Colorized scanning electron micrograph of filamentous Ebola virus particles (blue) rising from a chronically contaminated cell (yellow-green) of a cell tradition line. Credit score: NIAID, NIH
A brand new retrospective, laboratory-based observational research supplies detailed insights into the causes of fevers of unknown origin in sub-Saharan Africa. Along with scientists from Guinea and Slovakia, researchers from the German Middle for An infection Analysis (DZIF) at Charité—Universitätsmedizin Berlin examined 550 sufferers from Guinea who developed a persistent fever on the time of the foremost Ebola outbreak in 2014, however examined damaging for the Ebola virus on web site.
The aim was to make use of trendy diagnostic strategies to higher perceive the underlying infectious illnesses. The research is printed in The Journal of Infectious Ailments.
Fever is a typical symptom of many illnesses, together with infections, most cancers, and autoimmune illnesses. When the reason for a persistent fever stays unclear regardless of in depth investigation, it’s known as fever of unknown origin (FUO). Roughly half of all FUO instances worldwide stay undiagnosed.
In sub-Saharan Africa, malaria is commonly suspected and handled with out laboratory affirmation or additional investigation. Nevertheless, 90 million pediatric hospitalizations per 12 months in sub-Saharan Africa are attributable to fevers not attributable to malaria however by different infections, usually attributable to numerous micro organism and viruses.
A analysis workforce from the German Middle for An infection Analysis (DZIF) and Charité—Universitätsmedizin Berlin, in collaboration with scientists from Guinea and Slovakia, carried out a retrospective observational research to completely examine the pathogen variety of sufferers from Guinea with fever of unknown trigger throughout a serious Ebola outbreak in 2014. They mixed epidemiological, phylogenetic, molecular, serological and medical knowledge.
Utilizing serologic exams, PCR and high-throughput sequencing, a minimum of one pathogen was detected in 275 of 550 sufferers. Along with the anticipated malaria parasite Plasmodium, pathogenic micro organism equivalent to Salmonella and Klebsiella strains have been detected in virtually one-fifth of the sufferers.
The frequent detection of resistance to so-called first-line antibiotics within the samples examined and the excessive charge of co-infections have been additionally worrying: 1 in 5 contaminated sufferers had a number of infections on the similar time. Pathogens inflicting malaria and bacterial sepsis have been notably widespread, occurring collectively in 12% of adults and 12.5% of youngsters.
Infections with extremely pathogenic viruses have been additionally widespread: Yellow fever, Lassa and Ebola viruses have been detected by RT-PCR in about 6% of sufferers. Of explicit word was the detection of an infection with Orungo virus, a little-known pathogen for which there aren’t any sturdy assays.
Utilizing immunofluorescence assays, the researchers additionally recognized IgM antibodies in opposition to a number of viruses, together with Dengue, West Nile and Crimean-Congo hemorrhagic fever viruses, in sufferers who have been PCR-negative.
“In Africa, febrile illnesses of unknown cause are often recognized and treated as malaria without further diagnosis. In our study, we were able to detect a pathogen in about half of all patients with FUO, including bacterial pathogens that cause sepsis, hemorrhagic fever viruses including Ebola, and, as expected, various strains of the malaria parasite Plasmodium,” explains the research’s final writer Prof. Jan Felix Drexler.
The findings underscore the pressing have to additional strengthen laboratory capability in sub-Saharan Africa. Early detection of the infectious causes of FUO is essential for affected person care, efficient response to outbreaks, and growth of regionally applicable diagnostics.
“Our results show that regionally adapted treatment regimens should be discussed, that quality control in the context of outbreaks needs to be strengthened, and that knowledge of the pathogen spectrum can guide targeted strengthening of regional laboratories and translational research in the sense of point-of-care tests,” Drexler summarizes.
Extra info:
Ignacio Postigo-Hidalgo et al, Elucidating Infectious Causes of Fever of Unknown Origin: A Laboratory-Based mostly Observational Research of Sufferers with Suspected Ebola Virus Illness, Guinea, 2014, The Journal of Infectious Ailments (2024). DOI: 10.1093/infdis/jiae637
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