Etiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia

Trop Med Int Health. 2022 Jan 13. doi: 10.1111/tmi.13721. Online ahead of print.


Objective: Causes of acute febrile illness (AFI) often remain undetermined in developing countries, due to overlap of symptoms and limited available diagnostics. We aimed to assess the etiology of AFI in adults in a referral hospital in northwest Ethiopia.

Methods: While all participants were tested for malaria by rapid diagnostic test (RDT), microscopy was only done on physician's request. Dengue virus (DENV) infections were detected using an RDT and ELISAs and dengue, yellow fever and chikungunya cases were identified by PCR. Bacterial etiologies were investigated using blood culture and PCR.

Results: The etiology of acute infection was identified for 20.5% of 200 patients enrolled. 11.0% tested positive for Plasmodium, while microscopy was only requested for half of the identified malaria cases. For 4.0% of the Plasmodium-infected patients, an acute or past DENV (co-)infection was detected. We found 7.5% acute and 13.0% past DENV - all serotype 3 - infections. Bacterial infections were observed in 4.5% of the patients.

Conclusion: Malaria is still a considerable etiology of AFI and dengue is underrecognized. There are areas where both diseases occur concomitantly, and the DENV-3 serotype spreads from Sudan to northern Ethiopia. As only 20.5% of the etiologies were identified, a broader testing platform is required.

Keywords: Acute febrile illness; arbovirus; bacteria; etiology; malaria; northwest Ethiopia.