Presentation, aetiology and management of patients with acute febrile illness in outpatient setting in Eldoret, Kenya

Abstract

Background: Febrile illnesses cause significant mortality and morbidity and are a common presentation in the outpatient setting. Because hospital diagnoses in sub-Saharan Africa are often empirical and symptom-based, true causes of febrile illness are never established. Objectives: To describe the presentation, aetiology and management of patients presenting with an acute febrile illness in an outpatient setting. Methods: This was a cross-sectional study carried out at two sub-county hospitals in Eldoret. Consecutive patients 18 years and above presenting at the outpatient departments with tympanic temperature of 38oC and above were recruited. Demographic and clinical data were recorded and blood samples collected for complete blood count, aerobic and anaerobic blood cultures, thick blood smear for malaria parasites, malaria rapid diagnostic test, HIV test and random blood sugar. Identification and antibiotic susceptibility testing for all bacterial isolates were performed on positive cultures. Categorical variables were summarized as frequencies and percentages. Continuous variables were summarized as mean and median. Results: From January to September 2013, 180 participants were enrolled into the study: median age 28years (IQR 24-37); 99 (55%) male, 149 (83%) urban residents; and 4 (3%) tested positive for HIV. Most common presenting symptoms included headache 72 (18%), chills 61 (15.2%) and general body malaise 58 (14.5%). Median symptom durat ion was 3 days (IQR 2-4). Common clinical diagnoses made at the district hospitals were upper respiratory tract infection (URTI) with malaria in 35 (19.4%), URTI only in 32 (17.8%) and malaria only in 32 (17.8%) patients. Features of sepsis was present in 131 (72%) and 11 (6%) participants had signs of severe sepsis at presentation. Malaria was confirmed by RDT/blood slide in 42 (48.3%) participants. Of 180 blood cultures collected, 2 (1%; 95% CI: 0% - 4%) gram negative organisms were cultured; sphingomonas paucimobilis and sphingobacterium thalophilum. Antimalarials and antibiotics were prescribed to 87 (48.3%) and 167 (93%) participants respectively. Conclusions: Patients with acute febrile illness can present with nonspecific but severe symptoms; sepsis and severe sepsis. Laboratory work up other than BS and blood culture is important in ascertaining diagnosis and assessing of severity of illness. A number of patient with acute febrile illness receive antimicrobials without definite diagnosis. Recommendations: Triage of patients with acute febrile illnesses will assist in identifying those with severe symptoms. Ministry of Health guidelines on confirmatory diagnosis and treatment of malaria should be upheld. Additional local studies are required to establish causes of acute febrile illness in this population.