Opportunities and challenges to accurate diagnosis and management of acute febrile illness in adults and adolescents: A review

• Published in: Acta tropica Vol. 227; p. 106286
• Main Authors: Grundy, Brian S, Houpt, Eric R
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-03-2022
• Subjects: Adolescent; Adult; Africa; Anti-Bacterial Agents - therapeutic use; Antibiotics; Asia; Communicable Diseases; Diagnostics; Fever; Fever - diagnosis; Fever - drug therapy; Fever - etiology; Guidelines; Humans; Malaria - drug therapy; Urinary Tract Infections; Diagnostics; Antibiotics; Asia; Fever; Africa; Guidelines
• ISSN: 0001-706X; 1873-6254
• DOI: 10.1016/j.actatropica.2021.106286

•Acute febrile illnesses have many potential causes yet usually lack accurate diagnosis.•Declining malaria rates require further investigation of other fever etiologies.•Viral illnesses and bacterial zoonoses are common underdiagnosed causes of fever.•Clinical guidelines for undifferentiated non-malarial fever have limitations.•Further development of syndromic algorithms, pathogen diagnostics, and/or biomarkers is needed.
Acute febrile illnesses are common reasons to seek healthcare globally. They can be caused by diverse infectious diseases which require complex diagnostics. Current clinical guidelines provide guidance on how to manage severe illness, common localizing infections like pneumonia and urinary tract infections, as well as malaria. How to manage other cases of acute febrile illness is less clear and is the focus of this review. Without an etiologic diagnosis, clinicians frequently prescribe empiric antibiotics that may be unnecessary or inadequate. We reviewed recent studies on the etiology of acute febrile illnesses in adults and adolescents that employed multiple diagnostic modalities, including rapid diagnostic tests, serologies, and polymerase chain reaction. Although studies and etiologies were heterogenous, we enumerated the causes of febrile illness in these studies. Possible improvements in clinical decision-making algorithms are discussed.