M.J. Maze, Q. Bassat, N.A. Feasey, I. Mandomando, P. Musicha, J.A. Crump

Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies. To summarise recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria. A narrative literature review by searching the MEDLINE database, and recent conference abstracts. Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalised patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection, and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum betalactamase-producing Enterobacteriaceae and fluoroquinolone resistant Salmonella enterica. Among those with HIV infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important. Understanding the local epidemiology of fever aetiology, and use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalised patients infected with organisms that are not susceptible to empiric antibacterial regimens.