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Orf GS, Ahouidi AD, Mata M, Diedhiou C, Mboup A, Padane A, Manga NM, Dela-del Lawson AT, Averhoff F, Berg MG, Cloherty GA, Mboup S. Next-generation sequencing survey of acute febrile illness in Senegal (2020-2022). Front Microbiol 2024; 15:1362714. [PMID: 38655084 PMCID: PMC11037400 DOI: 10.3389/fmicb.2024.1362714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/13/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Acute febrile illnesses (AFI) in developing tropical and sub-tropical nations are challenging to diagnose due to the numerous causes and non-specific symptoms. The proliferation of rapid diagnostic testing and successful control campaigns against malaria have revealed that non-Plasmodium pathogens still contribute significantly to AFI burden. Thus, a more complete understanding of local trends and potential causes is important for selecting the correct treatment course, which in turn will reduce morbidity and mortality. Next-generation sequencing (NGS) in a laboratory setting can be used to identify known and novel pathogens in individuals with AFI. Methods In this study, plasma was collected from 228 febrile patients tested negative for malaria at clinics across Senegal from 2020-2022. Total nucleic acids were extracted and converted to metagenomic NGS libraries. To identify viral pathogens, especially those present at low concentration, an aliquot of each library was processed with a viral enrichment panel and sequenced. Corresponding metagenomic libraries were also sequenced to identify non-viral pathogens. Results and Discussion Sequencing reads for pathogens with a possible link to febrile illness were identified in 51/228 specimens, including (but not limited to): Borrelia crocidurae (N = 7), West Nile virus (N = 3), Rickettsia felis (N = 2), Bartonella quintana (N = 1), human herpesvirus 8 (N = 1), and Saffold virus (N = 1). Reads corresponding to Plasmodium falciparum were detected in 19 specimens, though their presence in the cohort was likely due to user error of rapid diagnostic testing or incorrect specimen segregation at the clinics. Mosquito-borne pathogens were typically detected just after the conclusion of the rainy season, while tick-borne pathogens were mostly detected before the rainy season. The three West Nile virus strains were phylogenetically characterized and shown to be related to both European and North American clades. Surveys such as this will increase the understanding of the potential causes of non-malarial AFI, which may help inform diagnostic and treatment options for clinicians who provide care to patients in Senegal.
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Affiliation(s)
- Gregory S. Orf
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Ambroise D. Ahouidi
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Maximillian Mata
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Cyrille Diedhiou
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Aminata Mboup
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Abdou Padane
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Noel Magloire Manga
- Unit of Infectious and Tropical Diseases, Université Assane Seck, Hôpital de la Paix, Ziguinchor, Senegal
| | | | - Francisco Averhoff
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Michael G. Berg
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Gavin A. Cloherty
- Core Diagnostics, Abbott Laboratories, Abbott Park, IL, United States
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Souleymane Mboup
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
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Velut G, de Laval F, Berry M, Dufour Gaume F, André N, Epelboin L, Lavergne A, Enfissi A, Djossou F, Rousset D, Briolant S. Etiology of Acute Febrile Illnesses in Adults in the Defense Community in French Guiana. Am J Trop Med Hyg 2024; 110:819-825. [PMID: 38377600 PMCID: PMC10993844 DOI: 10.4269/ajtmh.22-0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/13/2023] [Indexed: 02/22/2024] Open
Abstract
In tropical countries, acute febrile illnesses represent a complex clinical problem for general practitioners. We describe the prevalence of different etiologies of acute febrile illnesses occurring among French service members and their families, excluding children, in general practice in French Guiana. From June 2017 to March 2020, patients with a fever ≥37.8°C with a duration of less than 15 days who sought medical care at the army medical centers in Cayenne and Kourou were prospectively enrolled. Based on clinical presentation, blood, urine, nasopharyngeal, and stool samples were collected for diagnostic testing for viruses, bacteria, and parasites (by direct examination, microscopic examination of blood smears, culture, serology, or polymerase chain reaction), and standardized biological tests were systematically performed. Among 175 patients retained for analysis, fever with nonspecific symptoms was predominant (46.9%), with 10 Plasmodium vivax malaria cases, 8 dengue infections, and 6 cases of Q fever. The second most frequent cause of acute febrile illness was upper respiratory tract infections (32.0%) due to influenza virus (n = 18) or human rhinovirus (n = 10). Among the causes of acute febrile illness in French Guiana, clinicians should first consider arboviruses and malaria, as well as Q fever in cases of elevated C-reactive protein with nonspecific symptoms and influenza in cases of signs and symptoms associated with upper respiratory tract infections. Despite an expanded microbiological search, the etiology of 51.4% of acute febrile illnesses remain unknown. Further investigations will be necessary to identify the etiology of acute febrile illnesses, including new pathogens, in French Guiana.
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Affiliation(s)
- Guillaume Velut
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | - Franck de Laval
- Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
- Aix-Marseille Université, INSERM, Institut de Recherche pour le Développement, Economic and Social Sciences, Health Systems, and Medical Informatics, Marseille, France
| | - Morgane Berry
- Centre Médical Interarmées de Cayenne, Cayenne, French Guiana
| | | | - Nathalie André
- Direction Interarmées du Service de Santé des Forces Armées en Guyane, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Anne Lavergne
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Antoine Enfissi
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Felix Djossou
- Service des Maladies Infectieuses et Tropicales, et Centre d’investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur de la Guyane, Cayenne Cedex, French Guiana
| | - Sébastien Briolant
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs – Infections Tropicales et Méditerranéennes, Marseille, France
- Institut Hospitalo-Universitaire – Méditerranée Infection, Marseille, France
- Unité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
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Hossain MS, Ahmed TS, Haque MA, Chowdhury MAB, Uddin MJ. Prevalence of unqualified sources of antimalarial drug prescription for children under the age of five: A study in 19 low- and middle-income countries. PLoS One 2024; 19:e0300347. [PMID: 38512855 PMCID: PMC10956821 DOI: 10.1371/journal.pone.0300347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Antimalarial drug resistance poses a severe danger to global health. In Low- and Middle-Income Countries (LMICs), there is a lack of reliable information on antimalarial prescriptions for recent malarial fever in children under five. Our study aims to determine the prevalence of unqualified sources of antimalarial drug prescription for children under the age of five in 19 low- and middle-income countries. METHODS We performed a cross-sectional study of the Malaria Indicator Survey (MIS) datasets (n = 106265) across 19 LMICs. The recent MIS datasets were used, and the study only included children under five who had taken an antimalarial drug for a recent malarial fever. The outcome variable was classified into two distinct categories: those who had taken antimalarial drugs for malarial fever from qualified sources and those who did not. FINDINGS Among LMICs, we found that 87.1% of children under five received an antimalarial prescription from unqualified sources who had recently experienced malarial fever. In several LMICs (Tanzania, Nigeria, and Ghana), a substantial portion of recent antimalarial prescriptions for malaria was taken from unqualified sources (about 60%). Some LMICs (Guinea (31.8%), Mali (31.3%), Nigeria (20.4%), Kenya (2.6%), and Senegal (2.7%)) had low rates of antimalarial drug consumption even though children under five received a high percentage of antimalarial prescriptions from qualified sources for a recent malarial fever. Living in rural areas, having mothers with higher education, and having parents with more wealth were frequently taken antimalarial from qualified sources for recent malarial fever in children under five across the LMICs. INTERPRETATION The study draws attention to the importance of national and local level preventative strategies across the LMICs to restrict antimalarial drug consumption. This is because antimalarial prescriptions from unqualified sources for recent malarial fever in children under five were shockingly high in most LMICs and had high rates of unqualified prescriptions in certain other LMICs.
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Affiliation(s)
- Md Sabbir Hossain
- Biostatistics, Epidemiology and Public Health Research Team, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Talha Sheikh Ahmed
- Department of Geography and Environment, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Mohammad Anamul Haque
- Biostatistics, Epidemiology and Public Health Research Team, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Muhammad Abdul Baker Chowdhury
- Biostatistics, Epidemiology and Public Health Research Team, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md Jamal Uddin
- Biostatistics, Epidemiology and Public Health Research Team, Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
- Department of General Educational and Development, Daffodil International University, Dhaka, Bangladesh
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Rautman LH, Maiga-Ascofaré O, Eibach D, Hogan B, Dekker D, Jaeger A, Akenten CW, Owusu-Dabo E, Boateng FO, Hanson H, Boahen KG, Sarpong N, Adu-Sarkodie Y, Kreuels B, May J, Krumkamp R. Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study. Trop Med Int Health 2024; 29:206-213. [PMID: 38093593 DOI: 10.1111/tmi.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Healthcare resources are often limited in areas of sub-Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria. METHODS Febrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used. RESULTS There were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One-third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria-only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic. CONCLUSIONS Suspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over-prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance.
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Affiliation(s)
- Lydia Helen Rautman
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Oumou Maiga-Ascofaré
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Hogan
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | | | - Ellis Owusu-Dabo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felix Osei Boateng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Henry Hanson
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Kennedy Gyau Boahen
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benno Kreuels
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
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5
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Zhang H, Liang R, Zhu Y, Hu L, Xia H, Li J, Ye Y. Metagenomic next-generation sequencing of plasma cell-free DNA improves the early diagnosis of suspected infections. BMC Infect Dis 2024; 24:187. [PMID: 38347444 PMCID: PMC10863141 DOI: 10.1186/s12879-024-09043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) could improve the diagnosed efficiency of pathogens in bloodstream infections or sepsis. Little is known about the clinical impact of mNGS test when used for the early diagnosis of suspected infections. Herein, our main objective was to assess the clinical efficacy of utilizing blood samples to perform mNGS for early diagnosis of suspected infections, as well as to evaluate its potential in guiding antimicrobial therapy decisions. METHODS In this study, 212 adult hospitalized patients who underwent blood mNGS test in the early stage of suspected infections were enrolled. Diagnostic efficacy of mNGS test and blood culture was compared, and the clinical impact of mNGS on clinical care was analyzed. RESULTS In our study, the total detection rate of blood mNGS was significantly higher than that of culture method (74.4% vs. 12.1%, P < 0.001) in the paired mNGS test and blood culture. Blood stream infection (107, 67.3%) comprised the largest component of all the diseases in our patients, and the detection rate of single blood sample subgroup was similar with that of multiple type of samples subgroup. Among the 187 patients complained with fever, there was no difference in the diagnostic efficacy of mNGS when blood specimens or additional other specimens were used in cases presenting only with fever. While, when patients had other symptoms except fever, the performance of mNGS was superior in cases with specimens of suspected infected sites and blood collected at the same time. Guided by mNGS results, therapeutic regimens for 70.3% cases (149/212) were changed, and the average hospitalized days were significantly shortened in cases with the earlier sampling time of admission. CONCLUSION In this study, we emphasized the importance of blood mNGS in early infectious patients with mild and non-specific symptoms. Blood mNGS can be used as a supplement to conventional laboratory examination, and should be performed as soon as possible to guide clinicians to perform appropriate anti-infection treatment timely and effectively. Additionally, combining the contemporaneous samples from suspected infection sites could improve disease diagnosis and prognoses. Further research needs to be better validated in large-scale clinical trials to optimize diagnostic protocol, and the cost-utility analysis should be performed.
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Affiliation(s)
- Hui Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruobing Liang
- Department of Scientific Affaires, Hugobiotech Co., Ltd, Beijing, China
| | - Yunzhu Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lifen Hu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Han Xia
- Department of Scientific Affaires, Hugobiotech Co., Ltd, Beijing, China.
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Bacterial Resistance, Anhui Medical University, Hefei, China.
- Anhui Center for Surveillance of Bacterial Resistance, Hefei, China.
| | - Ying Ye
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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van der Hoeven M, van Lettow M, Boonstra P, Hoekstra T, Rutebemberwa E, Tweheyo R, Kok MO. Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda. BMJ Open 2024; 14:e074393. [PMID: 38316585 PMCID: PMC10860046 DOI: 10.1136/bmjopen-2023-074393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To assess the uptake of services provided by community health workers who were trained as community health entrepreneurs (CHEs) for febrile illness and diarrhoea. DESIGN A cross-sectional survey among households combined with mapping of all providers of basic medicine and primary health services in the study area. PARTICIPANTS 1265 randomly selected households in 15 rural villages with active CHEs. SETTING Bunyangabu district, Uganda. OUTCOME MEASURES We describe the occurrence and care sought for fever and diarrhoea in the last 3 months by age group in the households. Care provider options included: CHE, health centre or clinic (public or private), pharmacy, drug shop and other. Geographic Information Ssystem (GIS)-based geographical measures were used to map all care providers around the active CHEs. RESULTS Fever and diarrhoea in the last 3 months occurred most frequently in children under 5; 68% and 41.9%, respectively. For those who sought care, CHE services were used for fever among children under 5, children 5-17 and adults over 18 years of age in 34.7%, 29.9% and 25.1%, respectively. For diarrhoea among children under 5, children 5-17 and adults over 18 years of age, CHE services were used in 22.1%, 19.5% and 7.0%, respectively. For those who did not seek care from a CHE (only), drug shops were most frequently used services for both fever and diarrhoea, followed by health centres or private clinics. Many households used a combination of services, which was possible given the high density and diversity of providers found in the study area. CONCLUSIONS CHEs play a considerable role in providing care in rural areas where they are active. The high density of informal drug shops and private clinics highlights the need for clarity on the de facto roles played by different providers in both the public and private sector to improve primary healthcare.
