PDF(Pubmed)
Abstract：
BACKGROUND: Historically, malaria has been the predominant cause of acute febrile illness (AFI) in sub-Saharan Africa. However, during the last two decades, malaria incidence has declined due to concerted public health control efforts, including the widespread use of rapid diagnostic tests leading to increased recognition of non-malarial AFI etiologies. Our understanding of non-malarial AFI is limited due to lack of laboratory diagnostic capacity. We aimed to determine the etiology of AFI in three distinct regions of Uganda.
METHODS: A prospective clinic-based study that enrolled participants from April 2011 to January 2013 using standard diagnostic tests. Participant recruitment was from St. Paul\'s Health Centre (HC) IV, Ndejje HC IV, and Adumi HC IV in the western, central and northern regions, which differ by climate, environment, and population density. A Pearson\'s chi-square test was used to evaluate categorical variables, while a two-sample t-test and Krukalis-Wallis test were used for continuous variables.
RESULTS: Of the 1281 participants, 450 (35.1%), 382 (29.8%), and 449 (35.1%) were recruited from the western, central, and northern regions, respectively. The median age (range) was 18 (2-93) years; 717 (56%) of the participants were female. At least one AFI pathogen was identified in 1054 (82.3%) participants; one or more non-malarial AFI pathogens were identified in 894 (69.8%) participants. The non-malarial AFI pathogens identified were chikungunya virus, 716 (55.9%); Spotted Fever Group rickettsia (SFGR), 336 (26.2%) and Typhus Group rickettsia (TGR), 97 (7.6%); typhoid fever (TF), 74 (5.8%); West Nile virus, 7 (0.5%); dengue virus, 10 (0.8%) and leptospirosis, 2 (0.2%) cases. No cases of brucellosis were identified. Malaria was diagnosed either concurrently or alone in 404 (31.5%) and 160 (12.5%) participants, respectively. In 227 (17.7%) participants, no cause of infection was identified. There were statistically significant differences in the occurrence and distribution of TF, TGR and SFGR, with TF and TGR observed more frequently in the western region (p = 0.001; p < 0.001) while SFGR in the northern region (p < 0.001).
CONCLUSIONS: Malaria, arboviral infections, and rickettsioses are major causes of AFI in Uganda. Development of a Multiplexed Point-of-Care test would help identify the etiology of non-malarial AFI in regions with high AFI rates.
METHODS: A prospective clinic-based study that enrolled participants from April 2011 to January 2013 using standard diagnostic tests. Participant recruitment was from St. Paul\'s Health Centre (HC) IV, Ndejje HC IV, and Adumi HC IV in the western, central and northern regions, which differ by climate, environment, and population density. A Pearson\'s chi-square test was used to evaluate categorical variables, while a two-sample t-test and Krukalis-Wallis test were used for continuous variables.
RESULTS: Of the 1281 participants, 450 (35.1%), 382 (29.8%), and 449 (35.1%) were recruited from the western, central, and northern regions, respectively. The median age (range) was 18 (2-93) years; 717 (56%) of the participants were female. At least one AFI pathogen was identified in 1054 (82.3%) participants; one or more non-malarial AFI pathogens were identified in 894 (69.8%) participants. The non-malarial AFI pathogens identified were chikungunya virus, 716 (55.9%); Spotted Fever Group rickettsia (SFGR), 336 (26.2%) and Typhus Group rickettsia (TGR), 97 (7.6%); typhoid fever (TF), 74 (5.8%); West Nile virus, 7 (0.5%); dengue virus, 10 (0.8%) and leptospirosis, 2 (0.2%) cases. No cases of brucellosis were identified. Malaria was diagnosed either concurrently or alone in 404 (31.5%) and 160 (12.5%) participants, respectively. In 227 (17.7%) participants, no cause of infection was identified. There were statistically significant differences in the occurrence and distribution of TF, TGR and SFGR, with TF and TGR observed more frequently in the western region (p = 0.001; p < 0.001) while SFGR in the northern region (p < 0.001).
