Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens
© 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 adu...
Saved in:
Main Authors: | , , , , , , , , , , , , , , |
---|---|
Other Authors: | |
Format: | Article |
Published: |
2020
|
Subjects: | |
Online Access: | https://repository.li.mahidol.ac.th/handle/123456789/56230 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Institution: | Mahidol University |
id |
th-mahidol.56230 |
---|---|
record_format |
dspace |
spelling |
th-mahidol.562302020-06-02T11:53:20Z Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens 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 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 Medicine © 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. 2020-06-02T04:53:20Z 2020-06-02T04:53:20Z 2020-07-01 Article International Journal of Infectious Diseases. Vol.96, (2020), 334-342 10.1016/j.ijid.2020.05.016 18783511 12019712 2-s2.0-85085378856 https://repository.li.mahidol.ac.th/handle/123456789/56230 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85085378856&origin=inward |
institution |
Mahidol University |
building |
Mahidol University Library |
continent |
Asia |
country |
Thailand Thailand |
content_provider |
Mahidol University Library |
collection |
Mahidol University Institutional Repository |
topic |
Medicine |
spellingShingle |
Medicine 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 |
description |
© 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. |
author2 |
Foundation for Innovative New Diagnostics, Switzerland |
author_facet |
Foundation for Innovative New Diagnostics, Switzerland 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 |
format |
Article |
author |
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 |
author_sort |
Thomas Althaus |
title |
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens |
title_short |
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens |
title_full |
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens |
title_fullStr |
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens |
title_full_unstemmed |
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogens |
title_sort |
causes of fever in primary care in southeast asia and the performance of c-reactive protein in discriminating bacterial from viral pathogens |
publishDate |
2020 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/56230 |
_version_ |
1763495969963376640 |