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.

中文翻译：

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塞拉利昂发热患者病原体的前瞻性研究

介绍

塞拉利昂是世界上发热性疾病负担最重的国家之一。随着疟疾发病率的降低，更好地了解病原体的范围对于发热性疾病的准确诊断和经验治疗非常重要。

方法

收集发热患者的血液、鼻咽和粪便标本进行血清学、分子检测和微生物培养，以确定潜在的病原体。

结果

对于这项前瞻性研究，招募了 142 名发热患者。5-15岁儿童（P  = 0.185）和成人（P  = 0.018）的疟疾患病率较高。急性呼吸道感染 (ARI) 在 5 岁以下组中更常见（P  = 0.009）。对于腹泻，所有儿童组（P  = 0.024）均占主导地位。共有22.5%的发热患者有疟疾感染，19.7%有伤寒感染，2.8%有疟疾和伤寒合并感染。ARI是发热的最常见原因，占患者的31.7%，甲型流感病毒、肺炎支原体，并发现了其他五种呼吸道病原体。腹泻占16.2%，分离出7种腹泻菌。乙肝占8.5%，其中自发性细菌性腹膜炎5例，腹水涂片染色均为革兰阴性菌。结核性脑炎、寄生虫病（蛔虫和丝虫病）、金黄色葡萄球菌引起的皮肤感染分别占0.7%、2.1%和0.7%。

结论

确定了除疟疾之外的多种发热病原体的证据。疟疾快速诊断检测（RDTs）在医院外的传播和Widal检测的国家标准的建立将减少发热性疾病的误诊。针对革兰氏阴性菌的抗生素有助于经验性治疗。