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Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study
- Source :
- PLoS Neglected Tropical Diseases, PLoS neglected tropical diseases, PLoS Neglected Tropical Diseases, Vol 13, Iss 9, p e0007047 (2019)
- Publication Year :
- 2019
- Publisher :
- Public Library of Science (PLoS), 2019.
-
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.<br />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.
- 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
Subjects
Details
- ISSN :
- 19352735 and 19352727
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- PLOS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....07114a65ba7ead2dd68dcb32e49e5f68