Chest radiography for predicting the cause of febrile illness among inpatients in Moshi, Tanzania

Aim To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. Materials and methods Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States....

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Published in:	Clinical radiology Vol. 68; no. 10; pp. 1039 - 1046
Main Authors:	Fiorillo, S.P, Diefenthal, H.C, Goodman, P.C, Ramadhani, H.O, Njau, B.N, Morrissey, A.B, Maro, V.P, Saganda, W, Kinabo, G.D, Mwako, M.S, Bartlett, J.A, Crump, J.A
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-10-2013
Subjects:	Adolescent Adult Aged Aged, 80 and over Child Child, Preschool Diagnosis, Differential Female Fever - etiology HIV Infections - complications HIV Infections - diagnostic imaging Humans Infant Male Middle Aged Mycoses - complications Mycoses - diagnostic imaging Pneumococcal Infections - complications Pneumococcal Infections - diagnostic imaging Predictive Value of Tests Q Fever - complications Q Fever - diagnostic imaging Radiography, Thoracic - methods Radiology Tanzania
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Summary:	Aim To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. Materials and methods Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever. Results Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii , whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. Conclusions Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0009-9260 1365-229X
DOI:	10.1016/j.crad.2013.05.002