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Affiliation(s)
- Marinka van der Hoeven
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Monique van Lettow
- Department of Implementation and Operational Research, Madiro, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Division of Epidemiology and Centre of Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Pien Boonstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Raymond Tweheyo
- School of Public Health, Makerere University, Kampala, Uganda
| | - Maarten Olivier Kok
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Levine ZC, Sene A, Mkandawire W, Deme AB, Ndiaye T, Sy M, Gaye A, Diedhiou Y, Mbaye AM, Ndiaye IM, Gomis J, Ndiop M, Sene D, Faye Paye M, MacInnis BL, Schaffner SF, Park DJ, Badiane AS, Colubri A, Ndiaye M, Sy N, Sabeti PC, Ndiaye D, Siddle KJ. Investigating the etiologies of non-malarial febrile illness in Senegal using metagenomic sequencing. Nat Commun 2024; 15:747. [PMID: 38272885 PMCID: PMC10810818 DOI: 10.1038/s41467-024-44800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024] Open
Abstract
The worldwide decline in malaria incidence is revealing the extensive burden of non-malarial febrile illness (NMFI), which remains poorly understood and difficult to diagnose. To characterize NMFI in Senegal, we collected venous blood and clinical metadata in a cross-sectional study of febrile patients and healthy controls in a low malaria burden area. Using 16S and untargeted sequencing, we detected viral, bacterial, or eukaryotic pathogens in 23% (38/163) of NMFI cases. Bacteria were the most common, with relapsing fever Borrelia and spotted fever Rickettsia found in 15.5% and 3.8% of cases, respectively. Four viral pathogens were found in a total of 7 febrile cases (3.5%). Sequencing also detected undiagnosed Plasmodium, including one putative P. ovale infection. We developed a logistic regression model that can distinguish Borrelia from NMFIs with similar presentation based on symptoms and vital signs (F1 score: 0.823). These results highlight the challenge and importance of improved diagnostics, especially for Borrelia, to support diagnosis and surveillance.
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Affiliation(s)
- Zoë C Levine
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Harvard Graduate Program in Biological and Biomedical Science, Boston, MA, USA
- Harvard/MIT MD-PhD Program, Boston, MA, USA
| | - Aita Sene
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Winnie Mkandawire
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Awa B Deme
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Tolla Ndiaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Mouhamad Sy
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Amy Gaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Younouss Diedhiou
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Amadou M Mbaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Ibrahima M Ndiaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Jules Gomis
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Médoune Ndiop
- Programme National de lutte contre le Paludisme, Ministère de la Santé, Dakar Fann, Senegal
| | - Doudou Sene
- Programme National de lutte contre le Paludisme, Ministère de la Santé, Dakar Fann, Senegal
| | | | - Bronwyn L MacInnis
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Stephen F Schaffner
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Daniel J Park
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Aida S Badiane
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Andres Colubri
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Mouhamadou Ndiaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal
| | - Ngayo Sy
- Service de Lutte Anti Parasitaire, Thies, Senegal
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA.
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
| | - Daouda Ndiaye
- Department of Parasitology, Cheikh Anta Diop University Dakar, Dakar, Senegal.
- Centre International de Recherche et de Formation en Génomique Appliquée et de la Surveillance Sanitaire, Dakar, Senegal.
| | - Katherine J Siddle
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, USA.
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8
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Tack B, Vita D, Ntangu E, Ngina J, Mukoko P, Lutumba A, Vangeluwe D, Toelen J, Allegaert K, Lunguya O, Ravinetto R, Jacobs J. Challenges of Antibiotic Formulations and Administration in the Treatment of Bloodstream Infections in Children Under Five Admitted to Kisantu Hospital, Democratic Republic of Congo. Am J Trop Med Hyg 2023; 109:1245-1259. [PMID: 37903440 DOI: 10.4269/ajtmh.23-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
Severe bacterial infections in children need prompt, appropriate antibiotic treatment. We report challenges observed within a prospective, cohort study on antibiotic efficacy in non-typhi Salmonella bloodstream infection (NCT04850677) in Kisantu district hospital (Democratic Republic of Congo). Children (aged > 28 days to < 5 years) admitted with suspected bloodstream infection (August 1, 2021 through July 31, 2022) were enrolled and followed until day 3 or discharge for non-typhi Salmonella patients. Antibiotics were administered to 98.4% (1,838/1,867) of children, accounting for 2,296 antibiotic regimens (95.7% intravenous, 4.3% oral). Only 78.3% and 61.8% of children were, respectively, prescribed and administered antibiotics on the admission day. At least one dose was not administered in 3.6% of children, mostly because of mismatch of the four times daily cefotaxime schedule with the twice-daily administration rounds. Inappropriate intravenous administration practices included multidose use, air-venting, and direct injection instead of perfusion. There was inaccurate aliquoting in 18.0% (32/178) of intravenous ciprofloxacin regimens, and thus administered doses were > 16% below the intended dose. Dosing accuracy of oral suspensions was impaired by lack of instructions for reconstitution, volume indicators, and/or dosing devices. Adult-dose tablets were split without/beyond scoring lines in 84.4% (27/32) of tablets. Poor availability and affordability of age-appropriate oral formulations contributed to low proportions of intravenous-to-oral switch (33.3% (79/237) of non-typhi Salmonella patients). Other quality issues included poor packaging, nonhomogeneous suspensions, and unsafe water for reconstitution. In conclusion, poor antibiotic products (no age-appropriate formulations, poor quality and access), processes (delayed prescription/administration, missed doses), and practices (inaccurate doses, [bio]safety risks) must be urgently addressed to improve pediatric antibiotic treatment.
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Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
- Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium
| | - Daniel Vita
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Emmanuel Ntangu
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Japhet Ngina
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Pathy Mukoko
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Adèle Lutumba
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | | | - Jaan Toelen
- Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Democratic Republic of Congo
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
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9
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Gulleen EA, Holte S, Zhang Y, Mbarusha I, Mubiru D, Pedun B, Keng M, Heysell SK, Omoding A, Moore CC, Phipps W. Etiology of Fever and Associated Outcomes Among Adults Receiving Chemotherapy for the Treatment of Solid Tumors in Uganda. Open Forum Infect Dis 2023; 10:ofad508. [PMID: 37953812 PMCID: PMC10633783 DOI: 10.1093/ofid/ofad508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background Little is known about the microbiology and outcomes of chemotherapy-associated febrile illness among patients in sub-Saharan Africa. Understanding the microbiology of febrile illness could improve antibiotic selection and infection-related outcomes. Methods From September 2019 through June 2022, we prospectively enrolled adult inpatients at the Uganda Cancer Institute who had solid tumors and developed fever within 30 days of receiving chemotherapy. Evaluation included blood cultures, malaria rapid diagnostic tests, and urinary lipoarabinomannan testing for tuberculosis. Serum cryptococcal antigen was evaluated in participants with human immunodeficiency virus (HIV). The primary outcome was the mortality rate 40 days after fever onset, which we estimated using Cox proportional hazards models. Results A total of 104 febrile episodes occurred among 99 participants. Thirty febrile episodes (29%) had ≥1 positive microbiologic result. The most frequently identified causes of infection were tuberculosis (19%) and bacteremia (12%). The prevalence of tuberculosis did not differ by HIV status. The 40-day case fatality ratio was 25%. There was no difference in all-cause mortality based on HIV serostatus, presence of neutropenia, or positive microbiologic results. A universal vital assessment score of >4 was associated with all-cause mortality (hazard ratio, 14.5 [95% confidence interval, 5-42.7]). Conclusions The 40-day mortality rate among Ugandan patients with solid tumors who developed chemotherapy-associated febrile illness was high, and few had an identified source of infection. Tuberculosis and bacterial bloodstream infections were the leading diagnoses associated with fever. Tuberculosis should be included in the differential diagnosis for patients who develop fever after receiving chemotherapy in tuberculosis-endemic settings, regardless of HIV serostatus.
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Affiliation(s)
- Elizabeth A Gulleen
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Holte
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Yuzheng Zhang
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | | | | | - Michael Keng
- Division of Oncology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Christopher C Moore
- Division of Oncology, Department of Medicine, University of Virginia, Charlottesville, USA
| | - Warren Phipps
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, USA
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10
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Tagoe JNA, Yeboah C, Behene E, Kumordjie S, Nimo-Paintsil S, Attram N, Nyarko EO, Carroll JA, Fox AT, Watters C, Koram K, Anang AK, Sanders T, Letizia AG. Coinfection of Malaria and Bacterial Pathogens among Acute Febrile Patients in Selected Clinics in Ghana. Am J Trop Med Hyg 2023; 109:1036-1046. [PMID: 37748764 PMCID: PMC10622490 DOI: 10.4269/ajtmh.23-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/05/2023] [Indexed: 09/27/2023] Open
Abstract
Malaria remains the leading cause of acute febrile illness (AFI) in Africa despite successful control measures and programs. Acute febrile illnesses can be misdiagnosed as malaria as a result of the overlapping spectrum of nonspecific symptoms or may not be pursued because of limited diagnostic capabilities. This study investigated potential etiologies of AFIs in Ghana and determined the relationship between coinfection between malaria and Q fever, leptospirosis, and culturable bacteria in febrile patients. Participants were enrolled between July 2015 and December 2019 from four Ghanaian military treatment facilities. Of the 399 febrile participants, 222 (55.6%) males and 177 (44.6%) females were enrolled. Malaria was diagnosed in 275 (68.9%) participants. Malaria coinfection occurred with leptospirosis, Q fever, and blood-cultured bacteria in 11/206 (5.3%), 24/206 (11.7%), and 6/164 (3.7%) participants, respectively. Among the 124 malaria-negative samples, the positivity rates were 4.1% (3/74), 8.1% (6/74), and 3.6% (2/56) for leptospirosis, Q fever, and bacterial pathogens isolated from blood culture, respectively. The majority of documented clinical signs and symptoms were not significantly associated with specific diseases. Approximately 10% of malaria-positive participants also had evidence suggesting the presence of a bacterial coinfection. Therefore, even in the case of a positive malaria test, other pathogens contributing to febrile illness should be considered. Understanding the frequency of malaria coinfection and other etiological agents responsible for AFIs will improve diagnosis and treatment and better inform public health knowledge gaps in Ghana.
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Affiliation(s)
- Janice N. A. Tagoe
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Eric Behene
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Selassie Kumordjie
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | - Naiki Attram
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | | | - Anne T. Fox
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Chaselynn Watters
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Terrel Sanders
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
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11
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Gizamba JM, Mugisha L. Leptospirosis in humans and selected animals in Sub-Saharan Africa, 2014-2022: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:649. [PMID: 37784071 PMCID: PMC10546638 DOI: 10.1186/s12879-023-08574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Leptospirosis is an emerging neglected tropical zoonotic disease of public health importance causing substantial morbidities and mortalities among humans. The infection is maintained within the population through interactions between humans, animals, and the environment. Understanding the burden of disease in both humans and animals is necessary for effective prevention and control in Sub-Saharan Africa (SSA). Therefore, we aimed to determine the seroprevalence of leptospirosis in humans, selected domestic animals, and rodents in SSA. METHODS A comprehensive search was done in six databases: Scopus, PubMed, Google Scholar, CINAHL, Web of Science, and African Journals Online databases for articles published between 01 January 2014 and 30 August 2022. Thirty-seven articles distributed across 14 out of 46 countries in SSA were included. The random effects meta-analysis model was used to pool the extracted seroprevalence data. RESULTS The overall pooled seroprevalence of leptospirosis among humans was 12.7% (95% CI: 7.5,20.8), 15.1% (95% CI: 9.4,23.5), and 4.5% (95% CI: 0.4, 35.6) based on results obtained using ELISA, MAT, and PCR diagnostic methods respectively. The pooled seroprevalence estimates among cattle were 29.2%, 30.1%, and 9.7% based on ELISA, MAT, and PCR respectively. Further, the pooled seroprevalence in goats was 30.0% for studies that used MAT, and among rodents, the pooled seroprevalence estimates were 21.0% for MAT and 9.6% for PCR diagnostic criteria. The seroprevalence of leptospirosis varied extensively between studies, across SSA regions and study setting (rural or urban). CONCLUSION Leptospirosis is widespread in SSA in both humans and animals based on the current results of the pooled seroprevalence in the limited studies available. The burden is high in animals and humans and underestimated due to limited studies and challenges with limited diagnostic capacity in most healthcare settings in SSA. Hence, we recommend that leptospirosis should be listed as a disease of concern and be included on the list of routine diagnostics among patients presenting with febrile illness in healthcare settings. Further, we recommend the enhancement of surveillance of leptospirosis in all countries in SSA and the development of strategies with a One Health perspective to effectively prevent and control leptospirosis.
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Affiliation(s)
- Jacob Mugoya Gizamba
- Department of Wildlife and Aquatic Animal Resources, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
- Spatial Science Institute, University of Southern California, Los Angeles, USA.
| | - Lawrence Mugisha
- Department of Wildlife and Aquatic Animal Resources, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
- Ecohealth Research Group, Conservation &Ecosystem Health Alliance, Kampala, Uganda.
