A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone

Han Wang, Jing Zhao, Na Xie, Wanxue Wang, Ruping Qi, Xiaogang Hao, Yan Liu, Stephen Sevalie, Guotao Niu, Yangli Zhang, Ge Wu, Xiaona Lv, Yuhao Chen, Yanfei Ye, Sheng Bi, Moses Moseray, Saidu Cellessy, Ksaidu Kalon, Dawud Ibrahim Baika, Qun Luo, Han Wang, Jing Zhao, Na Xie, Wanxue Wang, Ruping Qi, Xiaogang Hao, Yan Liu, Stephen Sevalie, Guotao Niu, Yangli Zhang, Ge Wu, Xiaona Lv, Yuhao Chen, Yanfei Ye, Sheng Bi, Moses Moseray, Saidu Cellessy, Ksaidu Kalon, Dawud Ibrahim Baika, Qun Luo

Abstract

Introduction: Sierra Leone has one of the highest burdens of febrile illnesses in the world. As the incidence of malaria diminishes, a better understanding of the spectrum of etiological agents was important for accurate diagnosis and empirical treatment of febrile illness.

Methods: Blood, nasopharyngeal, and fecal specimens were collected from febrile patients for serological, molecular detection, and microbiologic culture to identify potential pathogens.

Results: For this prospective study, 142 febrile patients were enrolled. The prevalence of malaria was higher in children aged 5-15 years old (P = 0.185) and adults (P = 0.018). Acute respiratory infection (ARI) presented more commonly in the under 5 years old group (P = 0.009). For diarrhea, all children groups (P = 0.024) were predominant. A total of 22.5% of the febrile patients had malaria infection, 19.7% had typhoid infection, and 2.8% were coinfected with malaria and typhoid. ARI was the most common causes of fever, accounting for 31.7% of patients, influenza A virus, Mycoplasma pneumoniae, and five other respiratory pathogens were found. Diarrhea accounted for 16.2%, and seven kinds of diarrhea bacteria were isolated. Hepatitis B accounted for 8.5%, including five cases of spontaneous bacterial peritonitis, and ascites smear staining were both Gram-negative bacteria. Tuberculous encephalitis, parasitic diseases (ascaris and filariasis), and skin infection caused by Staphylococcus aureus accounted for 0.7%, 2.1%, and 0.7%, respectively.

Conclusions: Evidence of a wide spectrum of febrile etiological agents other than malaria was identified. The spread of malaria rapid diagnostic tests (RDTs) out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. Antibiotics against Gram-negative bacteria are helpful for empirical treatment.

Keywords: Acute respiratory infection; Diarrhea; Fevers; Malaria; Typhoid.

Conflict of interest statement

We have no competing interests to declare.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The distribution of major diseases according to age group. The patients with major diseases were divided into four groups:  55 years old (elderly group) [27]. Of the 32 malaria patients, 6 (18.8%) were  55 years old. 45 cases of acute respiratory infection, the distribution of the above four age groups: 15 cases (33.3%), 9 cases (20.0%), 11 cases (24.4%), and 10 cases (22.2%). The distribution of 28 cases of typhoid fever: 4 cases (15.4%), 8 cases (30.8%), 9 cases (34.6%), and 5 cases (19.2%). The distribution of 23 cases of diarrhea: 6 cases (26.1%), 8 cases (34.8%), 5 cases (21.7%), and 4 cases (17.4%), respectively. The chi-square test was used to compare the distribution of the age index. The differences in the distribution of the age group were statistically significant (χ2 = 16.732, P = 0.021). Briefly, malaria was predominant in children aged 5–15 years old (χ2 = 9.549, P = 0.185) and adults (χ2 = 18.852, P = 0.018). Diarrhea was predominant in children (χ2 = 15.358, P = 0.024), with a total proportion of 60% higher than adults and the elderly. Acute respiratory infection presented more commonly in < 5 years old (χ2 = 22.165, P = 0.009)
Fig. 2
Fig. 2
Flowchart of investigations performed in 142 febrile patients. PCR polymerase chain reaction, RDT rapid diagnostic test, CSF cerebrospinal fluid, ALT alanine aminotransferase, Ab antibody, SBP spontaneous bacterial peritonitis. ▲Nasal and throat PCR for respiratory agents: influenza A and B, respiratory syncytial virus, and parainfluenza
Fig. 3
Fig. 3
Distribution of clinical diagnoses among 142 febrile patients. Numbers are percentages of all diagnoses. The distribution of clinical diagnoses of febrile illness was as follows: 32 cases of malaria, 28 of typhoid, 23 of diarrhea, 20 of upper respiratory tract infection, 25 of lower respiratory tract infection,12 of hepatitis B infection, 4 of typical skin symptom, 3 of parasitic diseases, and 2 of meningismus. The parasitic diseases cases were from 2 patients with diarrhea and 1 patient with typical skin symptoms due to swelling of lower leg. Percentages may not sum to 100 because of coinfection and rounding

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