59 Causes of Fever in Africa

David Mabey 04/10/18

Malaria? In 2010 the guidelines changed to say every suspected malaria needed a rapid diagnostic test. And also since 2000 malaria cases have decreased by around 40% globally!

So this means the cances you have malaria when you turn up with fever, are less likely!

As RDT’s became more likely, the proportion of patients getting antibiotics has gone up (for empiric bacterial)

So WHO needs antibiotics? And WHAT antibiotics do they need?

What’s the breakdown? Of school kids in Tanzania (1000 kids)

  • 50% have acute resp tract infection (1/3 URTI, 15% pneumonia)
  • 10% malaria
  • 10% systemic infections (which were mostly viral, 80%)
  • 10% nasopharyngeal infection
  • 8% gastroenteritis
  • 3% typhoid
  • 0.2% meningitis

Of the kids with severe illness

  • 20% pneumonia
  • 25% malaria
  • 6% typhoid

59.1 Invasive Bacterial Disease In African Children

Of children admitted to hospital: 6.6% of children had a positive blood cultre, accounting for 1/4 deaths

Descending order of positive blood cultures in tanzanian children

  • Salmonella (non-typhoid)
  • Strep. pneumoniae
  • S. typhi (but incidence now increasing and one of most common)
  • E. coli
  • S. aureus
  • Kelbsieela
  • Cryptococcus

The distribution of what bugs school age kids get changes across Africa

59.1.1 Risk Factors For Invasive Bacterial Infections in African Children

  • Malnutrition (doubles risk)
  • HIV (triples risk)
  • Hospital Admission (increases risk by almost 40x)
  • Sickle Cell Disease (increases your odds of bacteraemia by 26x)
  • Malaria
  • Poverty
  • Age

Malaria particularly increases your risk of non-typhi salmonella. Especially amongst those who had recently had malaria. NTS are present in around ~5% of childrens guts normally in Tanzania.

Note your sickle cell trait reduces your risk of bactaraemia, this is because it reduces your risk of malaria. And being protected against malaria protects you against bacteraemia.

So a severly ill child with Malaria should get an antibiotic!

59.2 Empiric Treatment with Abx in kids with Severe Malaria

What bugs are resistant to what?

The problem is that invasive bacterial infections is rapidly increasing.

59.3 HIV Positive Patients with Severe Sepsis

TB!!!!

Responsible for 1/4 of patients with sepsis.

You can use the LAM test (urinary antigen test) plus Gene Xpert (this will allow you to catch more than 80% of cases)

59.4 Leptospirosis

Fisherman, Jaundice, Conjunctival Injection - Think Leptospirosis

Leptospirosis is a zoonosis

Can get across world, water workers

TAKE CLINICAL FEATURES FROM SLIDES

Usually diagnose serologically but can also be done with microscopy

Up to 20% of inpatients with non-specific febrile illnesses had leptospirosis in metaanalysis in africa.

Can cause pulmonary haemorrhage

59.5 Meingococcal Meningitis

There is a band across africa known as the meningitis belt!

Can be treated ith a single dose of ceftriaxone or long-acting chloramphenicol (tifomycin)