title: Etiology of pediatric fever in western Kenya: a case-control study of falciparum malaria, respiratory viruses, and streptococcal pharyngitis.
abstract: 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.
authors.affiliation: 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 wpo@duke.edu.
authors.forename: Wendy P
authors.initials: WP
authors.lastname: O'Meara
authors.affiliation: 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.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
authors.affiliation: 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.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Laktabai
authors.affiliation: 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.
authors.forename: Kabura
authors.initials: K
authors.lastname: Wamburu
authors.affiliation: 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.
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.affiliation: 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.
authors.forename: Janice
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: 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.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
authors.affiliation: 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.
authors.forename: Charles
authors.initials: C
authors.lastname: MacIntyre
authors.affiliation: 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.
authors.forename: Reeshi
authors.initials: R
authors.lastname: Sen
authors.affiliation: 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.
authors.forename: Diana
authors.initials: D
authors.lastname: Menya
authors.affiliation: 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.
authors.forename: William
authors.initials: W
authors.lastname: Pan
authors.affiliation: 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.
authors.forename: Bradly P
authors.initials: BP
authors.lastname: Nicholson
authors.affiliation: 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.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.affiliation: 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.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Holland
mesh_terms: D000208:Acute Disease; D000258:Adenovirus Infections, Human / Q000150:complications / Q000175:diagnosis; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000175:diagnosis; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D018184:Paramyxoviridae Infections / Q000150:complications / Q000175:diagnosis; D010612:Pharyngitis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000175:diagnosis; D012141:Respiratory Tract Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis; D013297:Streptococcus pyogenes / Q000302:isolation & purification