Most Febrile Childhood Illnesses Are Viral, Do Not Need Antibiotics

Valérie D'Acremont, MD, PhD Group leader Swiss Tropical and Public Health Institute | Basel | Switzerland Médecin-adjointe, PD-MER Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland MedicalResearch.com Interview with:
Valérie D’Acremont, MD, PhD
Group leader
Swiss Tropical and Public Health Institute | Basel | Switzerland
Médecin-adjointe, PD-MER
Travel clinic | Department of Ambulatory Care and Community Medicine | University hospital of Lausanne | Switzerland

MedicalResearch.com: What are the main findings of the study?

Dr. D’Acremont: We discovered that, in a rural and an urban area of Tanzania, half of the children with fever (temperature >38°C) had an acute respiratory infection, mainly of the upper tract (5% only had radiological pneumonia). These infections were mostly of viral origin, in particular influenza. The other children had systemic viral infections such as HHV6, parvovirus B19, EBV or CMV. Overall viral diseases represented 71% of the cases. Only a minority (22%) had a bacterial infection such as typhoid fever, urinary tract infection or sepsis due to bacteremia. Malaria was found in only 10% of the children, even in the rural setting.

MedicalResearch.com: Were any of the findings unexpected?

Dr. D’Acremont: It was unexpected to find so many respiratory infections, and so many viral diseases in general. We knew that malaria had decreased during the last years, but for the rural setting we did not expect the proportion to be so low. The other surprise was to identify mostly cosmopolitan diseases rather than tropical vector-born diseases such as Dengue or Rift Valley. The latter infections are however often epidemic, and the study might have taken place between two outbreaks. In fact, we have documented last month an outbreak of Dengue fever in Dar for the first time. The other reason for the predominance of cosmopolitan illnesses is that young children get mainly infected at home by their relatives, and less often outside at the river, from animals or at work, as it is the case for adults.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. D’Acremont: The take-home message is that in Tanzania, as probably in other African countries and even continents, most febrile children do not need to be treated with antimicrobials (provided they do not present signs of severe disease and malaria has been excluded by a rapid test). In many places, clinicians tend to overprescribe antibiotics to be on the safe side, which leads to a rapid increase in drug resistance. The latter is known to be one of the major public health threat the world is facing today, including the African continent that has limited resources to fight it.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. D’Acremont: Among all these febrile children with self-limited infections, a few still suffer from a potentially dangerous disease. We have presently limited tools to distinguish between serious and benign infection (or even simple colonization), not only in Africa but also in Northern countries. New biomarkers need to be found, in particular host biomarkers that would have the advantage of identifying severe disease regardless of the microbiological cause. They should then be turned into point-of-care tests that can be used at primary care level, in conjunction with evidence based algorithms to ensure rational use of both tests and medicines.

Citation:
Beyond Malaria — Causes of Fever in Outpatient Tanzanian Children

Valérie D’Acremont, M.D., Ph.D., Mary Kilowoko, M.P.H., Esther Kyungu, M.D., M.P.H., Sister Philipina, R.N., Willy Sangu, A.M.O., Judith Kahama-Maro, M.D., M.P.H., Christian Lengeler, Ph.D., Pascal Cherpillod, Ph.D., Laurent Kaiser, M.D., and Blaise Genton, M.D., Ph.D.

N Engl J Med 2014; 370:809-817
February 27, 2014DOI: 10.1056/NEJMoa1214482