Bibliographic Details
| Title: |
Challenges of acute febrile illness diagnosis in a national infectious diseases center in Rio de Janeiro: 16-year experience of syndromic surveillance. |
| Authors: |
Bressan, Clarisse da Silveira, Teixeira, Maria de Lourdes Benamor, Gouvêa, Maria Isabel Fragoso da Silveira, de Pina-Costa, Anielle, Santos, Heloísa Ferreira Pinto, Calvet, Guilherme Amaral, Lupi, Otilia, Siqueira, Andre Machado, Valls-de-Souza, Rogério, Valim, Clarissa, Brasil, Patrícia |
| Source: |
PLoS Neglected Tropical Diseases; 4/3/2023, Vol. 16 Issue 4, p1-13, 13p |
| Subject Terms: |
MEDICAL personnel, ACUTE diseases, COMMUNICABLE diseases, DENGUE hemorrhagic fever, SYMPTOMS, INNER cities |
| Geographic Terms: |
RIO de Janeiro (Brazil), BRAZIL |
| Abstract: |
Introduction: Acute febrile illnesses (AFI) are a frequent chief complaint in outpatients. Because the capacity to investigate the causative pathogen of AFIs is limited in low- and middle-income countries, patient management may be suboptimal. Understanding the distribution of causes of AFI can improve patient outcomes. This study aims to describe the most common etiologies diagnosed over a 16-years period in a national reference center for tropical diseases in a large urban center in Rio de Janeiro, Brazil. Methods: From August 2004-December 2019, 3591 patients > 12 years old, with AFI and/or rash were eligible. Complementary exams for etiological investigation were requested using syndromic classification as a decision guide. Results. Among the 3591 patients included, endemic arboviruses such as chikungunya (21%), dengue (15%) and zika (6%) were the most common laboratory-confirmed diagnosis, together with travel-related malaria (11%). Clinical presumptive diagnosis lacked sensitivity for emerging diseases such as zika (31%). Rickettsia disease and leptospirosis were rarely investigated and an infrequent finding when based purely on clinical features. Respiratory symptoms increased the odds for the diagnostic remaining inconclusive. Conclusions: Numerous patients did not have a conclusive etiologic diagnosis. Since syndromic classification used for standardization of etiological investigation and presumptive clinical diagnosis had moderate accuracy, it is necessary to incorporate new diagnostic technologies to improve diagnostic accuracy and surveillance capacity. Author summary: Different etiologies of acute fever may have an unspecific clinical presentation, especially in the early days of onset. Urban centers in low-and middle-income countries share the reality of overloaded healthcare systems—especially during outbreaks–whose diagnostic capacity is limited. Even in reference centers, determining the etiology of acute fever may not be possible in a large proportion of patients. The incidence of pathogens other than Malaria and Arboviruses is scarcely reported in Latin America. In cities where Dengue Fever is highly endemic, management of acutely ill patients is jeopardized by the unfamiliarity of health professionals with the spectrum possible diagnosis. Therefore, learning about the distribution of different etiologies of fever in outpatient services can impact positively in patient care. Since specific laboratory tests are determinant for differentiating among etiological agents of fever, further improvement for point-of-care diagnosis, as well as their availability for the front-row assistance settings is essential. This study aims to describe the most common etiologies of Acute Febrile Illnesses observed over a 16-year period time inside one of the largest reference centers for tropical diseases research in Brazil, discussing the accuracy of presumptive clinical diagnosis and the challenges of laboratorial investigation. [ABSTRACT FROM AUTHOR] |
|
Copyright of PLoS Neglected Tropical Diseases is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| Database: |
Complementary Index |
|
Full text is not displayed to guests. |
Login for full access.
|