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12
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Parra Barrera EL, Reales-González J, Salas D, Reyes Santamaría E, Bello S, Rico A, Pardo L, Parra E, Rodriguez K, Alarcon Z, Guerra Vega AP, Porras MA, Gomez-Rangel SY, Duarte C, Moreno J. Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019. PLoS Negl Trop Dis 2023; 17:e0011683. [PMID: 37844106 PMCID: PMC10602388 DOI: 10.1371/journal.pntd.0011683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/26/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Acute undifferentiated febrile illness is a common challenge for clinicians, especially in tropical and subtropical countries. Incorrect or delayed diagnosis of febrile patients may result in medical complications or preventable deaths. Common causes of acute undifferentiated febrile illness in Colombia include leptospirosis, rickettsioses, dengue fever, malaria, chikungunya, and Zika virus infection. In this study, we described the acute undifferentiated febrile illness in postmortem patients reported as suspected cases of leptospirosis through the national leptospirosis surveillance in Colombia, 2016-2019. METHODOLOGY/PRINCIPAL FINDINGS We retrospectively analyze human fresh and formalin-fixed tissue samples from fatal suspected leptospirosis cases reported by the Public Health Laboratories in Colombia. Leptospirosis confirmation was made by immunohistochemistry, real-time polymerase chain reaction (PCR) in the tissue samples. In some cases, the serum sample was used for confirmation by Microagglutination test (MAT). Simultaneously, tissue samples were tested by PCR for the most common viral (dengue, Zika, and chikungunya), bacterial (Brucella spp., and Rickettsia spp.), and parasitic (malaria). Fresh tissue samples from 92 fatal suspected leptospirosis cases were reported to the National Reference Laboratory from 22/32 departments in Colombia. We confirmed leptospirosis in 27% (25/92) of cases. Other pathogens identified by real-time PCR were Brucella spp. (10.9%), Rickettsia spp. (14.1%), and dengue (2.2%). Dengue (6.9%), hepatitis (3.5%), and Yellow Fever cases (2.2%) were detected by the pathology. All patients were negative for chikungunya and Plasmodium spp. Most cases were classified as undifferentiated febrile illnesses (45.7%; 42/92). CONCLUSIONS/SIGNIFICANCE This study underscores the importance of early and accurate recognition of leptospirosis to prevent mortalities. Moreover, it draws attention to the existence of other febrile syndromes in Colombia, including rickettsiosis and brucellosis, that currently lack sufficient human surveillance and regular reporting. Expanding laboratory surveillance to include viruses such as Hantavirus, Mayaro virus, Oropouche virus, and West Nile virus is crucial.
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Affiliation(s)
- Eliana L Parra Barrera
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jhonatan Reales-González
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Daniela Salas
- Grupo de Enfermedades Transmitidas por Vectores y Zoonosis, Instituto Nacional de Salud, Bogotá, Colombia
| | - Elizabeth Reyes Santamaría
- Departamento de Medicina interna y Departamento de Medicina crítica y cuidados intensivos. Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - Solmara Bello
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Angélica Rico
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Enfermedades Transmisibles Prevenibles por Vacunación en Salud, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Lissethe Pardo
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Edgar Parra
- Grupo de Patología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Karina Rodriguez
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Zonía Alarcon
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Angela Patricia Guerra Vega
- Grupo de Parasitología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Mayra A Porras
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Sergio Yebrail Gomez-Rangel
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jaime Moreno
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
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13
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Levine ZC, Sene A, Mkandawire W, Deme AB, Ndiaye T, Sy M, Gaye A, Diedhiou Y, Mbaye AM, Ndiaye I, Gomis J, Ndiop M, Sene D, Paye MF, MacInnis B, Schaffner SF, Park DJ, Badiane AS, Colubri A, Ndiaye M, Sy N, Sabeti PC, Ndiaye D, Siddle KJ. Improving diagnosis of non-malarial fevers in Senegal: Borrelia and the contribution of tick-borne bacteria. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.24.23294564. [PMID: 37662407 PMCID: PMC10473814 DOI: 10.1101/2023.08.24.23294564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The worldwide decline in malaria incidence is revealing the extensive burden of non-malarial febrile illness (NMFI), which remains poorly understood and difficult to diagnose. To characterize NMFI in Senegal, we collected venous blood and clinical metadata from febrile patients and healthy controls in a low malaria burden area. Using 16S and unbiased sequencing, we detected viral, bacterial, or eukaryotic pathogens in 29% of NMFI cases. Bacteria were the most common, with relapsing fever Borrelia and spotted fever Rickettsia found in 15% and 3.7% of cases, respectively. Four viral pathogens were found in a total of 7 febrile cases (3.5%). Sequencing also detected undiagnosed Plasmodium, including one putative P. ovale infection. We developed a logistic regression model to distinguish Borrelia from NMFIs with similar presentation based on symptoms and vital signs. These results highlight the challenge and importance of improved diagnostics, especially for Borrelia, to support diagnosis and surveillance.
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Affiliation(s)
- Zoë C Levine
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Harvard Graduate Program in Biological and Biomedical Science, Boston, MA, USA
- Harvard/MIT MD-PhD Program, Boston, MA, 02115, USA
| | - Aita Sene
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Winnie Mkandawire
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Awa B Deme
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Tolla Ndiaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Mouhamad Sy
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Amy Gaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Younouss Diedhiou
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Amadou M Mbaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Ibrahima Ndiaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Jules Gomis
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Médoune Ndiop
- Programme National de Lutte contre le Paludisme (PNLP), Ministère de la Santé, Dakar Fann, Senegal
| | - Doudou Sene
- Programme National de Lutte contre le Paludisme (PNLP), Ministère de la Santé, Dakar Fann, Senegal
| | | | - Bronwyn MacInnis
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Stephen F Schaffner
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Daniel J Park
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Aida S Badiane
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Andres Colubri
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Mouhamadou Ndiaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Ngayo Sy
- Service de Lutte Anti Parasitaire, Thies, Senegal
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Daouda Ndiaye
- Centre International de recherche, de formation en Génomique Appliquée et de Surveillance Sanitaire (CIGASS), Dakar, Senegal
| | - Katherine J Siddle
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, USA
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14
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Silva-Ramos CR, Faccini-Martínez ÁA, Serna-Rivera CC, Mattar S, Hidalgo M. Etiologies of Zoonotic Tropical Febrile Illnesses That Are Not Part of the Notifiable Diseases in Colombia. Microorganisms 2023; 11:2154. [PMID: 37763998 PMCID: PMC10535066 DOI: 10.3390/microorganisms11092154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 09/29/2023] Open
Abstract
In Colombia, tropical febrile illnesses represent one of the most important causes of clinical attention. Febrile illnesses in the tropics are mainly zoonotic and have a broad etiology. The Colombian surveillance system monitors some notifiable diseases. However, several etiologies are not monitored by this system. In the present review, we describe eleven different etiologies of zoonotic tropical febrile illnesses that are not monitored by the Colombian surveillance system but have scientific, historical, and contemporary data that confirm or suggest their presence in different regions of the country: Anaplasma, Arenavirus, Bartonella, relapsing fever group Borrelia, Coxiella burnetii, Ehrlichia, Hantavirus, Mayaro virus, Orientia, Oropouche virus, and Rickettsia. These could generate a risk for the local population, travelers, and immigrants, due to which they should be included in the mandatory notification system, considering their importance for Colombian public health.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | - Álvaro A. Faccini-Martínez
- Servicio de Infectología, Hospital Militar Central, Bogotá 110110, Colombia;
- Servicios y Asesorías en Infectología—SAI, Bogotá 110110, Colombia
| | - Cristian C. Serna-Rivera
- Grupo de Investigación en Ciencias Veterinarias (CENTAURO), Línea de Investigación Zoonosis Emergentes y Re-Emergentes, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín 050034, Colombia;
- Grupo de Investigación en Genética, Biodiversidad y Manejo de Ecosistemas (GEBIOME), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Universidad de Caldas, Manizales 170004, Colombia
| | - Salim Mattar
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230001, Colombia;
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
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Olliaro P, Nkeramahame J, Salami O, Moore CE, Horgan P, Baiden R, Kukula V, Adjei A, Kapisi J, Hopkins H, Kaawa-Mafigiri D, Ekusai-Sebatta D, Rutebemberwa E, Kitutu FE, Tinto H, Kiemde F, Compaoré A, Valia D, Dittrich S. Advancing Access to Diagnostic Tools Essential for Universal Health Coverage and Antimicrobial Resistance Prevention: An Overview of Trials in Sub-Saharan Africa. Clin Infect Dis 2023; 77:S125-S133. [PMID: 37490744 PMCID: PMC10368407 DOI: 10.1093/cid/ciad326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
We introduce the Antimicrobial Resistance Diagnostic Use Accelerator program, and the articles in this Supplement, which cover the program in 3 sub-Saharan Africa countries.
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Affiliation(s)
- Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- FIND, Geneva, Switzerland
| | | | | | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence & Impact Oxford, Oxford, United Kingdom
| | | | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Elizeus Rutebemberwa
- Department of Health Policy and Planning, Makerere University School of Public Health, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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Kapisi J, Sserwanga A, Kitutu FE, Rutebemberwa E, Awor P, Weber S, Keller T, Kaawa-Mafigiri D, Ekusai-Sebatta D, Horgan P, Dittrich S, Moore CE, Salami O, Olliaro P, Nkeramahame J, Hopkins H. Impact of the Introduction of a Package of Diagnostic Tools, Diagnostic Algorithm, and Training and Communication on Outpatient Acute Fever Case Management at 3 Diverse Sites in Uganda: Results of a Randomized Controlled Trial. Clin Infect Dis 2023; 77:S156-S170. [PMID: 37490746 PMCID: PMC10368415 DOI: 10.1093/cid/ciad341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Increasing trends of antimicrobial resistance are observed around the world, driven in part by excessive use of antimicrobials. Limited access to diagnostics, particularly in low- and middle-income countries, contributes to diagnostic uncertainty, which may promote unnecessary antibiotic use. We investigated whether introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages could safely reduce antibiotic prescribing compared with current standard-of-care for febrile patients presenting to outpatient clinics in Uganda. METHODS This was an open-label, multicenter, 2-arm randomized controlled trial conducted at 3 public health facilities (Aduku, Nagongera, and Kihihi health center IVs) comparing the proportions of antibiotic prescriptions and clinical outcomes for febrile outpatients aged ≥1 year. The intervention arm included a package of point-of-care tests, a diagnostic and treatment algorithm, and training-and-communication messages. Standard-of-care was provided to patients in the control arm. RESULTS A total of 2400 patients were enrolled, with 49.5% in the intervention arm. Overall, there was no significant difference in antibiotic prescriptions between the study arms (relative risk [RR]: 1.03; 95% CI: .96-1.11). In the intervention arm, patients with positive malaria test results (313/500 [62.6%] vs 170/473 [35.9%]) had a higher RR of being prescribed antibiotics (1.74; 1.52-2.00), while those with negative malaria results (348/688 [50.6%] vs 376/508 [74.0%]) had a lower RR (.68; .63-.75). There was no significant difference in clinical outcomes. CONCLUSIONS This study found that a diagnostic intervention for management of febrile outpatients did not achieve the desired impact on antibiotic prescribing at 3 diverse and representative health facility sites in Uganda.
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Affiliation(s)
- James Kapisi
- Department of Disease Surveillance, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Asadu Sserwanga
- Department of Disease Surveillance, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Phyllis Awor
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Stephan Weber
- Department of Statistics, ACOMED Statistics, Leipzig, Germany
| | - Thomas Keller
- Department of Statistics, ACOMED Statistics, Leipzig, Germany
| | | | - Deborah Ekusai-Sebatta
- Department of Disease Surveillance, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence & Impact Oxford, Oxford, United Kingdom
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European-Campus-Rottal-Inn, Pfarrkirchen, Germany
| | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | - Piero Olliaro
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | | | - Heidi Hopkins
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ssentongo P, Chinchilli VM, Shah K, Harbaugh T, Ba DM. Factors associated with pediatric febrile illnesses in 27 countries of Sub-Saharan Africa. BMC Infect Dis 2023; 23:391. [PMID: 37308809 DOI: 10.1186/s12879-023-08350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/24/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Evidence on the relative importance of various factors associated with febrile illness in children and their heterogeneity across countries can inform the prevention, identification, and management of communicable diseases in resource-limited countries. The objective of the study is to assess the relative significance of factors associated with childhood febrile illness in 27 sub-Saharan African countries. METHODS This cross-sectional study of 298,327 children aged 0 to 59 months assessed the strengths of associations of 18 factors with childhood fevers, using Demographic and Health Surveys (2010-2018) from 27 sub-Saharan African countries. A total of 7 child level factors (i.e., respiratory illness, diarrhea, breastfeeding initiation; vitamin A supplements; child's age; full vaccination; sex), 5 maternal factors (maternal education; maternal unemployment; antenatal care; maternal age, and maternal marriage status) and 6 household factors (household wealth; water source; indoor pollution, stool disposal; family planning needs and rural residence) were assessed. Febrile illness was defined as the presence of fever in 2 weeks preceding the survey. RESULTS Among the 298,327 children aged 0 to 59 months included in the analysis, the weighted prevalence of fever was 22.65% (95% CI, 22.31%-22.91%). In the pooled sample, respiratory illness was the strongest factor associated with fever in children (adjusted odds ratio [aOR], 5.46; 95% CI, 5.26-5.67; P < .0001), followed by diarrhea (aOR, 2.96; 95% CI, 2.85-3.08; P < .0001), poorest households (aOR, 1.33; 95% CI,1.23-1.44; P < .0001), lack of maternal education (aOR, 1.25; 95% CI, 1.10-1.41; P < .0001), and delayed breastfeeding (aOR, 1.18; 95% CI, 1.14-1.22; P < .0001. Febrile illnesses were more prevalent in children older than >6 months compared to those 6 months and younger. Unsafe water, unsafe stool disposal, and indoor pollution were not associated with child fever in the pooled analysis but had a large country-level heterogeneity. CONCLUSIONS Major causes of fevers in sub-Saharan Africa could be attributed to respiratory infections and possibly viral infections, which should not be treated by antimalarial drugs or antibiotics. Point-of-care diagnostics are needed to identify the pathogenic causes of respiratory infections to guide the clinical management of fevers in limited-resource countries.
