Date Published: February 26, 2018
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Christine Hercik, Leonard Cosmas, Ondari D. Mogeni, Newton Wamola, Wanze Kohi, Eric Houpt, Jie Liu, Caroline Ochieng, Clayton Onyango, Barry Fields, Sayoki Mfinanga, Joel M. Montgomery.
The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents. We collected both blood and naso/oro-pharyngeal (NP/OP) swabs from consecutive consenting patients ≥ 1 year of age, with an axillary temperature ≥ 37.5°C, and symptom onset of ≤ 5 days. Specimens were analyzed using both acute febrile illness (AFI) and respiratory TaqMan array cards (Resp TAC) for multiagent detection of 56 different bloodstream and respiratory agents. In addition, we collected epidemiologic data to further characterize our patient population. We enrolled 205 febrile patients, including 70 children (1 < 15 years of age; 34%) and 135 adults (≥ 15 years of age; 66%). AFI TAC and Resp TAC were performed on 191 whole blood specimens and 115 NP/OP specimens, respectively. We detected nucleic acid for Plasmodium (57%), Leptospira (2%), and dengue virus (1%) among blood specimens. In addition, we detected 17 different respiratory agents, most notably, Haemophilus influenzae (64%), Streptococcus pneumonia (56%), Moraxella catarrhalis (39%), and respiratory syncytial virus (11%) among NP/OP specimens. Overall median cycle threshold was measured at 26.5. This study provides a proof-of-concept for the use of a multiagent diagnostic approach for exploratory research on febrile illness and underscores the utility of quantitative molecular diagnostics in complex epidemiologic settings of sub-Saharan Africa.
Fever is an important indicator of localized or systemic infection. The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents as well as to establish epidemiologic risk for infection. Such information is critical to provide evidence-based recommendations for local treatment approaches and disease control programming.
The lack of consistency in methodological approaches to AFI surveillance in low-resource areas has resulted in an inability to provide more comprehensive information on a wide range of organisms potentiating fever syndrome.10,14,29–31 Our study seeks to provide a platform for preliminary exploratory research to determine the range of biological agents to consider during clinical assessment of fever syndrome. This is the first field study to investigate viral, bacterial, and parasitic agents of febrile illness using the syndromic AFI TAC diagnostic platform. The TAC system allows researchers to screen each specimen for a suite of microbial agents, rather than conduct multiple rounds of testing using pathogen-specific detection methods.