Background

The aetiologies of fever are poorly understood in sub-Saharan Africa. We aimed to assess the burden of malaria and bacteria in Côte d’Ivoire.

Methods

Blood samples from 438 febrile and 346 afebrile people were screened using molecular tools.

Results

Plasmodium falciparum was the most common microorganism associated with fever (46.8% in febrile, 23.4% in afebrile people; p < 0.001). Bacteraemia was detected in 21.7% of febrile people and 12.7% of afebrile people (p = 0.001). Streptococcus pneumoniae was the main cause of bacteraemia (7.1% of febrile and 0.6% of afebrile individuals; p < 0.001). Non-typhoidal Salmonella spp. was detected in 4.5% of febrile people and 1.2% of afebrile individuals (p < 0.001). Salmonella enterica Typhi and S. enterica Paratyphi were only detected in febrile subjects (1.4% and 2.1%), as well as Tropheryma whipplei (0.9%), Streptococcus pyogenes (0.7%), and Plasmodium ovale (4.6%). The prevalence in febrile and afebrile people was similar for Staphylococcus aureus (3.6–4.9%), Rickettsia felis (5.5–6.4%), Mansonella perstans (3.0–3.2%), and Plasmodium malariae (1.6–2.3%). Comorbidities were higher in febrile than in afebrile subjects (10.3% versus 5.5%; p = 0.01); 82% involving P. falciparum. All patients co-infected with P. falciparum and S. pneumoniae were febrile whereas 30% of those infected by P. falciparum alone were not (p = 0.02). Among febrile participants, 30.4% with malaria and 54.7% with bacteraemia had received neither antimalarial nor antibiotic therapy.

Conclusion

Identification of etiologies of acute febrile diseases in sub-Saharan Africa proposes keys to successful treatment and prevention of infectious diseases. Vaccination campaigns may decrease the morbidity of mono- and co-infections by preventable microorganisms.

中文翻译：

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通过科特迪瓦发热性疾病和一线抗感染药的回顾性分子诊断评估疟疾和菌血症的负担

背景

在撒哈拉以南非洲地区，人们对发烧的病因知之甚少。我们旨在评估科特迪瓦的疟疾和细菌负担。

方法

使用分子工具筛选了来自 438 名发热者和 346 名不发热者的血液样本。

结果

恶性疟原虫是与发热相关的最常见微生物（发热者为 46.8%，无发热者为 23.4%；p  < 0.001）。在 21.7% 的发热人群和 12.7% 的无发热人群中检测到菌血症 ( p  = 0.001)。肺炎链球菌是菌血症的主要原因（7.1% 的发热个体和 0.6% 的非发热个体；p  < 0.001）。非伤寒沙门氏菌属 在 4.5% 的发热人群和 1.2% 的无发热个体中检测到了这种病毒 ( p  < 0.001)。伤寒沙门氏菌和肠副伤寒沙门氏菌仅在发热受试者（1.4% 和 2.1%）以及Tropherymawhippei 中检测到(0.9%)、化脓性链球菌(0.7%) 和卵形疟原虫(4.6%)。金黄色葡萄球菌(3.6–4.9%)、猫立克次体(5.5–6.4%)、持久曼森氏菌(3.0–3.2%) 和疟原虫(1.6–2.3%)在发热和不发热人群中的患病率相似。发热患者的合并症高于无发热患者（10.3% 对 5.5%；p  = 0.01）；82% 涉及恶性疟原虫。所有感染恶性疟原虫和肺炎链球菌的患者都发热，而单独感染恶性疟原虫的患者中有30% 不发热（p = 0.02）。在发热的参与者中，30.4% 的疟疾患者和 54.7% 的菌血症患者既未接受抗疟治疗，也未接受抗生素治疗。

结论

确定撒哈拉以南非洲急性发热性疾病的病因是成功治疗和预防传染病的关键。疫苗接种活动可能会降低可预防微生物引起的单一和混合感染的发病率。