Indian Journal of Medical Research

SYSTEMATIC REVIEW
Year
: 2018  |  Volume : 148  |  Issue : 4  |  Page : 385--395

Persistent febrile illnesses in Nepal: A systematic review


Kanika Deshpande Koirala1, François Chappuis2, Kristien Verdonck4, Suman Rijal4, Marleen Boelaert4 
1 Department of Medicine, B.P. Koirala Institute of Health Science, Dharan, Nepal; Epidemiology and Control of Neglected Tropical Diseases Unit, Institute of Tropical Medicine, Antwerp, Belgium; Institute of Global Health, University of Geneva, Geneva, Switzerland
2 Institute of Global Health, University of Geneva; Division of Tropical & Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland

Correspondence Address:
Dr Marleen Boelaert
Epidemiology & Disease Control Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp
Belgium

Background & objectives: Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute febrile illnesses (AFIs). In contrast, there are limited data on the causes of persistent febrile illnesses (PFIs) in LMIC. Lack of clarity on the differential diagnosis of PFIs in the rural tropics leads to the absence of diagnostic guidance tools. Methods: In this study, a review of the potential causes of persistent fever defined as fever of more than seven days was done in Nepal, with a focus on nine pathogen-specific conditions. The current knowledge on their burden, distribution and diagnosis was summarized. Results: Limited data were found on the incidence and public health burden of leptospirosis, murine typhus and brucellosis due to the absence of diagnostic tools outside reference laboratories and the overlap of signs and symptoms with other febrile conditions. The incidence of malaria and visceral leishmaniasis (VL) was found to be decreasing in Nepal, with some changes of the geographical areas at risk. Interpretation & conclusions: This review indicates a need for more research on the causes of PFIs in Nepal and in the region and for the development of clinical guidance tailored to current local epidemiology. Guidance tools should include specific clinical features (e.g. eschar), results of rapid diagnostic tests (e.g. malaria, VL), appropriate indications for more sophisticated tests (e.g. abdominal ultrasound, polymerase chain reaction) and recommendations for adequate use of empirical treatment.


How to cite this article:
Koirala KD, Chappuis F, Verdonck K, Rijal S, Boelaert M. Persistent febrile illnesses in Nepal: A systematic review.Indian J Med Res 2018;148:385-395


How to cite this URL:
Koirala KD, Chappuis F, Verdonck K, Rijal S, Boelaert M. Persistent febrile illnesses in Nepal: A systematic review. Indian J Med Res [serial online] 2018 [cited 2020 Jul 10 ];148:385-395
Available from: http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2018;volume=148;issue=4;spage=385;epage=395;aulast=Koirala;type=0