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Affiliation(s)
- Paddy Ssentongo
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Khush Shah
- Department of Biology, Millersville University, Millersville, PA, USA
| | - Thaddeus Harbaugh
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
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Nooh F, Chernet A, Reither K, Okuma J, Brattig NW, Utzinger J, Probst-Hensch N, Paris DH, Dreyfus A. Prevalence of fever of unidentified aetiology in East African adolescents and adults: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:55. [PMID: 37231500 DOI: 10.1186/s40249-023-01105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Primary health care settings and hospitals of low- and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accuracy. In addition, there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa. The purpose of this study was to estimate the pooled prevalence of fever of unidentified aetiology among adolescent and adult febrile patients seeking health care in East Africa. METHODS We pursued a systematic review using readily available electronic databases (i.e. PubMed, Cumulative Index to Nursing & Allied Health Literature, Scopus, Cochrane Library and Web of Science) without language restriction from inception date of the respective databases to October 31, 2022. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were screened for relevance. Further analyses based on pre-set eligibility criteria were carried out for final inclusion. Two reviewers independently screened and extracted data. Risk of study bias was assessed. Meta-analysis of the prevalence of fever of unidentified aetiology was performed. RESULTS We identified 14,029 articles of which 25 were eligible for inclusion, reporting data from 8538 participants. The pooled prevalence of febrile cases with unidentified aetiology was 64% [95% confidence interval (CI): 51-77%, I2 = 99.6%] among febrile adolescents and adults in East Africa. For the proportion of patients with identified aetiology, the studies documented bacterial pathogens (human bloodstream infections), bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa. CONCLUSIONS Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentified potential life-threatening fever aetiology. Hence, we call for a comprehensive fever syndromic surveillance to broaden a consequential differential diagnosis of syndromic fever and to considerably improve the course of patients' disease and treatment outcomes.
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Affiliation(s)
- Faisal Nooh
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
- College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia.
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland.
| | - Afona Chernet
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Norbert W Brattig
- Department Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Anou Dreyfus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Section of Epidemiology, University of Zürich, Zurich, Switzerland
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Rahmalia A, Poespoprodjo JR, Landuwulang CUR, Ronse M, Kenangalem E, Burdam FH, Thriemer K, Devine A, Price RN, Peeters Grietens K, Ley B, Gryseels C. Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study. Malar J 2023; 22:162. [PMID: 37210520 PMCID: PMC10199529 DOI: 10.1186/s12936-023-04578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. METHODS This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. RESULTS Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1-2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with 'blue drugs' (referring to dihydroartemisinin-piperaquine). Conversely, 'brown drugs,' referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. CONCLUSION Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.
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Affiliation(s)
- Annisa Rahmalia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia.
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Chandra U R Landuwulang
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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20
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Singleton D, Ibarz-Pavon A, Swarthout TD, Bonomali F, Cornick J, Kalizang'oma A, Ntiza N, Brown C, Chipatala R, Nyangulu W, Chirombo J, Kawalazira G, Chibowa H, Mwansambo C, Maleta KM, French N, Heyderman RS. Cross-sectional health centre and community-based evaluation of the impact of pneumococcal and malaria vaccination on antibiotic prescription and usage, febrile illness and antimicrobial resistance in young children in Malawi: the IVAR study protocol. BMJ Open 2023; 13:e069560. [PMID: 37173105 DOI: 10.1136/bmjopen-2022-069560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Vaccination is a potentially critical component of efforts to arrest development and dissemination of antimicrobial resistance (AMR), though little is known about vaccination impact within low-income and middle-income countries. This study will evaluate the impact of vaccination on reducing carriage prevalence of resistant Streptococcus pneumoniae and extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. We will leverage two large ongoing cluster-randomised vaccine evaluations in Malawi assessing; first, adding a booster dose to the 13-valent pneumococcal conjugate vaccine (PCV13) schedule, and second, introduction of the RTS,S/AS01 malaria vaccine. METHODS AND ANALYSIS Six cross-sectional surveys will be implemented within primary healthcare centres (n=3000 users of outpatient facilities per survey) and their local communities (n=700 healthy children per survey): three surveys in Blantyre district (PCV13 component) and three surveys in Mangochi district (RTS,S/AS01 component). We will evaluate antibiotic prescription practices and AMR carriage in children ≤3 years. For the PCV13 component, surveys will be conducted 9, 18 and 33 months following a 3+0 to 2+1 schedule change. For the RTS,S/AS01 component, surveys will be conducted 32, 44 and 56 months post-RTS,S/AS01 introduction. Six health centres in each study component will be randomly selected for study inclusion. Between intervention arms, the primary outcome will be the difference in penicillin non-susceptibility prevalence among S. pneumoniae nasopharyngeal carriage isolates in healthy children. The study is powered to detect an absolute change of 13 percentage points (ie, 35% vs 22% penicillin non-susceptibility). ETHICS AND DISSEMINATION This study has been approved by the Kamuzu University of Health Sciences (Ref: P01-21-3249), University College London (Ref: 18331/002) and University of Liverpool (Ref: 9908) Research Ethics Committees. Parental/caregiver verbal or written informed consent will be obtained prior to inclusion or recruitment in the health centre-based and community-based activities, respectively. Results will be disseminated via the Malawi Ministry of Health, WHO, peer-reviewed publications and conference presentations.
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Affiliation(s)
- David Singleton
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Ana Ibarz-Pavon
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Todd D Swarthout
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
| | - Farouck Bonomali
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jennifer Cornick
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Akuzike Kalizang'oma
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
| | - Noah Ntiza
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Comfort Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Raphael Chipatala
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wongani Nyangulu
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - James Chirombo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | | - Neil French
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, UCL, London, UK
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Shelus V, Mumbere N, Mulogo EM, Barrington C, Baguma E, Muhindo R, Herrington JE, Emch M, Maman S, Boyce RM. Private sector antimalarial sales a decade after “test and treat”: A cross-sectional study of drug shop clients in rural Uganda. Front Public Health 2023; 11:1140405. [PMID: 37056663 PMCID: PMC10089286 DOI: 10.3389/fpubh.2023.1140405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundThe World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing.MethodsThe purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors (n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria.ResultsMost drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative.ConclusionsDespite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector.
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Affiliation(s)
- Victoria Shelus
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nobert Mumbere
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar M. Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - James E. Herrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Emch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ross M. Boyce
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Ross M. Boyce
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Chibwana MG, Thole HW, Anscombe C, Ashton PM, Green E, Barnes KG, Cornick J, Turner A, Witte D, Nthala S, Thom C, Kanyandula F, Ainani A, Mtike N, Tambala H, N’goma V, Mwafulirwa D, Asima E, Morton B, Gmeiner M, Gundah Z, Kawalazira G, French N, Feasey N, Heyderman RS, Swarthout TD, Jambo KC. Different clinical features in Malawian outpatients presenting with COVID-19 prior to and during Omicron variant dominance: A prospective observational study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001575. [PMID: 36963090 PMCID: PMC10022204 DOI: 10.1371/journal.pgph.0001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/03/2023] [Indexed: 03/11/2023]
Abstract
The SARS-CoV-2 Omicron variant has resulted in a high number of cases, but a relatively low incidence of severe disease and deaths, compared to the pre-Omicron variants. Therefore, we assessed the differences in symptom prevalence between Omicron and pre-Omicron infections in a sub-Saharan African population. We collected data from outpatients presenting at two primary healthcare facilities in Blantyre, Malawi, from November 2020 to March 2022. Eligible participants were aged >1month old, with signs suggestive of COVID-19, and those not suspected of COVID-19, from whom we collected nasopharyngeal swabs for SARS-CoV-2 PCR testing, and sequenced positive samples to identify infecting-variants. In addition, we calculated the risk of presenting with a given symptom in individuals testing SARS-CoV-2 PCR positive before and during the Omicron variant-dominated period. Among 5176 participants, 6.4% were under 5, and 77% were aged 18 to 50 years. SARS-CoV-2 infection prevalence peaked in January 2021 (Beta), July 2021 (Delta), and December 2021 (Omicron). We found that cough (risk ratio (RR), 1.50; 95% confidence interval (CI), 1.00 to 2.30), fatigue (RR 2.27; 95% CI, 1.29 to 3.86) and headache (RR 1.64; 95% CI, 1.15 to 2.34) were associated with a high risk of SARS-CoV-2 infection during the pre-Omicron period. In comparison, only headache (RR 1.41; 95% CI, 1.07 to 1.86) did associate with a high risk of SARS-CoV-2 infection during the Omicron-dominated period. In conclusion, clinical symptoms associated with Omicron infection differed from prior variants and were harder to identify clinically with current symptom guidelines. Our findings encourage regular review of case definitions and testing policies to ensure case ascertainment.
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Affiliation(s)
| | | | - Cat Anscombe
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Philip M. Ashton
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Edward Green
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kayla G. Barnes
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Harvard School of Public Health, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- University of Glasgow MRC Centre for Virus Research, Glasgow, United Kingdom
| | - Jen Cornick
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ann Turner
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Desiree Witte
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sharon Nthala
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Chikondi Thom
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | | | - Anna Ainani
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Natasha Mtike
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Hope Tambala
- Blantyre District Health Office, Ministry of Health, Blantyre, Malawi
| | | | | | - Erick Asima
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Markus Gmeiner
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Zaziwe Gundah
- Blantyre District Health Office, Ministry of Health, Blantyre, Malawi
| | - Gift Kawalazira
- Blantyre District Health Office, Ministry of Health, Blantyre, Malawi
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Robert S. Heyderman
- NIHR Global Health Research Unit on Mucosal Pathogens, University College London, London, United Kingdom
| | - Todd D. Swarthout
- NIHR Global Health Research Unit on Mucosal Pathogens, University College London, London, United Kingdom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Kamuzu University of Health Sciences, Blantyre, Malawi
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23
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Vora NM, Hannah L, Walzer C, Vale MM, Lieberman S, Emerson A, Jennings J, Alders R, Bonds MH, Evans J, Chilukuri B, Cook S, Sizer NC, Epstein JH. Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics. Emerg Infect Dis 2023; 29:1-9. [PMID: 36823026 PMCID: PMC9973692 DOI: 10.3201/eid2903.221079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The pathogens that cause most emerging infectious diseases in humans originate in animals, particularly wildlife, and then spill over into humans. The accelerating frequency with which humans and domestic animals encounter wildlife because of activities such as land-use change, animal husbandry, and markets and trade in live wildlife has created growing opportunities for pathogen spillover. The risk of pathogen spillover and early disease spread among domestic animals and humans, however, can be reduced by stopping the clearing and degradation of tropical and subtropical forests, improving health and economic security of communities living in emerging infectious disease hotspots, enhancing biosecurity in animal husbandry, shutting down or strictly regulating wildlife markets and trade, and expanding pathogen surveillance. We summarize expert opinions on how to implement these goals to prevent outbreaks, epidemics, and pandemics.
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24
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Tack B, Vita D, Nketo J, Wasolua N, Ndengila N, Herssens N, Ntangu E, Kasidiko G, Nkoji-Tunda G, Phoba MF, Im J, Jeon HJ, Marks F, Toelen J, Lunguya O, Jacobs J. Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo. PLoS Negl Trop Dis 2023; 17:e0011156. [PMID: 36877726 PMCID: PMC10019685 DOI: 10.1371/journal.pntd.0011156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/16/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. METHODOLOGY Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days - <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. PRINCIPAL FINDINGS From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. CONCLUSIONS Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. TRIAL REGISTRATION NCT04289688.
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Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- * E-mail:
| | - Daniel Vita
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - José Nketo
- Zone de Santé Kisantu, Kisantu, Democratic Republic of the Congo
| | - Naomie Wasolua
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Nathalie Ndengila
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Ntangu
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Grace Kasidiko
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Gaëlle Nkoji-Tunda
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Jaan Toelen
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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25
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Cock IE, Luwaca N, Van Vuuren SF. The traditional use of Southern African medicinal plants to alleviate fever and their antipyretic activities. JOURNAL OF ETHNOPHARMACOLOGY 2023; 303:115850. [PMID: 36306931 DOI: 10.1016/j.jep.2022.115850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Multiple plant species are used traditionally in southern Africa to treat fever. This review summarises the traditional use, highlights promising plant species and focuses on validation studies to highlight future areas of research. AIM OF THE STUDY This study aimed to critically review the use of southern African plants to alleviate fever. Additionally, an examination of research into those plants was undertaken to highlight gaps in the literature with the aim of stimulating further research in this field. MATERIALS AND METHODS Ethnobotanical books, reviews and primary research studies were searched to identify plant species traditionally used to treat fever in southern Africa and to summarise the current knowledge and identify areas requiring further research. This study was non-biased and did not have any taxonomic preferences, nor did it favour any southern African healing systems over the others. RESULTS The traditional therapeutic uses of 203 southern African plant species to alleviate fever were recorded. Leaves and roots/bulbs/rhizomes were the most commonly used plant part, and they were most commonly prepared as decoctions or infusions and consumed orally. Notably, only twenty-two species (∼11% of the identified species) have been scientifically evaluated for antipyretic properties, with substantially fewer mechanistic studies evident. CONCLUSIONS Despite the availability of ethnobotanical records, the antipyretic properties of southern African medicinal plants are poorly reported. Indeed, the efficacy of most plants is yet to be verified and very few mechanistic studies are available.
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Affiliation(s)
- I E Cock
- Centre for Planetary Health and Food Security, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia; School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia
| | - N Luwaca
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
| | - S F Van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa.
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26
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Green EW, Ndiaye M, Hossain IM, Olatunji YA, Sahito SM, Salaudeen R, Badji H, Manjang A, Ceesay L, Hill PC, Greenwood B, Mackenzie GA. Pneumonia, Meningitis, and Septicemia in Adults and Older Children in Rural Gambia: 8 Years of Population-Based Surveillance. Clin Infect Dis 2023; 76:694-703. [PMID: 35903006 PMCID: PMC9938739 DOI: 10.1093/cid/ciac603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Representative data describing serious infections in children aged ≥5 years and adults in Africa are limited. METHODS We conducted population-based surveillance for pneumonia, meningitis, and septicemia in a demographic surveillance area in The Gambia between 12 May 2008 and 31 December 2015. We used standardized criteria to identify, diagnose, and investigate patients aged ≥5 years using conventional microbiology and radiology. RESULTS We enrolled 1638 of 1657 eligible patients and investigated 1618. Suspected pneumonia, septicemia, or meningitis was diagnosed in 1392, 135, and 111 patients, respectively. Bacterial pathogens from sterile sites were isolated from 105 (7.5%) patients with suspected pneumonia, 11 (8.1%) with suspected septicemia, and 28 (25.2%) with suspected meningitis. Streptococcus pneumoniae (n = 84), Neisseria meningitidis (n = 16), and Staphylococcus aureus (n = 15) were the most common pathogens. Twenty-eight (1.7%) patients died in hospital and 40 (4.1%) died during the 4 months after discharge. Thirty postdischarge deaths occurred in patients aged ≥10 years with suspected pneumonia. The minimum annual incidence was 133 cases per 100 000 person-years for suspected pneumonia, 13 for meningitis, 11 for septicemia, 14 for culture-positive disease, and 46 for radiological pneumonia. At least 2.7% of all deaths in the surveillance area were due to suspected pneumonia, meningitis, or septicemia. CONCLUSIONS Pneumonia, meningitis, and septicemia in children aged ≥5 years and adults in The Gambia are responsible for significant morbidity and mortality. Many deaths occur after hospital discharge and most cases are culture negative. Improvements in prevention, diagnosis, inpatient, and follow-up management are urgently needed.
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Affiliation(s)
- Edward W Green
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ilias M Hossain
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yekini A Olatunji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shah M Sahito
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Murdoch Children's Research Institute, Melbourne, Australia
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27
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Etiology and clinical characteristics of pediatric acute fever among hospitalized children in an endemic malaria transmission area of Cameroon in Central Africa. PLoS One 2023; 18:e0278407. [PMID: 36693048 PMCID: PMC9873149 DOI: 10.1371/journal.pone.0278407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 11/15/2022] [Indexed: 01/25/2023] Open
Abstract
Acute fever in the majority of children in resource-limited countries is attributable to malaria and often treated without laboratory evidence. The aim of the study was to characterize acute pediatric infectious fevers (APIF) in the pediatric department of the Douala Laquintinie Hospital. A cross-sectional study was conducted among children aged 2 months to 15 years who were admitted with an acute fever (anal temperature ≥ 37.5°C less than 5 days in infants and 7 days in adolescents). 200 children were included and followed up during their hospitalization. The mean age was 3.7 (IQ25-75: 1-4.6) years. More than 3 out of 5 patients (62.5%) came from another health facility and anemia accounted for 29% of the reasons for consultation associated with fever. The main symptoms were vomiting (28%), cough (26%), convulsions (21%) and diarrhea (20%). Skin-mucosal pallor (43.0%) and hepatosplenomegaly (26.0%) were the most common physical signs encountered. Among febrile children, 116/200 (58%) were infected with at least 1 pathogen, and 1/200 (0.5%) had a fever of unknown etiology. Malaria (53% vs 80.5% presumptive) associated with anemia (95.3% of cases) was the most common pathology associated with APIF, followed by pneumonia (19.5%), meningitis (11.5%) and urinary tract infections (10% vs 54.5% presumptive). Malaria was over-diagnosed on admission and over-treated as well as urinary tract infection. A better understanding of common pathogens carriage, a better capacity for improved diagnosis and a better applied clinical algorithm for febrile illnesses in children are needed.
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28
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Comia IR, Miambo RD, Noormahomed EV, Mahoche M, Pondja A, Schooley RT, Benson C, Sacarlal J. A systematic review and meta-analysis of the epidemiology of Leptospirosis in HIV uninfected and in people living with HIV from the Southern African Development Community. PLoS Negl Trop Dis 2022; 16:e0010823. [PMID: 36508469 PMCID: PMC9744292 DOI: 10.1371/journal.pntd.0010823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis is an occupational, neglected febrile disease of bacterial origin transmitted between humans and animals. In this manuscript we summarize available data on Leptospira infection in HIV uninfected and in people living with HIV from the Southern African Development Community (SADC) countries, identifying gaps in knowledge and recommend future research priorities. METHODOLOGY Articles published between 1990 and 2021 were accessed by an online search of Google Scholar and Medline/PubMed performed between February 2020 and July 2022. The STATA program was used for the Meta-analysis. Pooled prevalence values with 95% confidence intervals and heterogeneity were determined. RESULTS Thirty studies from eight SADC countries, reporting the prevalence on Leptospira were reviewed. A pooled prevalence of 19% (CI: 13-25%), a heterogeneity level of 96% and index score ranging from 2 to 9 was determined. Only four (4) studies reported HIV co-infection status. Three species of Leptospira (Leptospira interrogans (4), L. kirschneri (3), Leptospira borgpetersenii (1) and 23 serogroups were identified. The most frequently reported serogroups were Icterohaemorrhagiae (13), Grippotyphosa and Australis (10) followed by Sejroe (8). CONCLUSION Studies on human leptospirosis in the SADC region are scarce, especially in people living with HIV. Additional studies aimed at determining the prevalence and the role of the pathogen in people living with HIV, including detailed clinical, molecular and demographic data are recommended.
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Affiliation(s)
- Isac Rodrigues Comia
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Regina Daniel Miambo
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- * E-mail:
| | - Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Manuel Mahoche
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Alberto Pondja
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
| | - Robert Turner Schooley
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Constance Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Jahit Sacarlal
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
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29
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Azizi H, Majdzadeh R, Ahmadi A, Raeisi A, Nazemipour M, Mansournia MA, Schapira A. Development and validation of an online tool for assessment of health care providers' management of suspected malaria in an area, where transmission has been interrupted. Malar J 2022; 21:304. [PMID: 36303211 DOI: 10.1186/s12936-022-04308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The alertness and practice of health care providers (HCPs) in the correct management of suspected malaria (CMSM) (vigilance) is a central component of malaria surveillance following elimination, and it must be established before malaria elimination certification can be granted. This study was designed to develop and validate a rapid tool, Simulated Malaria Online Tool (SMOT), to evaluate HCPs' practice in relation to the CMSM. METHODS The study was conducted in East Azerbaijan Province, Islamic Republic of Iran, where no malaria transmission has been reported since 2005. An online tool presenting a suspected malaria case for detection of HCPs' failures in recognition, diagnosis, treatment and reporting was developed based on literature review and expert opinion. A total of 360 HCPs were allocated to two groups. In one group their performance was tested by simulated patient (SP) methodology as gold standard, and one month later by the online tool to allow assessment of its sensitivity. In the other group, they were tested only by the online tool to allow assessment of any possible bias incurred by the exposure to SPs before the tool. RESULTS The sensitivity of the tool was (98.7%; CI 93.6-99.3). The overall agreement and kappa statistics were 96.6% and 85.6%, respectively. In the group tested by both methods, the failure proportion by SP was 86.1% (CI 80.1-90.8) and by tool 87.2% (CI 81.4-91.7). In the other group, the tool found 85.6% (CI 79.5-90.3) failures. There were no significant differences in detecting failures within or between the groups. CONCLUSION The SMOT tool not only showed high validity for detecting HCPs' failures in relation to CMSM, but it had high rates of agreement with the real-world situation, where malaria transmission has been interrupted. The tool can be used by program managers to evaluate HCPs' performance and identify sub-groups, whose malaria vigilance should be strengthened. It could also contribute to the evidence base for certification of malaria elimination, and to strengthening prevention of re-establishment of malaria transmission.
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Affiliation(s)
- Hosein Azizi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK.,School of Public Health, Knowledge Utilization Research Center, and Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Raeisi
- National Programme Manager for Malaria Elimination, Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Allan Schapira
- Bicol University College of Medicine, Legazpi City, Philippines
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30
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Ali IM, Tchuenkam VPK, Colton M, Stittleburg V, Mitchell C, Gaither C, Thwai K, Espinoza DO, Zhu Y, Jamal H, Key A, Juliano JJ, Christopher TB, Piantadosi A, Waggoner JJ, Collins MH. Arboviruses as an unappreciated cause of non-malarial acute febrile illness in the Dschang Health District of western Cameroon. PLoS Negl Trop Dis 2022; 16:e0010790. [PMID: 36223421 PMCID: PMC9591055 DOI: 10.1371/journal.pntd.0010790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/24/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Acute febrile illness is a common problem managed by clinicians and health systems globally, particularly in the Tropics. In many regions, malaria is a leading and potentially deadly cause of fever; however, myriad alternative etiologies exist. Identifying the cause of fever allows optimal management, but this depends on many factors including thorough knowledge of circulating infections. Arboviruses such as dengue (DENV) cause fever and may be underdiagnosed in sub-Saharan Africa where malaria is a major focus. We examined cases of fever in western Cameroon that tested negative for malaria and found 13.5% (13/96) were due to DENV, with 75% (9/12) of these being DENV serotype 2 infections. Two complete DENV2 genomes were obtained and clustered closely to recent isolates from Senegal and Burkina Faso. The seroprevalence of DENV in this region was 24.8% (96/387). Neutralizing antibodies to DENV2 were detected in all (15/15) seropositive samples tested. Chikungunya (CHIKV) is an arthritogenic alphavirus that is transmitted by Aedes mosquitoes, the same principal vector as DENV. The seroprevalence for CHIKV was 15.7% (67/427); however, CHIKV did not cause a single case of fever in the 96 subjects tested. Of note, being seropositive for one arbovirus was associated with being seropositive for the other (Χ2 = 16.8, p<0.001). Taken together, these data indicate that Aedes-transmitted arboviruses are endemic in western Cameroon and are likely a common but underappreciated cause of febrile illness. This work supports the need for additional study of arboviruses in sub-Saharan Africa and efforts to improve diagnostic capacity, surveillance systems, and arbovirus prevention strategies. Acute illness with fever is common but can be challenging for clinicians to manage, particularly in resource-limited settings. In sub-Saharan Africa, malaria is a major cause of fever, but other causes of fever are poorly documented or monitored, which impairs optimal medical care to patients and implementation of public health interventions to control leading causes of disease. Viruses transmitted by mosquitoes are a prevalent and expanding problem throughout the tropics and beyond; however, there is concern that these infections frequently go undetected in sub-Saharan Africa. We discovered a previously unrecognized outbreak of dengue virus in western Cameroon by testing remnant samples from over 400 patients that presented with fever. Our results indicate that dengue has circulated in this region for decades with little recognition. This study adds important information about causes of fever in sub-Saharan Africa and advocates for increasing investment in surveillance systems and prevention strategies for mosquito-borne viruses.
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Affiliation(s)
- Innocent M. Ali
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, West Region of Cameroon, Cameroon
| | - Valery P. K. Tchuenkam
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, West Region of Cameroon, Cameroon
| | - Mia Colton
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Victoria Stittleburg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Cedar Mitchell
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Claudia Gaither
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kyaw Thwai
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel O. Espinoza
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Yerun Zhu
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Haaris Jamal
- Emory University, Atlanta, Georgia, United States of America
| | - Autum Key
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jonathan J. Juliano
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tume B. Christopher
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, West Region of Cameroon, Cameroon
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jesse J. Waggoner
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Matthew H. Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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Sidote MN, Stoler J, Amoako N, Duodu S, Awandare G. Animal contact and paediatric acute febrile illness in Greater Accra Region, Ghana. Ghana Med J 2022; 56:221-230. [PMID: 37448994 PMCID: PMC10336642 DOI: 10.4314/gmj.v56i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective To examine the association between animal contact (primarily dogs and cats) and non-malarial fever, as well as with secondary symptoms of headache, nausea, vomiting, and cough, in 687 children in Greater Accra Region, Ghana. Design Cross-sectional study of acute febrile illness among children aged 1-15 years old between October 2016 and August 2017. Setting Ledzokuku-Krowor Municipal Assembly (LEKMA) Hospital, Teshie, Greater Accra Region. Participants The study included children with acute fever, defined as a measured temperature of greater than 37.5°C, occurring less than seven days before the hospital visit, and afebrile children as controls. Main outcome measures Measured fever, self-reported fever, and secondary symptoms, each adjusting for patient household characteristics. Results Animal contact was neither associated with measured fever (OR = 1.04, 95% CI 0.73-1.49) nor with self-reported fever (OR = 0.97, 95% CI 0.68-1.39). Animal contact was associated with headache (OR = 3.26, 95% CI 2.23-4.77, P < .01) and nausea (OR = 3.05, 95% CI 1.99-4.68, P < .01), but not with vomiting or cough. Additional models that used alternate inclusion criteria to define non-malarial fever yielded similar results. Several bacterial zoonoses that could plausibly have been transmitted by dogs and cats were diagnosed in the study population. Conclusion These findings suggest the need for future studies to evaluate animal contact as a risk factor for bacterial zoonoses that may serve as an etiological driver of acute febrile illness. Funding no external funding.
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Affiliation(s)
- Melissa N Sidote
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Justin Stoler
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, FL, USA
| | - Nicholas Amoako
- Kintampo Health Research Centre, Kintampo, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
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Manabe YC, Betz J, Jackson O, Asoala V, Bazan I, Blair PW, Chang A, Chusri S, Crump JA, Edgel KA, Faix DJ, Fernandez S, Fox AT, Garcia JA, Grogl M, Hansen EA, Heang V, House SL, Jongsakul K, Kaburise MB, Klungthong C, Lamorde M, Letizia AG, Lorenzana I, Luy M, Maro VP, Mores CN, Myers CA, Oduro AR, Parham L, Porzucek AJ, Prouty M, Rabiger DS, Rubach MP, Siles C, Silva M, Ukachu C, Waitumbi JN, Phillips CL, Jones BW. Clinical evaluation of the BioFire Global Fever Panel for the identification of malaria, leptospirosis, chikungunya, and dengue from whole blood: a prospective, multicentre, cross-sectional diagnostic accuracy study. THE LANCET. INFECTIOUS DISEASES 2022; 22:1356-1364. [PMID: 35716700 PMCID: PMC9420791 DOI: 10.1016/s1473-3099(22)00290-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 04/12/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute febrile illness is a common presentation for patients at hospitals globally. Assays that can diagnose a variety of common pathogens in blood could help to establish a diagnosis for targeted disease management. We aimed to evaluate the performance of the BioFire Global Fever Panel (GF Panel), a multiplex nucleic acid amplification test performed on whole blood specimens run on the BioFire FilmArray System, in the diagnosis of several pathogens that cause acute febrile illness. METHODS We did a prospective, multicentre, cross-sectional diagnostic accuracy study to evaluate the GF Panel. Consenting adults and children older than 6 months presenting with fever in the previous 2 days were enrolled consecutively in sub-Saharan Africa (Ghana, Kenya, Tanzania, Uganda), southeast Asia (Cambodia, Thailand), central and South America (Honduras, Peru), and the USA (Washington, DC; St Louis, MO). We assessed the performance of six analytes (chikungunya virus, dengue virus [serotypes 1-4], Leptospira spp, Plasmodium spp, Plasmodium falciparum, and Plasmodium vivax or Plasmodium ovale) on the GF Panel. The performance of the GF Panel was assessed using comparator PCR assays with different primers followed by bidirectional sequencing on nucleic acid extracts from the same specimen. We calculated the positive percent agreement and negative percent agreement of the GF Panel with respect to the comparator assays. This study is registered with ClinicalTrials.gov, NCT02968355. FINDINGS From March 26, 2018, to Sept 30, 2019, 1965 participants were enrolled at ten sites worldwide. Of the 1875 participants with analysable results, 980 (52·3%) were female and the median age was 22 years (range 0-100). At least one analyte was detected in 657 (35·0%) of 1875 specimens. The GF Panel had a positive percent agreement for the six analytes evaluated as follows: chikungunya virus 100% (95% CI 86·3-100), dengue virus 94·0% (90·6-96·5), Leptospira spp 93·8% (69·8-99·8), Plasmodium spp 98·3% (96·3-99·4), P falciparum 92·7% (88·8-95·6), and P vivax or P ovale 92·7% (86·7-96·6). The GF Panel had a negative percent agreement equal to or greater than 99·2% (98·6-99·6) for all analytes. INTERPRETATION This 1 h sample-to-answer, molecular device can detect common causative agents of acute febrile illness with excellent positive percent agreement and negative percent agreement directly in whole blood. The targets of the assay are prevalent in tropical and subtropical regions globally, and the assay could help to provide both public health surveillance and individual diagnoses. FUNDING BioFire Defense, Joint Project Manager for Medical Countermeasure Systems and US Army Medical Materiel Development Activity, and National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Joshua Betz
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Victor Asoala
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Isabel Bazan
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru
| | - Paul W Blair
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aileen Chang
- Department of Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Sarunyou Chusri
- Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand
| | - John A Crump
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Dennis J Faix
- US Naval Medical Research Unit Two, Phnom Penh, Cambodia
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Anne T Fox
- US Naval Medical Research Unit Three, Ghana Detachment, Accra, Ghana
| | - Jose A Garcia
- US Naval Medical Research Unit Two, Phnom Penh, Cambodia
| | - Max Grogl
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru
| | - Erin A Hansen
- Operational Infectious Diseases, Naval Health Research Center, San Diego, CA, USA
| | - Vireak Heang
- US Naval Medical Research Unit Two, Phnom Penh, Cambodia
| | - Stacey L House
- Washington University School of Medicine, Department of Emergency Medicine, St Louis, MO, USA
| | - Krisada Jongsakul
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew G Letizia
- US Naval Medical Research Unit Three, Ghana Detachment, Accra, Ghana
| | - Ivette Lorenzana
- Universidad Nacional Autónoma de Honduras, Centro de Investigaciones Geneticas, Instituto de Investigacion en Microdbiologia, Tegucigalpa, Honduras
| | - Malen Luy
- US Naval Medical Research Unit Two, Phnom Penh, Cambodia
| | - Vanance P Maro
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Christopher N Mores
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christopher A Myers
- Operational Infectious Diseases, Naval Health Research Center, San Diego, CA, USA
| | - Abraham R Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Leda Parham
- Universidad Nacional Autónoma de Honduras, Centro de Investigaciones Geneticas, Instituto de Investigacion en Microdbiologia, Tegucigalpa, Honduras
| | - Abigail J Porzucek
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Michael Prouty
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru
| | | | - Matthew P Rubach
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University, Durham, NC, USA
| | - Crystyan Siles
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru
| | - Maria Silva
- Virology and Emerging Infections Department, US Naval Medical Research Unit Six, Lima, Peru
| | - Chinaka Ukachu
- Operational Infectious Diseases, Naval Health Research Center, San Diego, CA, USA
| | - John N Waitumbi
- US Army Medical Research Directorate-Africa, Kenya Medical Research Institute, Nairobi, Kenya
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Van Duffel L, Yansouni CP, Jacobs J, Van Esbroeck M, Ramadan K, Buyze J, Tsoumanis A, Barbé B, Boelaert M, Verdonck K, Chappuis F, Bottieau E. ACCURACY OF C-REACTIVE PROTEIN AND PROCALCITONIN FOR DIAGNOSING BACTERIAL INFECTIONS AMONG SUBJECTS WITH PERSISTENT FEVER IN THE TROPICS. Open Forum Infect Dis 2022; 9:ofac434. [PMID: 36092831 PMCID: PMC9454028 DOI: 10.1093/ofid/ofac434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background In low-resource settings, inflammatory biomarkers can help identify patients with acute febrile illness who do not require antibiotics. Their use has not been studied in persistent fever (defined as fever lasting for ≥7 days at presentation). Methods C-reactive protein (CRP) and procalcitonin (PCT) levels were measured in stored serum samples of patients with persistent fever prospectively enrolled in Cambodia, the Democratic Republic of Congo, Nepal, and Sudan. Diagnostic accuracy was assessed for identifying all bacterial infections and the subcategory of severe infections judged to require immediate antibiotics. Results Among 1838 participants, CRP and PCT levels were determined in 1777 (96.7%) and 1711 (93.1%) samples, respectively, while white blood cell (WBC) count was available for 1762 (95.9%). Areas under the receiver operating characteristic curve for bacterial infections were higher for CRP (0.669) and WBC count (0.651) as compared with PCT (0.600; P <.001). Sensitivity for overall and severe bacterial infections was 76.3% (469/615) and 88.2% (194/220) for CRP >10 mg/L, 62.4% (380/609) and 76.8% (169/220) for PCT >0.1 µg/L, and 30.5% (184/604) and 43.7% (94/215) for WBC >11 000/µL, respectively. Initial CRP level was <10 mg/L in 45% of the participants who received antibiotics at first presentation. Conclusions In patients with persistent fever, CRP and PCT showed higher sensitivity for bacterial infections than WBC count, applying commonly used cutoffs for normal values. A normal CRP value excluded the vast majority of severe infections and could therefore assist in deciding whether to withhold empiric antibiotics after cautious clinical assessment.
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Affiliation(s)
- Lukas Van Duffel
- Infectious Diseases Unit, Morgagni-Pierantoni Hospital , AUSL of Romagna, Forlì , Italy
| | - Cedric P Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre , Montreal , Canada
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
- Department of Microbiology, Immunology and Transplantation , KU Leuven, Leuven , Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
| | - Kadrie Ramadan
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine , Antwerp , Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine , Antwerp , Belgium
| | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva , Geneva , Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp , Belgium
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Simmons SS, Hagan JE, Schack T. Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106171. [PMID: 35627708 PMCID: PMC9140720 DOI: 10.3390/ijerph19106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Information on the concentration of body mass index and child death among females in Malawi, where the epidemics of weight gain have been disconcerting and preventable deaths among children linger, is limited. Therefore, the study examined the polarity of body mass index and the death of children among females. Using data from the Malawian Demographic and Health Survey from 2000 to 2015–2016, the study applied for the first time the index of concentration at the extremes and indirect demographic techniques to estimate the polarity of body mass index and child mortality among 65,499 females aged 15 to 49 years. The preponderance of obesity more than doubled from 2000 to 2015–2016 and was highest among females who were older (35–49 years), urban dwellers, rich, and located in districts within the central and southern regions. In addition, child survival was low among underweight, overweight, and obese females. While national-, regional-, and individual-level statistics are in development, these findings provide helpful information for health experts and other stakeholders to initiate appropriate age-region specific programs and interventions in Malawi, including targeting females in the high socio-economic bracket.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
- Institute of Demography, National Research University-Higher School of Economics, 101000 Moscow, Russia
| | - John Elvis Hagan
- Department of Health, Physical Education & Recreation, College of Education Studies, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
- Correspondence:
| | - Thomas Schack
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
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Bottieau E, Van Duffel L, El Safi S, Koirala KD, Khanal B, Rijal S, Bhattarai NR, Phe T, Lim K, Mukendi D, Kalo JRL, Lutumba P, Barbé B, Jacobs J, Van Esbroeck M, Foqué N, Tsoumanis A, Parola P, Yansouni CP, Boelaert M, Verdonck K, Chappuis F. Etiological spectrum of persistent fever in the tropics and predictors of ubiquitous infections: a prospective four-country study with pooled analysis. BMC Med 2022; 20:144. [PMID: 35491421 PMCID: PMC9059373 DOI: 10.1186/s12916-022-02347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent fever, defined as fever lasting for 7 days or more at first medical evaluation, has been hardly investigated as a separate clinical entity in the tropics. This study aimed at exploring the frequencies and diagnostic predictors of the ubiquitous priority (i.e., severe and treatable) infections causing persistent fever in the tropics. METHODS In six different health settings across four countries in Africa and Asia (Sudan, Democratic Republic of Congo [DRC], Nepal, and Cambodia), consecutive patients aged 5 years or older with persistent fever were prospectively recruited from January 2013 to October 2014. Participants underwent a reference diagnostic workup targeting a pre-established list of 12 epidemiologically relevant priority infections (i.e., malaria, tuberculosis, HIV, enteric fever, leptospirosis, rickettsiosis, brucellosis, melioidosis, relapsing fever, visceral leishmaniasis, human African trypanosomiasis, amebic liver abscess). The likelihood ratios (LRs) of clinical and basic laboratory features were determined by pooling all cases of each identified ubiquitous infection (i.e., found in all countries). In addition, we assessed the diagnostic accuracy of five antibody-based rapid diagnostic tests (RDTs): Typhidot Rapid IgM, Test-itTM Typhoid IgM Lateral Flow Assay, and SD Bioline Salmonella typhi IgG/IgM for Salmonella Typhi infection, and Test-itTM Leptospira IgM Lateral Flow Assay and SD Bioline Leptospira IgG/IgM for leptospirosis. RESULTS A total of 1922 patients (median age: 35 years; female: 51%) were enrolled (Sudan, n = 667; DRC, n = 300; Nepal, n = 577; Cambodia, n = 378). Ubiquitous priority infections were diagnosed in 452 (23.5%) participants and included malaria 8.0% (n = 154), tuberculosis 6.7% (n = 129), leptospirosis 4.0% (n = 77), rickettsiosis 2.3% (n = 44), enteric fever 1.8% (n = 34), and new HIV diagnosis 0.7% (n = 14). The other priority infections were limited to one or two countries. The only features with a positive LR ≥ 3 were diarrhea for enteric fever and elevated alanine aminotransferase level for enteric fever and rickettsiosis. Sensitivities ranged from 29 to 67% for the three RDTs targeting S. Typhi and were 9% and 16% for the two RDTs targeting leptospirosis. Specificities ranged from 86 to 99% for S. Typhi detecting RDTs and were 96% and 97% for leptospirosis RDTs. CONCLUSIONS Leptospirosis, rickettsiosis, and enteric fever accounted each for a substantial proportion of the persistent fever caseload across all tropical areas, in addition to malaria, tuberculosis, and HIV. Very few discriminative features were however identified, and RDTs for leptospirosis and Salmonella Typhi infection performed poorly. Improved field diagnostics are urgently needed for these challenging infections. TRIAL REGISTRATION NCT01766830 at ClinicalTrials.gov.
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Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Lukas Van Duffel
- Infectious Diseases Operative Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Sayda El Safi
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Basudha Khanal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Rijal
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Kruy Lim
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Deby Mukendi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.,Service de neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Roger Lilo Kalo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foqué
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Philippe Parola
- IHU-Méditerranée Infection & Aix-Marseille University, Marseille, France
| | - Cedric P Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Canada
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Palomar AM, Molina I, Bocanegra C, Portillo A, Salvador F, Moreno M, Oteo JA. Old zoonotic agents and novel variants of tick-borne microorganisms from Benguela (Angola), July 2017. Parasit Vectors 2022; 15:140. [PMID: 35449022 PMCID: PMC9022410 DOI: 10.1186/s13071-022-05238-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Ticks and tick-borne diseases constitute a real threat for the livestock industry, which is increasing in Angola. In addition, ticks are vectors of zoonoses of public health concern, and scarce information is available from this country. In an effort to contribute to the prevention of zoonotic infectious diseases affecting humans and animals, the molecular screening of certain tick-related microorganisms collected on cattle in Angola was performed under a ‘One Health’ scope. Methods Ticks collected from cattle in Cubal (Benguela Province, Angola) in July 2017 were analysed in pools using specific PCR assays for bacteria (Rickettsia, Anaplasmataceae, Borrelia, Coxiella and Spiroplasma) and protozoa (Theileria and Babesia) detection. Results A total of 124 tick specimens were grouped in 25 pools (two Amblyomma variegatum, three Hyalomma truncatum, 16 Rhipicephalus decoloratus, two Rhipicephalus duttoni, one Rhipicephalus evertsi mimeticus and one Rhipicephalus sp.). The amplified microorganisms were (pools): Rickettsia africae (two A. variegatum and one R. decoloratus), Rickettsia aeschlimannii (three H. truncatum), Ehrlichia spp. (six R. decoloratus), Coxiella spp. (all but H. truncatum), Francisella sp. (one H. truncatum), Spiroplasma sp. closely related to Spiroplasma ixodetis (three R. decoloratus), Babesia bigemina (two R. decoloratus) and Babesia spp. (two A. variegatum). The obtained nucleotide sequences from Ehrlichia spp., two Coxiella genotypes (from R. duttoni and Rhipicephalus sp.), Francisella sp. and Babesia spp. (from A. variegatum) reached low identities with known genetically characterized species. Conclusions This study demonstrates the circulation in Angola of the pathogen R. aeschlimannii and potential novel tick-related microorganisms belonging to Ehrlichia, Coxiella, Francisella, Spiroplasma and Babesia spp. and corroborates the presence of R. africae and B. bigemina. Our results should be considered in developing protocols for the management of fever of unknown origin and for veterinary practices. Further studies are required to evaluate the risk of tick-borne diseases in Angola. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05238-2.
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Affiliation(s)
- Ana M Palomar
- Infectious Diseases Department, Center of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), San Pedro University Hospital-Center of Biomedical Research From La Rioja (CIBIR), Piqueras, 98, 26006, Logroño, La Rioja, Spain
| | - Israel Molina
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, 08035, Barcelona, Spain
| | - Cristina Bocanegra
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, 08035, Barcelona, Spain
| | - Aránzazu Portillo
- Infectious Diseases Department, Center of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), San Pedro University Hospital-Center of Biomedical Research From La Rioja (CIBIR), Piqueras, 98, 26006, Logroño, La Rioja, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, 08035, Barcelona, Spain
| | | | - José A Oteo
- Infectious Diseases Department, Center of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), San Pedro University Hospital-Center of Biomedical Research From La Rioja (CIBIR), Piqueras, 98, 26006, Logroño, La Rioja, Spain.
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Liyew B, Tarekegn GE, Kassew T, Tsegaye N, Asfaw MG, Tilahun AD, Tadesse AZ, Alamneh TS. Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0264707. [PMID: 35298490 PMCID: PMC8929549 DOI: 10.1371/journal.pone.0264707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia. Method The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05. Result This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers. Conclusion The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.
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Affiliation(s)
- Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Gebrekidan Ewnetu Tarekegn
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanet Tsegaye
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie Tadesse
- Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Raab M, Pfadenhauer LM, Doumbouya D, Froeschl G. Clinical presentations, diagnostics, treatments and treatment costs of children and adults with febrile illness in a tertiary referral hospital in south-eastern Guinea: A retrospective longitudinal cohort study. PLoS One 2022; 17:e0262084. [PMID: 35007283 PMCID: PMC8746772 DOI: 10.1371/journal.pone.0262084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background Febrile illness is frequent among patients in the tropics. It is caused by a wide variety of common diseases such as malaria or gastrointestinal infections but also by less common but highly contagious pathogens with epidemic potential. This study describes the clinical features of adult and paediatric patients with febrile illness in in the largest tertiary referral hospital in south-eastern Guinea, a region at high risk for viral haemorrhagic fever outbreaks. The study further compares their diagnostic characteristics, treatments and outcomes with non-febrile patients in order to contribute to the local epidemiology of febrile illness. Methods We used retrospective data collection to record demographic and clinical data of all incoming patients during a study period of three months. For the follow-up study of inpatients, we retrospectively reviewed patient charts for diagnostic characteristics, diagnoses and outcomes. Results Of the 4317 incoming patients during the study period, 9.5% had a febrile illness. The most used diagnostic measures to identify causative agents in febrile patients were point-of-care tests and most treatments relied on antibiotics. Most common discharge diagnoses for febrile inpatients were malaria (9.6% adults, 56.7% children), salmonella gastroenteritis/typhoid (10.6% adults, 7.8% children) and respiratory infection/pneumonia (5.3% adults, 18.7% children). Inpatient mortality for children was significantly higher in febrile than non-febrile children (18.5% vs. 5.1%, p<0.001) and considerably higher in febrile than non-febrile adults (29.8% vs. 25.0%, p = 0.404). Conclusions Malaria, respiratory infection and gastroenteritis are considered the main causes for febrile illness. The wide reliance on rapid diagnostic tests to diagnose febrile patients not only risks to over- or under-diagnose certain diseases but also leaves the possibility of highly infectious diseases in febrile patients unexplored. Furthermore, the heavy reliance on antibiotics risks to cause antimicrobial resistance. High mortality rates in febrile patients, especially children, should be of concern to public health authorities.
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Affiliation(s)
- Manuel Raab
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Munich, Germany
- * E-mail:
| | - Lisa M. Pfadenhauer
- Institute of Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University Munich, Munich, Germany
| | - Dansira Doumbouya
- Paediatric Service, Hôpital Régional de Nzérékoré, Nzérékoré, Guinea
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Munich, Germany
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Artificial Intelligence and Malaria. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wainaina M, Vey da Silva DA, Dohoo I, Mayer-Scholl A, Roesel K, Hofreuter D, Roesler U, Lindahl J, Bett B, Al Dahouk S. A systematic review and meta-analysis of the aetiological agents of non-malarial febrile illnesses in Africa. PLoS Negl Trop Dis 2022; 16:e0010144. [PMID: 35073309 PMCID: PMC8812962 DOI: 10.1371/journal.pntd.0010144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 02/03/2022] [Accepted: 01/04/2022] [Indexed: 12/16/2022] Open
Abstract
Background The awareness of non-malarial febrile illnesses (NMFIs) has been on the rise over the last decades. Therefore, we undertook a systematic literature review and meta-analysis of causative agents of non-malarial fevers on the African continent. Methodology We searched for literature in African Journals Online, EMBASE, PubMed, Scopus, and Web of Science databases to identify aetiologic agents that had been reported and to determine summary estimates of the proportional morbidity rates (PMr) associated with these pathogens among fever patients. Findings A total of 133 studies comprising 391,835 patients from 25 of the 54 African countries were eligible. A wide array of aetiologic agents were described with considerable regional differences among the leading agents. Overall, bacterial pathogens tested from blood samples accounted for the largest proportion. The summary estimates from the meta-analysis were low for most of the agents. This may have resulted from a true low prevalence of the agents, the failure to test for many agents or the low sensitivity of the diagnostic methods applied. Our meta-regression analysis of study and population variables showed that diagnostic methods determined the PMr estimates of typhoidal Salmonella and Dengue virus. An increase in the PMr of Klebsiella spp. infections was observed over time. Furthermore, the status of patients as either inpatient or outpatient predicted the PMr of Haemophilus spp. infections. Conclusion The small number of epidemiological studies and the variety of NMFI agents on the African continent emphasizes the need for harmonized studies with larger sample sizes. In particular, diagnostic procedures for NMFIs should be standardized to facilitate comparability of study results and to improve future meta-analyses. Reliable NMFI burden estimates will inform regional public health strategies. Previous systematic reviews have highlighted the research priorities of causative agents for non-malarial febrile illnesses by counting the number of publications attributed to an agent. However, proportional morbidity rates are calculated by dividing the number of cases with a specific disease (numerator) by the total number of diagnosed fever cases (denominator) and are better indicators of the relative importance of aetiological agents in a population. Therefore, we present the leading causes of non-malarial febrile illnesses in African patients in both healthcare and community settings. Preference is given to HIV-negative patients when data could be found. We also determined summary estimates of Brucella spp., Chikungunya virus, Dengue virus, Haemophilus spp., Klebsiella spp., Leptospira spp., non-typhoidal Salmonella spp., typhoidal Salmonella spp., Staphylococcus spp., and Streptococcus spp. The wide array of aetiological agents causing febrile illnesses on the African continent does not only complicate malaria control programs but may also hamper response to epidemic and pandemic illnesses such as Ebola and COVID-19. The harmonisation of diagnostics and study designs will reduce between-study differences, which may result in better estimates of disease burden on the continent and in the different African regions. This information is important for Pan-African surveillance and control efforts.
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Affiliation(s)
- Martin Wainaina
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- International Livestock Research Institute, Nairobi, Kenya
- * E-mail:
| | - David Attuy Vey da Silva
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ian Dohoo
- University of Prince Edward Island, Charlottetown, Canada
| | - Anne Mayer-Scholl
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Kristina Roesel
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- International Livestock Research Institute, Nairobi, Kenya
| | - Dirk Hofreuter
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Uwe Roesler
- Institute for Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany
| | - Johanna Lindahl
- International Livestock Research Institute, Nairobi, Kenya
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, Aachen, Germany
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Ando N, Kutsuna S, Takaya S, Katanami Y, Ohmagari N. Imported African Tick Bite Fever in Japan: A Literature Review and Report of Three Cases. Intern Med 2022; 61:1093-1098. [PMID: 35370251 PMCID: PMC9038472 DOI: 10.2169/internalmedicine.7109-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
African tick bite fever (ATBF) is an acute febrile illness caused by Rickettsia africae. ATBF is an important differential diagnosis of acute febrile illness among returned travelers. However, little information is available on ATBF cases imported to Japan, as only seven have been reported to date. To characterize the epidemiological and clinical profiles of patients diagnosed with ATBF in Japan, we reported three new ATBF cases at our hospital between May 2015 and April 2018 and conducted a literature review.
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Affiliation(s)
- Naokatsu Ando
- AIDS Clinical Center, National Center for Global Health and Medicine, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Saho Takaya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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Kourouma K, Grovogui FM, Delamou A, Chérif MS, Ingelbeen B, Beavogui AH, van Griensven J, Bottieau E. Management of febrile illness in rural Guinea over a seven-year period: A retrospective study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001133. [PMID: 36962689 PMCID: PMC10021211 DOI: 10.1371/journal.pgph.0001133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Febrile illnesses constitute a major clinical challenge in tropical settings. We aimed to assess the frequency, presentation and management of febrile illness at two health facilities in Forécariah, Guinea, with a focus on appropriateness of antibiotic prescription. MATERIALS AND METHODS This was a retrospective study conducted in patient files in a health center and a district hospital. Proportions of antibiotic prescription were determined by age group and syndromes as well as appropriateness of antibiotic prescription using the WHO model list (2019). RESULTS From 2014 to 2020, 23,583 of 62,185 (38.0%) visits were related to febrile illness. Most patients with fever were female (56.1%) and evaluated at the health center (81.0%). Gastrointestinal (40.6%) and respiratory syndromes (36.8%), and undifferentiated fever (30.0%) were the most common presentations. Malaria was confirmed in 61.3% of the cohort. Overall, the rate of antibiotic prescription was high (14,834/23,583, 62.9%), mostly among patients aged <5 years (5,285/7,566, 69.9%), those with respiratory (7,577/8,684, 87.3%) and gastrointestinal (6,324/9,585, 66.0%) syndromes. Moreover, 7,432/14,465 (51.4%) patients with malaria were also prescribed an antibiotic. Penicillin (42.0%), cotrimoxazole (26.3%) and quinolones (18.7%) were the most frequently prescribed antibiotics. Overall, appropriateness of antibiotic prescription was low (38.3%), and even more so in patients with respiratory (29.1%) and gastrointestinal (25.8%) syndromes. CONCLUSIONS Febrile illness is a major cause of consultation in rural Guinea. Rate of antibiotic prescription was high, even in confirmed malaria and was often considered inappropriate. There is a pressing need to investigate the etiological spectrum and improve the diagnostic approach of febrile illness in Guinea.