CONCLUSIONS: Malaria, arboviral infections, and rickettsioses are major causes of AFI in Uganda. Development of a Multiplexed Point-of-Care test would help identify the etiology of non-malarial AFI in regions with high AFI rates.
摘要：
背景：历史上，疟疾一直是撒哈拉以南非洲急性高热病（AFI）的主要原因。然而,在过去的二十年里，由于协调一致的公共卫生控制努力，疟疾发病率有所下降，包括快速诊断测试的广泛使用，从而增加了对非疟疾AFI病因的认识。由于缺乏实验室诊断能力，我们对非疟疾AFI的理解有限。我们旨在确定乌干达三个不同地区AFI的病因。
方法：一项基于前瞻性临床的研究，从2011年4月至2013年1月使用标准诊断测试招募参与者。参与者招募来自圣保罗健康中心（HC）IV，NdejjeHCIV,和西方的AdumiHCIV，中部和北部地区，因气候而异，环境,和人口密度。Pearson卡方检验用于评估分类变量，连续变量采用双样本t检验和Krukalis-Wallis检验。
结果：在1281名参与者中，450（35.1%），382（29.8%），和449名(35.1%)从西部招募，中央,和北部地区，分别。中位年龄（范围）为18（2-93）岁;717（56％）的参与者是女性。在1054名（82.3％）参与者中至少发现了一种AFI病原体；在894名（69.8％）参与者中发现了一种或多种非疟疾AFI病原体。确定的非疟疾AFI病原体是基孔肯雅病毒，716（55.9%）；斑点发热组立克次体（SFGR），336（26.2%）和斑疹伤寒组立克次体（TGR），97（7.6％）；伤寒（TF），74（5.8％）；西尼罗河病毒，7（0.5％）；登革热病毒，10（0.8％）和钩端螺旋体病，2例（0.2%）。没有发现布鲁氏菌病的病例。在404（31.5％）和160（12.5％）参与者中同时或单独诊断出疟疾。分别。在227名（17.7%）参与者中，未发现感染原因.TF的发生和分布差异有统计学意义。TGR和SFGR，在西部地区观察到TF和TGR的频率更高（p=0.001；p<0.001），而在北部地区观察到SFGR（p<0.001）。
结论：疟疾，虫媒病毒感染，立克次体病是乌干达AFI的主要原因。开发多重护理点测试将有助于确定AFI发病率高的地区非疟疾AFI的病因。
方法：一项基于前瞻性临床的研究，从2011年4月至2013年1月使用标准诊断测试招募参与者。参与者招募来自圣保罗健康中心（HC）IV，NdejjeHCIV,和西方的AdumiHCIV，中部和北部地区，因气候而异，环境,和人口密度。Pearson卡方检验用于评估分类变量，连续变量采用双样本t检验和Krukalis-Wallis检验。
结果：在1281名参与者中，450（35.1%），382（29.8%），和449名(35.1%)从西部招募，中央,和北部地区，分别。中位年龄（范围）为18（2-93）岁;717（56％）的参与者是女性。在1054名（82.3％）参与者中至少发现了一种AFI病原体；在894名（69.8％）参与者中发现了一种或多种非疟疾AFI病原体。确定的非疟疾AFI病原体是基孔肯雅病毒，716（55.9%）；斑点发热组立克次体（SFGR），336（26.2%）和斑疹伤寒组立克次体（TGR），97（7.6％）；伤寒（TF），74（5.8％）；西尼罗河病毒，7（0.5％）；登革热病毒，10（0.8％）和钩端螺旋体病，2例（0.2%）。没有发现布鲁氏菌病的病例。在404（31.5％）和160（12.5％）参与者中同时或单独诊断出疟疾。分别。在227名（17.7%）参与者中，未发现感染原因.TF的发生和分布差异有统计学意义。TGR和SFGR，在西部地区观察到TF和TGR的频率更高（p=0.001；p<0.001），而在北部地区观察到SFGR（p<0.001）。
结论：疟疾，虫媒病毒感染，立克次体病是乌干达AFI的主要原因。开发多重护理点测试将有助于确定AFI发病率高的地区非疟疾AFI的病因。
