title: Challenges of establishing the correct diagnosis of outbreaks of acute febrile illnesses in Africa: the case of a likely Brucella outbreak among nomadic pastoralists, northeast Kenya, March-July 2005.
abstract: An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.
authors: Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mari@cdc.gov
authors: Mary D
authors: MD
authors: Ari
authors: Argata
authors: A
authors: Guracha
authors: Moustafa Abdel
authors: MA
authors: Fadeel
authors: Charles
authors: C
authors: Njuguna
authors: M Kariuki
authors: MK
authors: Njenga
authors: Rosalia
authors: R
authors: Kalani
authors: Hassan
authors: H
authors: Abdi
authors: Osman
authors: O
authors: Warfu
authors: Victor
authors: V
authors: Omballa
authors: Christopher
authors: C
authors: Tetteh
authors: Robert F
authors: RF
authors: Breiman
authors: Guillermo
authors: G
authors: Pimentel
authors: Daniel R
authors: DR
authors: Feikin
mesh_terms: D000293:Adolescent; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D002002:Brucella / Q000276:immunology; D002006:Brucellosis / Q000175:diagnosis* / Q000453:epidemiology*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis; D008297:Male; D008892:Milk / Q000382:microbiology; D019095:Point-of-Care Systems; D014171:Transients and Migrants; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial