Persistent febrile illnesses in Nepal: A systematic review

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dc.contributor.authorKoirala, KDen_US
dc.contributor.authorChappuis, Fen_US
dc.contributor.authorVerdonck, Ken_US
dc.contributor.authorRijal, Sen_US
dc.contributor.authorBoelaert, Men_US
dc.date.accessioned2020-04-10T01:40:05Z
dc.date.available2020-04-10T01:40:05Z
dc.date.issued2018-10
dc.description.abstractBackground & objectives: Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute febrile illnesses (AFIs). In contrast, there are limited data on the causes of persistent febrile illnesses (PFIs) in LMIC. Lack of clarity on the differential diagnosis of PFIs in the rural tropics leads to the absence of diagnostic guidance tools. Methods: In this study, a review of the potential causes of persistent fever defined as fever of more than seven days was done in Nepal, with a focus on nine pathogen-specific conditions. The current knowledge on their burden, distribution and diagnosis was summarized. Results: Limited data were found on the incidence and public health burden of leptospirosis, murine typhus and brucellosis due to the absence of diagnostic tools outside reference laboratories and the overlap of signs and symptoms with other febrile conditions. The incidence of malaria and visceral leishmaniasis (VL) was found to be decreasing in Nepal, with some changes of the geographical areas at risk. Interpretation & conclusions: This review indicates a need for more research on the causes of PFIs in Nepal and in the region and for the development of clinical guidance tailored to current local epidemiology. Guidance tools should include specific clinical features (e.g. eschar), results of rapid diagnostic tests (e.g. malaria, VL), appropriate indications for more sophisticated tests (e.g. abdominal ultrasound, polymerase chain reaction) and recommendations for adequate use of empirical treatment.en_US
dc.identifier.affiliationsDepartment of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal; Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium; Institute of Global Health, University of Geneva, Geneva, Switzerlanden_US
dc.identifier.affiliationsInstitute of Global Health, University of Geneva; Division of Tropical & Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerlanden_US
dc.identifier.affiliationsEpidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgiumen_US
dc.identifier.affiliationsDepartment of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepalen_US
dc.identifier.citationKoirala KD, Chappuis F, Verdonck K, Rijal S, Boelaert M. Persistent febrile illnesses in Nepal: A systematic review. Indian Journal of Medical Research. 2018 Oct; 148(4): 385-395en_US
dc.identifier.issn0971-5916
dc.identifier.issn0975-9174
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/195682
dc.languageenen_US
dc.publisherIndian Council of Medical Researchen_US
dc.relation.issuenumber4en_US
dc.relation.volume148en_US
dc.source.urihttps://dx.doi.org/10.4103/ijmr.IJMR_505_18en_US
dc.subjectDifferential diagnosisen_US
dc.subjectepidemiologyen_US
dc.subjectmalariaen_US
dc.subjectNepalen_US
dc.subjectpersistent febrile illnessesen_US
dc.subjectvisceral leishmaniasisen_US
dc.titlePersistent febrile illnesses in Nepal: A systematic reviewen_US
dc.typeJournal Articleen_US
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