Table 1.
Acute Febrile Illness studies evaluating more than one pathogen in Latin America, 2007-2016
| [Reference] design | Study location/type of healthcare type/[setting] | Study time | Inpatient/outpatient | Inclusion criteria | N | Age group | Diagnostic tests conducted | Pathogens detected (%) |
|---|---|---|---|---|---|---|---|---|
| Caribe | ||||||||
| [24] [prospective] | Bridgetown, Barbados [tertiary hospital/urban] | 2009–2011 | Inpatient | Febrile children admitted to hospital with negative testing for DENV | 272 | Children [<15 years] | DENV/Hantavirus serology | Hantavirus (14) DENV (0) Undetermined (86) |
| [16] [prospective] | Trinidad and Tobago [primary health clinic] | 2013–2014 | Outpatient | Febrile (axillary temperature of ≥38°C) or history of fever <7 days without an identifiable focus of infection | 158 | Adult [18–88 years] | DENV/CHIKV serology DENV/CHIKV RT-PCR |
CHIKV(19) DENV (66) Undetermined (29) |
| [8] [prospective] | Willemstad, Curacao [tertiary hospital/urban] | 2008–2009 | Both [55.6% were admitted] | Febrile patients (rectal temperature ≥ 38.5° C) presenting at ED | 403 | Adult [18–80 years] | Bacterial cultures DENV serology |
Klebsiela pneumoniae (92) DENV (3.72) Parasite/fungi (1.98) |
| [11] [prospective] | Ponce, Puerto Rico [tertiary hospital/urban] Guayama, Puerto Rico [hospital/urban] |
2012–2015 | Both [24.9% hospitalized] | AFI (≥38 C [oral] or ≥ 38.5 C [axillary] or reported a history of fever ≤7 days duration) | 8996 | Children & Adult | DENV/CHIKV/FLUA/B/AdV/HRSV/HMPV/PIV/HRV/HCoV/Coxiella burnetii/Rickettsia rickettsia/R. typhi/Ehrlichia chaffensis/EV RT-PCR DENV/CHIKV/Lepto/Burkholderia pseudomallei/Rickettsia spp./Ehrlichia spp./Coxiella spp. serology |
CHIKV(18.2) FLUA/B (11.9) DENV (10.8) Respiratory viruses (10.3) EV (0.9) Lepto (0.1) Melioidosis (0.02) |
| [18] [prospective] | Ponce, Puerto Rico [tertiary hospital/urban] | 2009 | Both [19% admitted] | Surveillance of AFI: All ages; fever (≥38° C) or history of fever <7 days, without an identified source | 284 | Children & Adult [6 months–82 years] | Influenza RT-PCR Influenza RDT DENV RT-PCR DENV serology Lepto serology EV PCR Blood Culture Urine Culture |
FLUA (80) DENV(18.6) Lepto (0.58) EV (1.74) E coli (0.58) S saprophyticus (0.58) |
| Central & South America | ||||||||
| [10] [prospective] | Cordoba, Colombia [tertiary hospital/urban] | 2012–2013 | Inpatient | UTFI (fever without a focus of infection) admitted to ED | 100 | Children & Adult [1–79 years] | DENV serology Lepto MAT Hantavirus serology Rickettsia serology Brucellosis antigen Malaria smear HAV/HBV serology |
Lepto (27) DENV(26) Hanta (4) Malaria (4) Rickett (2) HAV (1) Brucellosis (1) HBV (0) |
| [19] [prospective] | Multicenter, Nicaragua [health facilities/hospitals/urban/rural] | 2015–2016 | Both [68.9% hospitalized] | AFI (within 7 days of illness onset) suspected of arboviruses | 346 | Adult [>15 years] | ZIKV/CHIKV/DENV RT-PCR | ZIKV (13.6) CHIKV (26.3) DENV (15.6) Undetermined (24) |
| [20] [retrospective] | Mato Grosso, Brazil [urban] | 2011–2012 | NR | AFI (<5 days) and suspected of DENV | 604 | Children & Adult [10–59 years] | MAYV/Aura virus/East/West/Venezuelan equine encephalitis virus/DENV RT-PCR | MAYV (2.5) DENV (1.98) |
