Causes of fever in Tanzanian adults attending outpatient clinics: a prospective cohort study

Abstract Objectives Exploring fever etiologies improves patient management. While most febrile adults are outpatients, all studies were conducted in inpatients. This study describes the spectrum of diseases in adults attending outpatient clinics in urban Tanzania. Methods We recruited consecutive adults with > 38°C in a prospective cohort study. We collected medical history and performed clinical examination. We performed 27’364 microbiological diagnostic tests (rapid tests, serologies, cultures and molecular analyses) for a large range of pathogens on blood and nasopharyngeal samples. We based our diagnosis on pre-defined clinical and microbiological criteria. Results Of 519 patients, 469/519 (89%) had a clinically or microbiologically documented infection and 128/519 (25%) were HIV-infected. We identified 643 diagnoses: 264/643 (41%) acute respiratory infections [36/643 (5.6%) pneumonia, 39/643 (6.1%) tuberculosis], 71/643 (11%) infections with another focus [31/643 (4.8%) gastrointestinal, 26/643 (4.0%) urogenital, 8/643 (1.2%) central nervous system] and 252/643 (39%) infections without focus [134/643 (21%) dengue, 30/643 (4.7%) malaria, 28/643 (4.4%) typhoid]. 318/519 (61%), 179/519 (34%), 30/519 (6%) and 15/519 (3%) of patients respectively had a viral, bacterial, parasitic and fungal acute infection. HIV-infected patients had more bacterial infections than HIV-negative [80/122 (66%) versus 100/391 (26%); p 200 cells/mm3, p=0.02]. Conclusions Viral diseases caused most febrile episodes in adults attending outpatient clinics except in HIV-infected patients. HIV status and a low CD4 level strongly determined the need for antibiotics. Systematic HIV screening is essential to appropriately manage febrile patients. Clinicaltrials.gov Identifier NCT01947075.