Pathogens causing acute febrile illness among children and adolescents in Burkina Faso, Madagascar and Sudan


Florian Marks, Jie Liu, Abdramane Bassiahi Soura, Nagla Gasmelseed, Darwin Operario, Brian Grundy, John Wieser, Jean Gratz, Christian G Meyer, Justin Im, Jacqueline Kyungah Lim, Vera von Kalckreuth, Ligia Maria Cruz Espinoza, Frank Konings, Hyon Jin Jeon, Raphaël Rakotozandrindrainy, Jixian Zhang, Ursula Panzner, and Eric Houpt


The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood.
Blood samples taken from study participants with acute fever (≥37.5°C) or a history of fever and recruited into the previous Typhoid-Fever-Surveillance-in-Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral and parasitic pathogens. Clinical metadata were also assessed.
A total of 615 blood samples available for analysis originated from Burkina Faso (n=53), Madagascar (n=364) and Sudan (n=198) and were taken from participants ranging from 0-19 years of age. Most individuals [86.4% (531/615)] presenting at healthcare facilities were outpatient adolescents (11-19 years-old). Leading clinical diagnoses were respiratory tract infections [45.9% (282/615)], malaria [27.3% (168/615)], and gastrointestinal tract infections [10.7% (66/615)]. Through the TaqMan-Array Card, at least one pathogen was detected in 62% (33/53), 24% (86/364), and 60% (118/198) of specimens, from Burkina Faso, Madagascar and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25/53), 2.2% (8/364) and 45% (90/198) of AFI at respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357/516) of patients with clinical diagnoses of malaria, respiratory, or gastrointestinal infections were prescribed a WHO-guideline-recommended empiric antibiotic, whereas only 45% (106/237) of patients with pathogens detected were treated with an antibiotic exerting likely activity.
A PCR-approach for identifying multiple bacterial, viral and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome.

Click here to read the article, published in Clinical Infectious Diseases.