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Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

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  • Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina; Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya; Centers for Disease Control and Prevention, Nairobi, Kenya; Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya; Durham Veterans Affairs Medical Center, Durham, North Carolina

In Kenya, more than 10 million episodes of acute febrile illness are treated annually among children under 5 years. Most are clinically managed as malaria without parasitological confirmation. There is an unmet need to describe pathogen-specific etiologies of fever. We enrolled 370 febrile children and 184 healthy controls. We report demographic and clinical characteristics of patients with Plasmodium falciparum, group A streptococcal (GAS) pharyngitis, and respiratory viruses (influenza A and B, respiratory syncytial virus [RSV], parainfluenza [PIV] types 1–3, adenovirus, human metapneumovirus [hMPV]), as well as those with undifferentiated fever. Of febrile children, 79.7% were treated for malaria. However, P. falciparum was detected infrequently in both cases and controls (14/268 [5.2%] versus 3/133 [2.3%], P = 0.165), whereas 41% (117/282) of febrile children had a respiratory viral infection, compared with 24.8% (29/117) of controls (P = 0.002). Only 9/515 (1.7%) children had streptococcal infection. Of febrile children, 22/269 (8.2%) were infected with > 1 pathogen, and 102/275 (37.1%) had fevers of unknown etiology. Respiratory viruses were common in both groups, but only influenza or parainfluenza was more likely to be associated with symptomatic disease (attributable fraction [AF] 67.5% and 59%, respectively). Malaria was overdiagnosed and overtreated. Few children presented to the hospital with GAS pharyngitis. An enhanced understanding of carriage of common pathogens, improved diagnostic capacity, and better-informed clinical algorithms for febrile illness are needed.

Author Notes

* Address correspondence to Wendy P. O'Meara, Duke University, Box 5760, Eldoret 30100, Kenya. E-mail: wpo@duke.edu

Financial support: This study was supported by a pilot grant from Duke Global Health Institute.

Authors' addresses: Wendy P. O'Meara, Division of Infectious Diseases and International Health, Duke University Medical Center, Duke Global Health Institute, Durham, NC, and Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya, E-mail: wpo@duke.edu. Joshua A. Mott, Barry Fields, and Kabura Wamburu, Centers for Disease Control and Prevention, Nairobi, Kenya, E-mails: zud9@cdc.gov, bsf2@cdc.gov, and WKabura@kemricdc.org. Jeremiah Laktabai and Janice Armstrong, Moi University School of Medicine, College of Health Sciences, Eldoret, Kenya, E-mails: drlaktabai@yahoo.com and janasimiyu@yahoo.com. Steve M. Taylor and Christopher W. Woods, Division of Infectious Diseases and International Health, Duke University Medical Center, Duke Global Health Institute, Durham Veterans Affairs Medical Center, Durham, NC, E-mails: steve.taylor@duke.edu and chris.woods@duke.edu. Charles MacIntyre, Reeshi Sen, and William Pan, Duke Global Health Institute, Durham, NC, E-mails: cwmacintyre@gmail.com, reeshisen00@gmail.com, and william.pan@duke.edu. Diana Menya, Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya, E-mail: dianamenya@gmail.com. Bradly P. Nicholson, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham Veterans Affairs Medical Center, Durham, NC, E-mail: brad.nicholson@duke.edu. Thomas L. Holland, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, E-mail: Thomas.Holland@duke.edu.

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