-Saharan Africa and Southeastern and Southern Asia. Patients presenting with fever are enrolled and provide clinical data, pharyngeal swabs and a venous blood sample; selected participants also provide a urine sample. Laboratory assessments target infections that are treatable and/or preventable. Selected point-of-care tests, as well as blood and urine cultures and antimicrobial susceptibility testing, are performed on site. On day 28, patients provide a second venous blood sample for serology and information on clinical outcome. Further diagnostic assays are performed at international reference laboratories. Blood and pharyngeal samples from matched community controls enable calculation of AFs, and surveys of treatment seeking allow estimation of the incidence of common infections. Additional assays detect markers that may differentiate bacterial from non-bacterial causes of illness and/or prognosticate illness severity. Social science research on antimicrobial use will inform future recommendations for fever case management. Residual samples from participants are stored for future use.Ethics and disseminationEthics approval was obtained from all relevant institutional and national committees; written informed consent is obtained from all participants or parents/guardians. Final results will be shared with participating communities, and in open-access journals and other scientific fora. Study documents are available online (https://doi.org/10.17037/PUBS.04652739).


2018 ◽  
Vol 24 (8) ◽  
pp. 808-814 ◽  
Author(s):  
M.J. Maze ◽  
Q. Bassat ◽  
N.A. Feasey ◽  
I. Mandomando ◽  
P. Musicha ◽  
...  

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Jesse Waggoner ◽  
Julie Brichard ◽  
Francis Mutuku ◽  
Bryson Ndenga ◽  
Claire Jane Heath ◽  
...  

Abstract Background In sub-Saharan Africa, malaria is frequently overdiagnosed as the cause of an undifferentiated febrile illness, whereas arboviral illnesses are presumed to be underdiagnosed. Methods Sera from 385 febrile Kenyan children, who presented to 1 of 4 clinical sites, were tested using microscopy and real-time molecular assays for dengue virus (DENV), chikungunya virus (CHIKV), malaria, and Leptospira. Results Malaria was the primary clinical diagnosis for 254 patients, and an arboviral infection (DENV or CHIKV) was the primary diagnosis for 93 patients. In total, 158 patients (41.0%) had malaria and 32 patients (8.3%) had CHIKV infections. Compared with real-time polymerase chain reaction, microscopy demonstrated a percent positive agreement of 49.7%. The percentage of malaria cases detected by microscopy varied significantly between clinical sites. Arboviral infections were the clinical diagnosis for patients on the Indian Ocean coast (91 of 238, 38.2%) significantly more often than patients in the Lake Victoria region (2 of 145, 1.4%; P < .001). However, detection of CHIKV infections was significantly higher in the Lake Victoria region (19 of 145 [13.1%] vs 13 of 239 [5.4%]; P = .012). Conclusions The clinical diagnosis of patients with an acute febrile illness, even when aided by microscopy, remains inaccurate in malaria-endemic areas, contributing to inappropriate management decisions.


2020 ◽  
Author(s):  
Ross M. Boyce ◽  
Matthew Collins ◽  
Rabbison Muhindo ◽  
Regina Nakakande ◽  
Emily J Ciccone ◽  
...  

Background: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. Methods: Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. Results: Only 6 of 1,416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p<0.001). Conclusions: Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics.


Author(s):  
Johan van Griensven ◽  
Lieselotte Cnops ◽  
Anja De Weggheleire ◽  
Steven Declercq ◽  
Emmanuel Bottieau

Abstract


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ross M. Boyce ◽  
Matthew Collins ◽  
Rabbison Muhindo ◽  
Regina Nakakande ◽  
Emily J. Ciccone ◽  
...  

Abstract Background The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. Methods Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. Results Only 6 of 1416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p < 0.001). Conclusions Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics.


PLoS ONE ◽  
2019 ◽  
Vol 14 (7) ◽  
pp. e0220371 ◽  
Author(s):  
Paul Roddy ◽  
Ursula Dalrymple ◽  
Tomas O. Jensen ◽  
Sabine Dittrich ◽  
V. Bhargavi Rao ◽  
...  

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