title: Causes of non-malarial febrile illness in outpatients in Tanzania.
abstract: OBJECTIVE
  In sub-Saharan Africa, the use of malaria rapid diagnostic tests (mRDT) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of mRDT-negative fever aetiologies among children and adults in Tanzania.
  
  
  METHODS
  A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative mRDT were enrolled from a Tanzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology.
  
  
  RESULTS
  Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X-rayed children meeting WHO pneumonia criteria, 47.4% had a normal X-ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2-14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively).
  
  
  CONCLUSIONS
  Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying African children in need of antibiotics among the majority who do not.
authors.affiliation: Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.|Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.
authors.forename: Helena
authors.initials: H
authors.lastname: Hildenwall
authors.affiliation: Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.
authors.forename: Ben
authors.initials: B
authors.lastname: Amos
authors.affiliation: Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.|National Institute for Medical Research, Amani Centre, Muheza, Tanga, Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Florida
authors.initials: F
authors.lastname: Muro
authors.affiliation: Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.|Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Cederlund
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
keywords: AIEPI; IMAI; Integrated Management of Adolescent and Adult Illness; Integrated Management of Childhood Illness; PCIME; Tanzania; Tanzanie; aetiology; etiología; fever; fiebre; fièvre; malaria; manejo integrado enfermedades en adultos; no-malaria; non paludique; non-malaria; étiologie