Study on causes of fever in primary healthcare center uncovers pathogens of public health concern in Madagascar.

BACKGROUND: The increasing use of malaria diagnostic tests reveals a growing proportion of patients with fever but no malaria. Clinicians and health care workers in low-income countries have few tests to diagnose causes of fever other than malaria although several diseases share common symptoms. We propose here to assess etiologies of fever in Madagascar to ultimately improve management of febrile cases. METHODOLOGY: Consenting febrile outpatients aged 6 months and older were recruited in 21 selected sentinel sites throughout Madagascar from April 2014 to September 2015. Standard clinical examinations were performed, and blood and upper respiratory specimens were taken for rapid diagnostic tests and molecular assays for 36 pathogens of interest for Madagascar in terms of public health, regardless of clinical status. PRINCIPAL FINDINGS: A total of 682 febrile patients were enrolled. We detected at least one pathogen in 40.5% (276/682) of patients and 6.2% (42/682) with co-infections. Among all tested patients, 26.5% (181/682) had at least one viral infection, 17.0% (116/682) had malaria and 1.0% (7/682) presented a bacterial or a mycobacterial infection. None or very few of the highly prevalent infectious agents in Eastern Africa and Asia were detected in this study, such as zoonotic bacteria or arboviral infections. CONCLUSIONS: These results raise questions about etiologies of fever in Malagasy communities. Nevertheless, we noted that viral infections and malaria still represent a significant proportion of causes of febrile illnesses. Interestingly our study allowed the detection of pathogens of public health interest such as Rift Valley Fever Virus but also the first case of laboratory-confirmed leptospirosis infection in Madagascar.

Typical Jaccoud's arthropathy in a patient with sarcoidosis.

Jaccoud's arthropathy (JA) is a deforming, non-erosive form of arthritis initially described in rheumatic fever but recently observed more frequently in patients with systemic lupus erythematosus. However, cases of JA have been described in association with other diffuse connective tissue diseases, neoplasias, and infection. We describe a rare case of sarcoidosis in a female subject who developed JA in her hands later in the course of the disease.

Crianças desnutridas pregressas, com sobrepeso e obesas apresentam desempenho motor pobre / Children with previous poor nutrition, overweigh and obesity demonstrated poor motor performance

O estudo objetiva investigar a associação entre o estado nutricional e o desempenho motor de crianças. Participaram 287 crianças, divididas entre 151 meninos e 136 meninas com idades entre 5 e 10 anos ( ou = 8,1+1,7dp) e estado nutricional recomendado para a idade (NCHS, 2002; ALVES, 2008). Avaliou-se o desempenho motor por meio do Test of Gross Motor Development - Second Edition - TGMD-2 (ULRICH, 2000). Como resultado obteve-se que, independentemente do estado nutricional, um maior número de meninas apresentou desempenho motor muito pobre quando comparadas aos meninos. Crianças grande obesas e obesas e com desnutrição pregressa apresentam maior incidência de desenvolvimento motor muito pobre. Concluiu-se que o estado nutricional foi um fator associado ao desempenho das habilidades motoras das crianças investigadas.

The objective of this study was to investigate the association between nutritional status and motor performance of children. Methods: The study included 287 children, 151 boys and 136 girls aged between 5 and 10 years ( or = 8.1+1.7 SD) with nutritional status recommended for age (NCHS, 2002; ALVES, 2008). We evaluated the motor performance through the Test of Gross Motor Development - Second Edition - TGMD-2 (Ulrich, 2000). Results: Despite of the nutritional status a higher number of girls exhibited a poor motor performance compared to the boys. Large obese, obese and with previous poor nutrition showed higher prevalence of poor motor performance. Conclusion: The nutritional status was associated with performance of motor skills in the investigated children.