{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:02:50Z","timestamp":1791252170018,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,11,26]],"date-time":"2015-11-26T00:00:00Z","timestamp":1448496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In sub\u2010<jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>aharan <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>frica, the use of malaria rapid diagnostic tests (m<jats:styled-content style=\"fixed-case\">RDT<\/jats:styled-content>) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of m<jats:styled-content style=\"fixed-case\">RDT<\/jats:styled-content>\u2010negative fever aetiologies among children and adults in <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>anzania.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative m<jats:styled-content style=\"fixed-case\">RDT<\/jats:styled-content> were enrolled from a <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>anzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx\/throat and urine. Patients were followed on Days 7 and 14 and children meeting <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> criteria for pneumonia were followed on Day 2 with chest radiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339\/530) of children. Of 38 X\u2010rayed children meeting <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> pneumonia criteria, 47.4% had a normal X\u2010ray. Overall, only 1.3% of 1028 blood cultures were positive. <jats:italic>Salmonella typhi<\/jats:italic> was the most prevalent pathogen isolated (7\/13, 53.8%) and <jats:italic>S. typhi<\/jats:italic> patients reported fever for a median of 7 days (range 2\u201314). Children with bacteraemia did not present with <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24\/428 and 29\/498, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>frican children in need of antibiotics among the majority who do not.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12635","type":"journal-article","created":{"date-parts":[[2015,11,6]],"date-time":"2015-11-06T15:05:47Z","timestamp":1446822347000},"page":"149-156","source":"Crossref","is-referenced-by-count":37,"title":["Causes of non\u2010malarial febrile illness in outpatients in <scp>T<\/scp>anzania"],"prefix":"10.1111","volume":"21","author":[{"given":"Helena","family":"Hildenwall","sequence":"first","affiliation":[{"name":"Global Health \u2013 Health Systems and Policy Karolinska Institutet Stockholm Sweden"},{"name":"Joint Malaria Programme St Augustine's Hospital Muheza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Amos","sequence":"additional","affiliation":[{"name":"Joint Malaria Programme St Augustine's Hospital Muheza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Mtove","sequence":"additional","affiliation":[{"name":"Joint Malaria Programme St Augustine's Hospital Muheza Tanzania"},{"name":"National Institute for Medical Research Amani Centre Muheza Tanga Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florida","family":"Muro","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Centre Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Cederlund","sequence":"additional","affiliation":[{"name":"Department of Radiology Karolinska University Hospital Huddinge Sweden"},{"name":"Department of Clinical Science Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Reyburn","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,11,26]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Guidelines for the Treatment of Malaria","author":"WHO","year":"2010"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61270-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38251.658229.55"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-12-293"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"712","DOI":"10.4269\/ajtmh.2009.80.712","article-title":"Accuracy of malaria diagnosis by microscopy, rapid diagnostic test, and PCR methods and evidence of antimalarial overprescription in non\u2010severe febrile patients in two Tanzanian hospitals","volume":"80","author":"Nicastri E","year":"2009","journal-title":"Am J Trop Med Hyg"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040275"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002324"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02774.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214482"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0104197"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq103"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2012.08.006"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-12-338"},{"key":"e_1_2_7_15_1","volume-title":"Integrated Management of Childhood Illness Chart Booklet","author":"WHO\/UNICEF","year":"2008"},{"key":"e_1_2_7_16_1","unstructured":"WHO.Integrated management of adolescent and adult illness.Geneva: 2009 Contract No.: WHO\/CDS\/IMA I\/2004.1."},{"key":"e_1_2_7_17_1","unstructured":"WHO.Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children.Geneva: 2001 Contract No.: WHO\/V&B\/01.35."},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0691"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-10-290"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68180-4"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-13-400"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60888-X"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit798"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2106.140999"},{"key":"e_1_2_7_25_1","volume-title":"Pocket Book of Hospital Care of Children, Guidelines for the Management of Common Childhood Illnesses","author":"WHO","year":"2013"},{"issue":"1","key":"e_1_2_7_26_1","first-page":"119","article-title":"Integrated management of childhood illness: conclusions. 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