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 over diagnosed and over-treated. 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.
