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Title: Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens
Authors: Thomas Althaus
Janjira Thaipadungpanit
Rachel C. Greer
Myo Maung Maung Swe
Sabine Dittrich
Pimnara Peerawaranun
Pieter W. Smit
Tri Wangrangsimakul
Stuart Blacksell
Jonas M. Winchell
Maureen H. Diaz
Nicholas P.J. Day
Frank Smithuis
Paul Turner
Yoel Lubell
Foundation for Innovative New Diagnostics, Switzerland
Municipal Health Service of Amsterdam
Centers for Disease Control and Prevention
Mahidol University
Nuffield Department of Clinical Medicine
Myanmar-Oxford Clinical Research Unit (MOCRU), Medical Action Myanmar (MAM)
Maasstad Ziekenhuis
Angkor Hospital for Children
Keywords: Medicine
Issue Date: 1-Jul-2020
Citation: International Journal of Infectious Diseases. Vol.96, (2020), 334-342
Abstract: © 2020 The Author(s) Objectives: This study investigated causes of fever in the primary levels of care in Southeast Asia, and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens. Methods: Blood and nasopharyngeal swab specimens were taken from children and adults with fever (>37.5 °C) or history of fever (<14 days) in Thailand and Myanmar. Results: Of 773 patients with at least one blood or nasopharyngeal swab specimen collected, 227 (29.4%) had a target organism detected. Influenza virus type A was detected in 85/227 cases (37.5%), followed by dengue virus (30 cases, 13.2%), respiratory syncytial virus (24 cases, 10.6%) and Leptospira spp. (nine cases, 4.0%). Clinical outcomes were similar between patients with a bacterial or a viral organism, regardless of antibiotic prescription. CRP was higher among patients with a bacterial organism compared with those with a viral organism (median 18 mg/L, interquartile range [10–49] versus 10 mg/L [≤8–22], p = 0.003), with an area under the curve of 0.65 (95% CI 0.55–0.75). Conclusions: Serious bacterial infections requiring antibiotics are an exception rather than the rule in the first line of care. CRP testing could assist in ruling out such cases in settings where diagnostic uncertainty is high and routine antibiotic prescription is common. The original CRP randomised controlled trial was registered with, number NCT02758821.
ISSN: 18783511
Appears in Collections:Scopus 2020

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