Causes of fever in a cohort of Nepali children and the potential impact of molecular testing during a dengue fever outbreak
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Identifying the cause of infection is important for clinical management and public health decisions, including vaccination strategies.
In low-resource settings, causes of fever are often not identified. In this study, molecular testing panels were used to identify the causes of pediatric fever in the Kathmandu Valley, Nepal. A dengue fever outbreak facilitated the investigation of dengue diagnostics.
Methods: Children under 14 years of age were recruited to this prospective cohort study at Patan Hospital, Nepal. Clinical data and routine diagnostics were used to classify cases, including nonstructural protein 1 (NS1) antigen testing for dengue. Additional molecular diagnostics were performed on blood (12 viral, 26 bacterial and 6 fungal targets) and respiratory samples (17 viral and 3 bacterial targets).
Results: From September 1, 2021, to April 19, 2023, 565 children were enrolled, median age 3 (interquartile-range 1–7) years. Pathogens identified included dengue virus (n = 101), respiratory syncytial virus (n = 30), influ enza (n = 25), typhoidal Salmonella spp. (n = 7) and Neisseria meningitidis (n = 2). During the dengue outbreak, dengue olymerase chain reaction (PCR) and NS1 positivity rates were both high early in dengue disease, but if >3 days of symptoms, PCR positivity rates declined (10.3%) while NS1 positivity remained high into the second week of illness (80%).
Conclusions: This prospective cohort study is the most comprehensive effort to date to describe the causes of pediatric fever in the Kathmandu Valley, Nepal. The United States Centers for Disease Control and Pre vention recommends dengue PCR or NS1 antigen testing during the first 7 days of dengue fever. Our data indicate that PCR positivity declines after 3 days of symptoms, resulting in missed cases when relying solely on PCR.
In low-resource settings, causes of fever are often not identified. In this study, molecular testing panels were used to identify the causes of pediatric fever in the Kathmandu Valley, Nepal. A dengue fever outbreak facilitated the investigation of dengue diagnostics.
Methods: Children under 14 years of age were recruited to this prospective cohort study at Patan Hospital, Nepal. Clinical data and routine diagnostics were used to classify cases, including nonstructural protein 1 (NS1) antigen testing for dengue. Additional molecular diagnostics were performed on blood (12 viral, 26 bacterial and 6 fungal targets) and respiratory samples (17 viral and 3 bacterial targets).
Results: From September 1, 2021, to April 19, 2023, 565 children were enrolled, median age 3 (interquartile-range 1–7) years. Pathogens identified included dengue virus (n = 101), respiratory syncytial virus (n = 30), influ enza (n = 25), typhoidal Salmonella spp. (n = 7) and Neisseria meningitidis (n = 2). During the dengue outbreak, dengue olymerase chain reaction (PCR) and NS1 positivity rates were both high early in dengue disease, but if >3 days of symptoms, PCR positivity rates declined (10.3%) while NS1 positivity remained high into the second week of illness (80%).
Conclusions: This prospective cohort study is the most comprehensive effort to date to describe the causes of pediatric fever in the Kathmandu Valley, Nepal. The United States Centers for Disease Control and Pre vention recommends dengue PCR or NS1 antigen testing during the first 7 days of dengue fever. Our data indicate that PCR positivity declines after 3 days of symptoms, resulting in missed cases when relying solely on PCR.
Date Issued
2026-07-01
Date Acceptance
2026-01-05
Citation
Pediatric Infectious Disease Journal, 2026, 45 (7), pp.e224-e228
ISSN
0891-3668
Publisher
Ovid Technologies (Wolters Kluwer Health)
Start Page
e224
End Page
e228
Journal / Book Title
Pediatric Infectious Disease Journal
Volume
45
Issue
7
Copyright Statement
© 2026 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and repro- duction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1097/INF.0000000000005167
Subjects
polymerase chain reaction
molecular
Nepal
dengue
diagnostics
Publication Status
Published