Persistent febrile illnesses in Nepal: A systematic review

Area of Science:

• Tropical medicine
• Infectious diseases
• Public health

Background:

• Febrile illnesses are common in low- and middle-income countries (LMICs), but research often overlooks persistent febrile illnesses (PFIs).
• Limited data exists on the causes and diagnosis of PFIs in rural tropical settings.
• This lack of clarity hinders the development of essential diagnostic guidance tools.

Purpose of the Study:

• To review potential causes of persistent fever (over seven days) in Nepal.
• To summarize current knowledge on the burden, distribution, and diagnosis of nine specific pathogen-related conditions causing PFIs.
• To identify research gaps and inform the development of diagnostic guidance for PFIs in the region.

Main Methods:

• A literature review was conducted focusing on potential causes of persistent febrile illness in Nepal.
• The review summarized existing data on the burden, distribution, and diagnostic challenges of selected infectious agents.
• Emphasis was placed on pathogen-specific conditions relevant to PFIs.

Main Results:

• Data on leptospirosis, murine typhus, and brucellosis incidence and burden were limited due to diagnostic tool scarcity and symptom overlap.
• The incidence of malaria and visceral leishmaniasis (VL) is declining in Nepal, with shifts in geographical risk areas.
• Diagnostic challenges persist for several PFI-causing pathogens in resource-limited settings.

Conclusions:

• There is a critical need for enhanced research into the causes of PFIs in Nepal and surrounding regions.
• Development of clinical guidance tools tailored to local epidemiology is essential for improving PFI diagnosis and management.
• Effective guidance should integrate clinical features, rapid diagnostic test results, advanced testing indications, and empirical treatment recommendations.