Research Article: Dengue and Chikungunya Fever among Viral Diseases in Outpatient Febrile Children in Kilosa District Hospital, Tanzania

Date Published: November 20, 2014

Publisher: Public Library of Science

Author(s): Beatrice Chipwaza, Joseph P. Mugasa, Majige Selemani, Mbaraka Amuri, Fausta Mosha, Steve D. Ngatunga, Paul S. Gwakisa, A. Desiree LaBeaud.

Abstract: IntroductionViral etiologies of fever, including dengue, Chikungunya, influenza, rota and adeno viruses, cause major disease burden in tropical and subtropical countries. The lack of diagnostic facilities in developing countries leads to failure to estimate the true burden of such illnesses, and generally the diseases are underreported. These diseases may have similar symptoms with other causes of acute febrile illnesses including malaria and hence clinical diagnosis without laboratory tests can be difficult. This study aimed to identify viral etiologies as a cause of fever in children and their co-infections with malaria.MethodsA cross sectional study was conducted for 6 months at Kilosa district hospital, Tanzania. The participants were febrile children aged 2–13 years presented at the outpatient department. Diagnostic tests such as IgM and IgG ELISA, and PCR were used.ResultsA total of 364 patients were enrolled, of these 83(22.8%) had malaria parasites, 76 (20.9%) had presumptive acute dengue infection and among those, 29(38.2%) were confirmed cases. Dengue was more likely to occur in children ≥ 5 years than in <5 years (OR 2.28, 95% CI: 1.35–3.86). Presumptive acute Chikungunya infection was identified in 17(4.7%) of patients. We observed no presenting symptoms that distinguished patients with Chikungunya infection from those with dengue infection or malaria. Co-infections between malaria and Chikungunya, malaria and dengue fever as well as Chikungunya and dengue were detected. Most patients with Chikungunya and dengue infections were treated with antibacterials. Furthermore, our results revealed that 5(5.2%) of patients had influenza virus while 5(12.8%) had rotavirus and 2(5.1%) had adenovirus.ConclusionOur results suggest that even though viral diseases are a major public health concern, they are not given due recognition as a cause of fever in febrile patients. Emphasis on laboratory diagnostic tests for proper diagnosis and management of febrile patients is recommended.

Partial Text: Febrile illness is one of the most common reasons for seeking medical attention. Febrile illnesses which are caused by different etiological agents are the leading cause of morbidity and mortality particularly in developing countries [1]. For many years, malaria has been the foremost cause of fever in children and it contributed for substantial under five mortalities in sub-Saharan Africa [2]. In recent years, there has been achievement in malaria control strategies which has led to a reduction of malaria prevalence as well as malaria transmission, morbidity and mortality [3]–[5]. However, despite the decrease of malaria, fever is still a major complaint among patients and thus highlights the importance of non malarial causes of fever. Recent studies have demonstrated that a high proportion of fevers are due to non-malaria febrile illnesses [6], [7]. Several non-malarial febrile illnesses due to different etiological agents have been reported in Tanzania. Diseases such as urinary tract infections, respiratory tract infections, and typhoid fever are among the most common particularly in children [7].

The total number of febrile children enrolled in the study was 364, including 186 (51.1%) males, 178 (48.9%) females. The patients aged less than 5 years were 205(56.3%) and above 5 years were 159 (43.7%). One hundred eighty four patients were enrolled during the rainy season while 180 during the dry season. The majority of patients (75.6%) had mild fever during the time of enrollment and only 5% had high fever. The duration of fever (history of fever) in many patients was between 1–7 days while few had fever for more than 7 days. Before recruitment 103 (28.3%) of the patients had received anti-malarials and antibacterials whereas 261 (71.7%) neither used anti-malarials nor antibacterials. The patients’ demographic characteristics, the enrollment season and temperature are summarized in Table 1.

We have demonstrated that DENV and CHIKV are among the viral etiologies of fevers in children in Kilosa district. To our knowledge, these diseases have neither been reported in this area nor have they been considered in the routine diagnosis of febrile patients in most health facilities in Tanzania. Our results have shown that many patients with malaria, presumptive acute CHIKV or DENV infections were clinically manifested by similar symptoms. Therefore, our findings point out the necessity of applying appropriate diagnostic tests in febrile patients.

In this study, we intended to bring attention on the presence of viral etiologies of febrile illnesses in Kilosa district. Our results suggest that DENV, CHIKV, rota and adeno viruses should be considered in differential diagnosis of patients with fever. Furthermore, we found that these diseases were manifested with similar symptoms hence clinical diagnosis alone was not sufficient to discriminate them. The absence of diagnostic facilities was shown to be a major factor leading to improper management such that most patients were prescribed with unwarranted antibacterials. With a significant decline of malaria-related fevers in malaria endemic areas, these findings suggest that emphasis on non-malarial febrile illnesses is of paramount importance and this should be accompanied with the use diagnostic tools to enable proper diagnosis and management of febrile illnesses.



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