Diagnosis of Persistent Fever in the Tropics: Set of Standard Operating Procedures Used in the NIDIAG Febrile Syndrome Study

Emilie Alirol, Ninon Seiko Horie, Barbara Barbé, Veerle Lejon, Kristien Verdonck, Philippe Gillet, Jan Jacobs, Philippe Büscher, Basudha Kanal, Narayan Raj Bhattarai, Sayda El Safi, Thong Phe, Kruy Lim, Long Leng, Pascal Lutumba, Deby Mukendi, Emmanuel Bottieau, Marleen Boelaert, Suman Rijal, François Chappuis, Emilie Alirol, Ninon Seiko Horie, Barbara Barbé, Veerle Lejon, Kristien Verdonck, Philippe Gillet, Jan Jacobs, Philippe Büscher, Basudha Kanal, Narayan Raj Bhattarai, Sayda El Safi, Thong Phe, Kruy Lim, Long Leng, Pascal Lutumba, Deby Mukendi, Emmanuel Bottieau, Marleen Boelaert, Suman Rijal, François Chappuis

Abstract

In resource-limited settings, the scarcity of skilled personnel and adequate laboratory facilities makes the differential diagnosis of fevers complex [1-5]. Febrile illnesses are diagnosed clinically in most rural centers, and both Rapid Diagnostic Tests (RDTs) and clinical algorithms can be valuable aids to health workers and facilitate therapeutic decisions [6,7]. The persistent fever syndrome targeted by NIDIAG is defined as presence of fever for at least one week. The NIDIAG clinical research consortium focused on potentially severe and treatable infections and therefore targeted the following conditions as differential diagnosis of persistent fever: visceral leishmaniasis (VL), human African trypanosomiasis (HAT), enteric (typhoid and paratyphoid) fever, brucellosis, melioidosis, leptospirosis, malaria, tuberculosis, amoebic liver abscess, relapsing fever, HIV/AIDS, rickettsiosis, and other infectious diseases (e.g., pneumonia). From January 2013 to October 2014, a prospective clinical phase III diagnostic accuracy study was conducted in one site in Cambodia, two sites in Nepal, two sites in Democratic Republic of the Congo (DRC), and one site in Sudan (clinicaltrials.gov no. NCT01766830). The study objectives were to (1) determine the prevalence of the target diseases in patients presenting with persistent fever, (2) assess the predictive value of clinical and first-line laboratory features, and (3) assess the diagnostic accuracy of several RDTs for the diagnosis of the different target conditions.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Ye Y, Madise N, Ndugwa R, Ochola S, Snow RW. Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya. Malar J. 2009;8: 160 10.1186/1475-2875-8-160
    1. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, et al. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ. 2004;329: 1212 10.1136/bmj.38251.658229.55
    1. Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, et al. Malaria misdiagnosis in Uganda–implications for policy change. Malar J. 2009;8: 66 10.1186/1475-2875-8-66
    1. D’Acremont V, Lengeler C, Genton B. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J. 2010;9: 240 10.1186/1475-2875-9-240
    1. Joshi R, Colford JM, Reingold AL, Kalantri S. Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents. Am J Trop Med Hyg. 2008;78: 393–9.
    1. Chappuis F, Alirol E, d’Acremont V, Bottieau E, Yansouni CP. Rapid diagnostic tests for non-malarial febrile illness in the tropics. Clin Microbiol Infect. 2013;19: 422–31. 10.1111/1469-0691.12154
    1. Shao AF, Rambaud-Althaus C, Samaka J, Faustine AF, Perri-Moore S, Swai N, et al. New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania. PLoS One. 2015;10: e0132316 10.1371/journal.pone.0132316
    1. Kleppinger CF, Ball LK. Building quality in clinical trials with use of a quality systems approach. Clin Infect Dis. 2010;51 Suppl 1: S111–6. 10.1086/653058
    1. Tuck MK, Chan DW, Chia D, Godwin AK, Grizzle WE, Krueger KE, et al. Standard operating procedures for serum and plasma collection: early detection research network consensus statement standard operating procedure integration working group. J Proteome Res. 2009;8: 113–7. 10.1021/pr800545q
    1. Nathens AB, Johnson JL, Minei JP, Moore EE, Shapiro M, Bankey P, et al. Inflammation and the Host Response to Injury, a large-scale collaborative project: Patient-Oriented Research Core—standard operating procedures for clinical care. I. Guidelines for mechanical ventilation of the trauma patient. J Trauma. 2005;59: 764–9.
    1. Minei JP, Nathens AB, West M, Harbrecht BG, Moore EE, Shapiro MB, et al. Inflammation and the Host Response to Injury, a Large-Scale Collaborative Project: patient-oriented research core—standard operating procedures for clinical care. II. Guidelines for prevention, diagnosis and treatment of ventilator-associated pneumonia (. J Trauma. 2006;60: 1106–13; discussion 1113. 10.1097/01.ta.0000220424.34835.f1
    1. 89% of trials meet enrollment, but timelines slip, half of sites under-enroll. Tufts CSDD Impact Report. 2013.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa