Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar

Julia Guillebaud, Barivola Bernardson, Tsiry Hasina Randriambolamanantsoa, Laurence Randrianasolo, Jane Léa Randriamampionona, Cesare Augusto Marino, Voahangy Rasolofo, Milijaona Randrianarivelojosia, Ines Vigan-Womas, Voula Stivaktas, Marietjie Venter, Patrice Piola, Jean-Michel Héraud, Julia Guillebaud, Barivola Bernardson, Tsiry Hasina Randriambolamanantsoa, Laurence Randrianasolo, Jane Léa Randriamampionona, Cesare Augusto Marino, Voahangy Rasolofo, Milijaona Randrianarivelojosia, Ines Vigan-Womas, Voula Stivaktas, Marietjie Venter, Patrice Piola, Jean-Michel Héraud

Abstract

Background: The increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases.

Methodology: Consenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status.

Principal findings: A total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections.

Conclusions: These results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Map of Madagascar showing the…
Fig 1. Map of Madagascar showing the 21 sentinel sites selected for the study.
[Source: This map was generated using a free source of public domain available at: http://www.maplibrary.org/library/stacks/Africa/Madagascar/index.htm].
Fig 2. Proportions of diseases under surveillance…
Fig 2. Proportions of diseases under surveillance within the FSSN according to their respective case definition.
*p-value

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