Mots-clés
Fièvre d’origine indéterminée
Dengue
Chikungunya
cliniciens
République démocratique du Congo
Comment citer
Résumé
La fièvre est l'un des motifs principaux de consultation dans les formations médicales des pays tropicaux. Dans les pays tropicaux, le paludisme a toujours été le diagnostic le plus fréquemment évoqué en cas de fièvre. Cependant, avec le changement épidémiologique, le poids du paludisme a baissé et d'autres pathologies causant la fièvre ont pris de l'importance. Ainsi, certaines étiologies des fièvres ont pris plus d’importance mais malheureusement leur identification dépend des plateaux techniques performant de laboratoire et des cliniciens avertis. Parmi ces étiologies, les arboviroses comme la dengue et le chikungunya sont répandues dans le monde y compris en République Démocratique du Congo (RDC). Ce développement épidémiologique a donné lieu à la définition des fièvres d’origine indéterminée (FOI) par manque d’étiologie dans le monde. Les pays développés ont réduit l’importance des FOI par le développement du plateau technique tant clinique que laboratoire. Dans les pays à faibles ressources, les FOI sont plus importantes amenant les cliniciens à prescrire systématiquement les antipaludiques et les antibiotiques sans savoir ce qu’ils ne traitent car les examens de laboratoire sont négatifs, en opposition aux recommandations de l’Organisation Mondiale de la Santé. Cette attitude expose au mécanisme de développement de résistance. Il apparaît dès lors nécessaire de réduire l’importance des fièvres d’origine indéterminée par le renforcement des capacités diagnostiques, l’amélioration des plateaux techniques et la formation continue des professionnels de santé. Une meilleure sensibilisation des cliniciens aux causes non palustres de fièvre, notamment aux arboviroses telles que la dengue et le chikungunya, pourrait contribuer à une prise en charge plus rationnelle des patients fébriles et à une prescription thérapeutique mieux adaptée.
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