Publication: Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens
Issued Date
2020-07-01
Resource Type
ISSN
18783511
12019712
12019712
Other identifier(s)
2-s2.0-85085378856
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Mahidol University
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SCOPUS
Bibliographic Citation
International Journal of Infectious Diseases. Vol.96, (2020), 334-342
Suggested Citation
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 Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens. International Journal of Infectious Diseases. Vol.96, (2020), 334-342. doi:10.1016/j.ijid.2020.05.016 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/56230
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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
Other Contributor(s)
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
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
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 ClinicalTrials.gov, number NCT02758821.