151. Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study
- Author
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Jean-Pierre Van Geertruyden, Marjan Van Esbroeck, Steve Ahuka-Mundeke, Sam Proesmans, Hypolite Muhindo Mavoko, Veerle Vanlerberghe, Freddy Katshongo, Raquel Inocêncio da Luz, Kevin K. Ariën, Birgit De Smet, Blaise Fungula, Pascal Lutumba, Lieselotte Cnops, and John Milambu
- Subjects
Male ,RNA viruses ,0301 basic medicine ,Viral Diseases ,Physiology ,RC955-962 ,Fevers ,Dengue virus ,Pathology and Laboratory Medicine ,medicine.disease_cause ,Biochemistry ,Dengue fever ,Serology ,Dengue ,0302 clinical medicine ,Arctic medicine. Tropical medicine ,Immune Physiology ,Outpatients ,Medicine and Health Sciences ,Chikungunya ,Enzyme-Linked Immunoassays ,Child ,Rapid diagnostic test ,Chikungunya Virus ,Immune System Proteins ,Yellow fever ,Middle Aged ,Infectious Diseases ,Arboviral Infections ,Medical Microbiology ,Child, Preschool ,Viral Pathogens ,Viruses ,Democratic Republic of the Congo ,Female ,Public aspects of medicine ,RA1-1270 ,Pathogens ,Research Article ,Neglected Tropical Diseases ,Adult ,medicine.medical_specialty ,Adolescent ,Fever ,Alphaviruses ,Immunology ,030231 tropical medicine ,Research and Analysis Methods ,Microbiology ,Antibodies ,Togaviruses ,Young Adult ,03 medical and health sciences ,Signs and Symptoms ,Diagnostic Medicine ,Internal medicine ,parasitic diseases ,Parasitic Diseases ,medicine ,Humans ,Seroprevalence ,Immunoassays ,Microbial Pathogens ,Aged ,Biology and life sciences ,Flaviviruses ,business.industry ,Organisms ,Public Health, Environmental and Occupational Health ,Chikungunya Infection ,Proteins ,Dengue Virus ,Tropical Diseases ,medicine.disease ,Malaria ,Cross-Sectional Studies ,030104 developmental biology ,Immunologic Techniques ,Chikungunya Fever ,Human medicine ,business - Abstract
Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections. Results Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment. Discussion Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings. Trial registration ClinicalTrials.gov NCT02656862., Author summary Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: “What causes the fever?” Previous studies have shown that the burden of arboviral infections–like dengue and chikungunya–in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with ‘undifferentiated fever’ at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.
- Published
- 2019