| [17] [cross-sectional] | Campo Grande, MS, Brazil [primary health clinic/urban] | 2016 | Both [9 admitted] | Suspicion of arboviral infections and <7 days of illness | 134 | Adult [>15 years] | DENV/CHIKV/ZIKV serology DENV/CHIKV/ZIKV/MAYV RT-PCR |
Undetermined (20.8) ZIKV(28.3) DENV(26.8) CHIKV (38) MAYV (0) |
| [31] [prospective] | Léon, Nicaragua [tertiary Hospital/rural/urban] | 2008–2009 | Both | Febrile (≥38.5° C) patients ≥ 1 month old | 825 | Children & Adult [≥1 month old] | Rickettsia serology Rickettsia RT-PCR Q Fever serology Q fever RT-PCR |
Rickett (4.54) Q fever (1.87) Undetermined (95.4%) |
| [23] [prospective] | Recife, Brazil [health clinic/urban] | 2015–2016 | Both | Age ≥ 5 years; fever or history of fever ≤72 h; undifferentiated fever; non-severe illness | 263 | Children & Adult [6–67 years] | ZIKV/CHIKV/DENV serology ZIKV/CHIKV/DENV RT-PCR DENV/ZIKV PRNT |
DENV(0.38) ZIKV (15.9) CHIKV (52) Undetermined (68.4) |
| [21] [cross-sectional] | Puerto Maldonado, Peru [primary health care units/urban/rural] | 2016 | Outpatients | AFI (≥38 C < 7 days) but without an identified focus of fever | 139 | Children & Adult [0–45 years] | DENV/OROV/CHIKV/MAYV/ZIKV RT-PCR | CHIKV (9.35) OROV (8.63) DENV (6.47) ZIKV (5) Undetermined (70.5) |
| [12] [prospective] | Rio de Janeiro, Brazil [tertiary hospital/urban] | 2015–2016 | Inpatients | Suspected DENV | 30 | NR | DENV/CHIKV/ZIKV serology DENV/CHIKV/ZIKV RT-PCR |
ZIKV (56.6) CHIKV(3.33) Undetermined (40%) |
| [13] [cross-sectional] | Villa del Rosario, Colombia [hospital/urban/rural] | 2015–2016 | Outpatient | Any age, suspected of arboviruses and <7 of fever | 157 | Children & Adult [0–50 years] | DENV/CHIKV/ZIKV RT-PCR | DENV(40) CHIKV (57) ZIKV (35) Undetermined (47.7) |
| [14] [cross-sectional] | Piura, Peru [primary health clinics/rural] | 2016 | Outpatient | AFI (axillary temperature ≥ 38° C) and <7 days | 496 | Children & Adult [0–60 years] | DENV/CHIKV/ZIKV RT-PCR | DENV (34.2) ZIKV (7.86) CHIKV (4.6) Undetermined (53.2) |
| [15] [prospective] | Villeta, Cundinamarca, Colombia [hospital/urban/rural] | 2011–2013 | Outpatient | AUFS and suspected of DENV | 104 | Children & Adult [10–60 years] | DENV/Lepto/Rickett/Anaplasma /Q fever serology |
DENV (16.3) Lepto (24) Rickett (5.76) Q fever (0) Undetermined (53.8) |
| [9] [retrospective] | Uraba antioqueno, Colombia [health clinics/urban/rural] | 2007–2008 | Outpatients | NMFI [malaria smear negative]; axillary temperature ≥ 38° C; <7 days; without an source of infection; 5–65 years | 220 | Children & Adult [10–40 years] | DENV/Lepto/Rickett/Hanta/Arena serology | DENV (37.2) Lepto (14) Rickett (2.72) Arenavirus (0.45) Hantavirus (0) Undetermined (52.2%) |
AdV, adenovirus; AFI, acute febrile illness; AUFS, acute undifferentiated febrile syndrome; CHIKV, chikungunya virus; DENV, dengue virus; EV, enterovirus; FLU A/B, influenza A/B; HAV, hepatitis A virus; HBV, hepatitis B virus; HCoV, human coronaviruses; HMPV, human metapneumovirus; HRSV, human respiratory syncytial virus; HRV, human rhinovirus; Lepto, Leptospirosis; MAT, microscopic agglutination test; MAYV, mayaro virus; NMFI, non-malaria febrile illness; NR, not reported; OROV, oropouche virus; PIV, parainfluenza virus; PRNT, plaque reduction neutralization assay; RDT, rapid diagnostic test; Rickett, rickettsioses; RT-PCR, reverse transcriptase polymerase chain reaction; ZIKV, zika virus.