Fever dilemma

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Science  09 Mar 2018:
Vol. 359, Issue 6380, pp. 1090-1092
DOI: 10.1126/science.359.6380.1090

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Until recently, in regions where malaria is common, nearly every feverish child was treated for the disease. Malaria was one of the deadliest causes of fever, but it was hard to diagnose. To be safe, health workers were trained to treat most fevers with a dose of antimalarial medicine. Rapid diagnostic tests for malaria have reduced unnecessary prescriptions for malaria medicines, but they exposed a new problem: the previously hidden prevalence of "negative syndrome"—feverish kids who don't have malaria. In 2014, the World Health Organization estimated that 142 million suspected malaria cases tested negative. When their one diagnostic test comes up negative, health workers in many clinics give the only other medicine they have: antibiotics. But bacterial infections cause only a small fraction of fevers. The unnecessary prescriptions can cause side effects in patients and increase the risk that antibiotic-resistant strains of bacteria will emerge and spread. Meanwhile, patients who have a fungal, parasitic, or viral infection don't get the drugs or supportive treatments that might actually help them recover. Public health advocates are starting to focus on better ways to diagnose what is causing a patient's fever. Some are gathering data on the myriad causes of fever. Others are working on robust diagnostic tests that can work in remote clinics. And others are developing electronic tools—diagnostic apps—that can help identify the patients most in need of additional treatment.