|dc.description.abstract||In sub-Saharan Africa, malaria is frequently over diagnosed as the cause of an undifferentiated febrile illness,
whereas arboviral illnesses are presumed to be underdiagnosed.
Sera from 385 febrile Kenyan children, who presented to 1 of 4 clinical sites, were tested using microscopy and real-time molecular assays for dengue virus (DENV), chikungunya virus (CHIKV), malaria, and Leptospira.
Malaria was the primary clinical diagnosis for 254 patients, and an arboviral infection (DENV or CHIKV) was the pri mary diagnosis for 93 patients. In total, 158 patients (41.0%) had malaria and 32 patients (8.3%) had CHIKV infections. Compared
with real-time polymerase chain reaction, microscopy demonstrated a percent positive agreement of 49.7%. The percentage of
malaria cases detected by microscopy varied significantly between clinical sites. Arboviral infections were the clinical diagnosis for
patients on the Indian Ocean coast (91 of 238, 38.2%) significantly more often than patients in the Lake Victoria region (2 of 145,
1.4%; P < .001). However, detection of CHIKV infections was significantly higher in the Lake Victoria region (19 of 145 [13.1%] vs
13 of 239 [5.4%]; P = .012).
The clinical diagnosis of patients with an acute febrile illness, even when aided by microscopy, remains inaccurate
in malaria-endemic areas, contributing to inappropriate management decisions.||en_US