A recent laboratory study has offered valuable insights into the causes of fevers of unknown origin (FUO) in sub-Saharan Africa.
Collaborating with researchers from Guinea and Slovakia, scientists from the German Center for Infection Research (DZIF) at Charité — Universitätsmedizin Berlin focused their efforts on 550 patients who experienced persistent fever during the devastating Ebola outbreak in Guinea in 2014.
Remarkably, these patients tested negative for the Ebola virus on-site.
The researchers aimed to employ modern diagnostic techniques to uncover the infectious diseases that may have been responsible for these unexplained fevers.
Their findings have been published in The Journal of Infectious Diseases.
Understanding FUO in Sub-Saharan Africa
Fever is a common symptom that can arise from a variety of medical conditions, including infections, cancer, and autoimmune diseases.
When doctors can’t identify the underlying cause despite thorough investigations, the case is labeled FUO.
Globally, about half of FUO instances end up without a clear diagnosis.
In sub-Saharan Africa, malaria is often assumed to be the culprit and treated accordingly, sometimes without any laboratory verification or further exploration.
Research suggests something more complex; around 90 million pediatric hospitalizations each year in this region result from fevers caused by infections other than malaria, primarily tied to a range of bacteria and viruses.
Research Methodology and Findings
To delve into the array of pathogens responsible for these unexplained fevers during the Ebola crisis, the research team employed diverse methods, including epidemiological studies, phylogenetics, molecular diagnostics, serological assessments, and comprehensive clinical evaluations.
These approaches enabled the identification of previously undetected co-infections and provided insights into the interplay between viral infections and autoimmune diseases in affected individuals.
By integrating genomic and immunological data, the researchers uncovered patterns that distinguished various fever-causing agents, improving diagnostic accuracy.
Their findings contributed to the development of more targeted treatment and surveillance strategies for future outbreaks.
By leveraging advanced serological testing, PCR, and sequencing technologies, the scientists successfully identified at least one pathogen in 275 of the 550 patients studied.
Beyond the expected malaria-causing parasite, Plasmodium, they found harmful bacteria such as Salmonella and Klebsiella present in nearly 20 percent of the subjects.
Alarmingly, the study revealed high levels of antibiotic resistance among the samples, indicating a troubling prevalence of co-infections.
Specifically, one in five patients showed signs of multiple infections occurring simultaneously, with many suffering from both malaria and bacteria linked to sepsis—a concerning trend for both adults and children alike.
Additionally, several highly pathogenic viruses were detected; viruses like Yellow fever, Lassa, and Ebola were found in about six percent of the patients using RT-PCR tests.
Notably, the study identified Orungo virus, a lesser-known pathogen that currently lacks effective testing methodologies.
Researchers extended their investigation through immunofluorescence assays, which uncovered IgM antibodies against several viruses—including those responsible for Dengue, West Nile, and Crimean-Congo hemorrhagic fever—in patients who received negative PCR results.
Implications for Future Research and Health Strategies
The study’s authors emphasized that, in many cases in Africa, febrile illnesses with no identifiable source are often treated as malaria, typically without further diagnostic testing.
Their research was able to identify pathogens in almost half of the FUO cases examined.
The results encompassed not only bacterial pathogens associated with sepsis but also hemorrhagic fever viruses, including Ebola, alongside malaria parasites.
These findings underline the urgent need to enhance laboratory capabilities in sub-Saharan Africa.
Swift identification of the infectious agents driving FUO cases is crucial for improving patient outcomes, managing potential outbreaks effectively, and creating diagnostic resources tailored to the regional context.
The outcomes of this research encourage vital conversations around developing region-specific treatment protocols, improving quality control during outbreaks, and fostering a better understanding of the pathogen landscape.
Such knowledge is essential for strategically strengthening regional laboratories and supporting translational research that can facilitate effective point-of-care testing.
Source: Science Daily