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Affiliation(s)
- Karifa Kourouma
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) Forécariah, Maferinyah, Guinea
| | - Fassou Mathias Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) Forécariah, Maferinyah, Guinea
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) Forécariah, Maferinyah, Guinea
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Mahamoud Sama Chérif
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) Forécariah, Maferinyah, Guinea
- Regional Direction of Health, Faranah, Guinea
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (CNFRSR) Forécariah, Maferinyah, Guinea
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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Müller SA, Wood RR, Hanefeld J, El-Bcheraoui C. Seroprevalence and Risk Factors of COVID-19 in Healthcare Workers From Eleven African Countries: A Scoping Review and Appraisal of Existing Evidence. Health Policy Plan 2021; 37:505-513. [PMID: 34726740 PMCID: PMC8689910 DOI: 10.1093/heapol/czab133] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
A better understanding of serological data and risk factors for COVID-19 infection in healthcare workers are especially important in African countries where human resources and health services are more constrained. We reviewed and appraised the evidence of SARS-CoV-2 seroprevalence and its risk factors in healthcare workers in Africa to inform response and preparedness strategies during the SARS CoV-2 pandemic. We followed the PRISMA-ScR guidelines in this scoping review. Databases including PubMed, Embase and preprint servers were searched accordingly from the start of the COVID-19 pandemic to 19th April 2021. Our search yielded twelve peer-reviewed and four pre-print articles comprising data on 9,223 HCWs from eleven countries in Africa. Seroprevalence varied widely and ranged from 0% to 45.1%. Seropositivity was associated with older age, lower education, working as a nurse/non- clinical HCW, or in gynaecology, emergency, outpatient or surgery departments. Asymptomatic rates were high and half of the studies recommended routine testing of HCWs. This scoping review found a varying, but often high SARS-CoV-2 seroprevalence in HCWs in eleven African countries and identified certain risk factors. COVID-19 public health strategies for policy and planning should consider these risk factors and the potential for high seroprevalence among HCWs when prioritizing infection prevention and control measures and vaccine deployment.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Rebekah Ruth Wood
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Charbel El-Bcheraoui
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
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Larsen CS. What causes fever in Côte d'Ivoire? Travel Med Infect Dis 2021; 43:102147. [PMID: 34339861 DOI: 10.1016/j.tmaid.2021.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sulis G, Sayood S, Gandra S. Antimicrobial resistance in low- and middle-income countries: current status and future directions. Expert Rev Anti Infect Ther 2021; 20:147-160. [PMID: 34225545 DOI: 10.1080/14787210.2021.1951705] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Rising rates of antimicrobial resistance (AMR) globally continue to pose agrave threat to human health. Low- and middle-income countries (LMICs) are disproportionately affected, partly due to the high burden of communicable diseases.Areas covered: We reviewed current trends in AMR in LMICs and examined the forces driving AMR in those regions. The state of interventions being undertaken to curb AMR across the developing world are discussed, and the impact of the current COVID-19 pandemic on those efforts is explored.Expert opinion: The dynamics that drive AMR in LMICs are inseparable from the political, economic, socio-cultural, and environmental forces that shape these nations. The COVID-19 pandemic has further exacerbated underlying factors that increase AMR. Some progress is being made in implementing surveillance measures in LMICs, but implementation of concrete measures to meaningfully impact AMR rates must address the underlying structural issues that generate and promote AMR. This, in turn, will require large infrastructural investments and significant political will.
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Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sena Sayood
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
| | - Sumanth Gandra
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
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Kelly RF, Jennings A, Hunt J, Hamman SM, Mazeri S, Nkongho EF, Ngwa VN, Tanya V, Sander M, Ndip L, Bessell PR, Morgan KL, Handel IG, Muwonge A, Bronsvoort BMDC. The epidemiology of bacterial zoonoses in pastoral and dairy cattle in Cameroon, Central Africa. Zoonoses Public Health 2021; 68:781-793. [PMID: 34129288 DOI: 10.1111/zph.12865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/22/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
Previous work identified that bacterial zoonoses (Brucella species, Coxiella burnetii and Leptospira hardjo) were present in Cameroonian pastoral cattle. To assess the characteristics of this zoonotic risk, we analyse seroprevalence of each pathogen and the associated management, herd and environmental factors in Cameroonian pastoral and dairy cattle. Cross-sectional samples included pastoralist herds in the Northwest Region (NWR n = 750) and Vina Division (VD n = 748) and small holder dairy herds in the NWR (n = 60). Exposure to Brucella spp., C. burnetii and L. hardjo were screened for using commercial ELISAs and population adjusted estimates made. In addition, individual, herd and ecological metadata were collected and used to identify risk factors associated with animal-level seropositivity. In the pastoral cattle, seroprevalence to Brucella spp. was relatively low but was higher in the NWR (4.2%, CI: 2.5%-7.0%) than the VD (1.1%: CI 0.5%-2.4%), while L. hardjo seroprevalence was much higher though similar in the NWR (30.7%, CI 26.3%-35.5%) and VD (35.9%, CI 31.3%-40.7%). No differences were noted in C. burnetii seroprevalence between the two study sites (NWR: 14.6%, CI 11.8%-18.0%. VD: 12.4%, 9.6%-15.9%). Compared to pastoral, dairy cattle had lower seroprevalences for L. hardjo (1.7%, CI: 0.0%-4.9%), C. burnetii (0.0%, CI 0.0%-6.0%) but similar for Brucella spp. (5.0%, CI 0.0%-10.6%). Increased odds of Brucella spp. seropositivity were associated with owning sheep or rearing sheep and fencing cattle in at night. Adult cattle had increased odds of being seropositive for both C. burnetii and L. hardjo. Additionally, exposure to C. burnetii was associated with local ecological conditions and L. hardjo was negatively associated with cattle undertaking transhumance. This work highlights that exposure to these 3 important production diseases and occupational zoonoses are widespread in Cameroonian cattle. Further work is required to understand transmission dynamics between humans and livestock to inform implementation of effective control measures.
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Affiliation(s)
- Robert F Kelly
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Amy Jennings
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Jennifer Hunt
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Saidou M Hamman
- Regional Centre of Wakwa, Institute of Agricultural Research for Development, Ngaoundere, Cameroon
| | - Stella Mazeri
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Egbe F Nkongho
- School of Life Sciences, University of Lincoln, Lincoln, UK
| | - Victor N Ngwa
- School of Veterinary Sciences, University of Ngaoundere, Ngaoundere, Cameroon
| | | | - Melissa Sander
- Tuberculosis Reference Laboratory Bamenda, Hospital Roundabout, Bamenda, Cameroon
| | - Lucy Ndip
- Laboratory of Emerging Infectious Diseases, University of Buea, Buea, Cameroon
| | - Paul R Bessell
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Kenton L Morgan
- Institute of Ageing and Chronic Disease and School of Veterinary Science, University of Liverpool, Neston, UK
| | - Ian G Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Adrian Muwonge
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - Barend M de C Bronsvoort
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
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47
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Schubert G, Achi V, Ahuka S, Belarbi E, Bourhaima O, Eckmanns T, Johnstone S, Kabore F, Kra O, Mendes A, Ouedraogo AS, Poda A, Some AS, Tomczyk S, Couacy-Hymann E, Kayembe JM, Meda N, Muyembe Tamfum JJ, Ouangraoua S, Page N, Venter M, Leendertz FH, Akoua-Koffi C. The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents. BMC Infect Dis 2021; 21:539. [PMID: 34098893 PMCID: PMC8184052 DOI: 10.1186/s12879-021-06238-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa. Methods ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d’Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d’Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors. Discussion ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.
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Affiliation(s)
| | - Vincent Achi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | - Steve Ahuka
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Ouattara Bourhaima
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | | | - Siobhan Johnstone
- National Institute for Communicable Diseases, Johannesburg, Republic of South Africa
| | | | - Ouffoue Kra
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | - Adriano Mendes
- University of Pretoria, Pretoria, Republic of South Africa
| | - Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | | | | | - Emmanuel Couacy-Hymann
- Laboratoire National d'Appui au Développement Agricole / Laboratoire Central de Pathologie Animale, Bingerville, Côte d'Ivoire
| | - Jean-Marie Kayembe
- Hôpital Universitaire/Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Jean-Jacques Muyembe Tamfum
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Hôpital Universitaire/Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, Republic of South Africa.,University of Pretoria, Pretoria, Republic of South Africa
| | | | | | - Chantal Akoua-Koffi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire. .,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire.
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48
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Chidzwondo F, Mutapi F. Challenge of diagnosing acute infections in poor resource settings in Africa. AAS Open Res 2021. [DOI: 10.12688/aasopenres.13234.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Frequent disease outbreaks and acute infections occur in rural and low-income urban areas of Africa, with many health systems unprepared to diagnose and control diseases that are recurrent, endemic or have extended their geographic zone. In this review, we focus on acute infections that can be characterized by sudden onset, rapid progression, severe symptoms and poor prognosis. Consequently, these infections require early diagnosis and intervention. While effective vaccines have been developed against some of these diseases, lack of compliance and accessibility, and the need for repeated or multiple vaccinations mean large populations can remain vulnerable to infection. It follows that there is a need for enhancement of national surveillance and diagnostic capacity to avert morbidity and mortality from acute infections. We discuss the limitations of traditional diagnostic methods and explore the relative merits and applicability of protein-, carbohydrate- and nucleic acid-based rapid diagnostic tests that have been trialled for some infectious diseases. We also discuss the utility and limitations of antibody-based serological diagnostics and explore how systems biology approaches can better inform diagnosis. Lastly, given the complexity and high cost associated with after-service support of emerging technologies, we propose that, for resource-limited settings in Africa, multiplex point-of-care diagnostic tools be tailor-made to detect both recurrent acute infections and endemic infections.
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49
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Boillat-Blanco N, Mbarack Z, Samaka J, Mlaganile T, Kazimoto T, Mamin A, Genton B, Kaiser L, D'Acremont V. Causes of fever in Tanzanian adults attending outpatient clinics: a prospective cohort study. Clin Microbiol Infect 2021; 27:913.e1-913.e7. [PMID: 32896654 PMCID: PMC8186429 DOI: 10.1016/j.cmi.2020.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Exploring fever aetiologies improves patient management. Most febrile adults are outpatients, but all previous studies were conducted in inpatients. This study describes the spectrum of diseases in adults attending outpatient clinics in urban Tanzania. METHODS We recruited consecutive adults with temperature ≥38°C in a prospective cohort study. We collected medical history and performed a clinical examination. We performed 27 364 microbiological diagnostic tests (rapid tests, serologies, cultures and molecular analyses) for a large range of pathogens on blood and nasopharyngeal samples. We based our diagnosis on predefined clinical and microbiological criteria. RESULTS Of 519 individuals, 469 (89%) had a clinically or microbiologically documented infection and 128 (25%) were human immunodeficiency virus (HIV) -infected. We identified 643 diagnoses: 264 (41%) acute respiratory infections (36 (5.6%) pneumonia, 39 (6.1%) tuberculosis), 71 (11%) infections with another focus (31 (4.8%) gastrointestinal, 26 (4.0%) urogenital, 8 (1.2%) central nervous system) and 252 (39%) infections without focus (134 (21%) dengue, 30 (4.7%) malaria, 28 (4.4%) typhoid). Of the 519 individuals, 318 (61%), 179 (34%), 30 (6%) and 15 (3%), respectively, had a viral, bacterial, parasitic and fungal acute infection. HIV-infected individuals had more bacterial infections than HIV-negative (80/122 (66%) versus 100/391 (26%); p < 0.001). Patients with advanced HIV disease had a higher proportion of bacterial infections (55/76 (72%) if CD4 ≤200 cells/mm3 and 25/52 (48%) if CD4 >200 cells/mm3, p 0.02). CONCLUSIONS Viral diseases caused most febrile episodes in adults attending outpatient clinics except in HIV-infected patients. HIV status and a low CD4 level strongly determined the need for antibiotics. Systematic HIV screening is essential to appropriately manage febrile patients.
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Affiliation(s)
- N Boillat-Blanco
- Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Z Mbarack
- Mwananyamala Hospital, Dar Es Salaam, United Republic of Tanzania
| | - J Samaka
- Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania
| | - T Mlaganile
- Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania
| | - T Kazimoto
- Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania
| | - A Mamin
- Division of Infectious Diseases and Centre for Emerging Viral Diseases, University of Geneva Hospitals, And Faculty of Medicine, Geneva, Switzerland
| | - B Genton
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - L Kaiser
- Division of Infectious Diseases and Centre for Emerging Viral Diseases, University of Geneva Hospitals, And Faculty of Medicine, Geneva, Switzerland
| | - V D'Acremont
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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50
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Cordey S, Laubscher F, Hartley MA, Junier T, Keitel K, Docquier M, Guex N, Iseli C, Vieille G, Le Mercier P, Gleizes A, Samaka J, Mlaganile T, Kagoro F, Masimba J, Said Z, Temba H, Elbanna GH, Tapparel C, Zanella MC, Xenarios I, Fellay J, D'Acremont V, Kaiser L. Blood virosphere in febrile Tanzanian children. Emerg Microbes Infect 2021; 10:982-993. [PMID: 33929935 PMCID: PMC8171259 DOI: 10.1080/22221751.2021.1925161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Viral infections are the leading cause of childhood acute febrile illnesses motivating consultation in sub-Saharan Africa. The majority of causal viruses are never identified in low-resource clinical settings as such testing is either not part of routine screening or available diagnostic tools have limited ability to detect new/unexpected viral variants. An in-depth exploration of the blood virome is therefore necessary to clarify the potential viral origin of fever in children. Metagenomic next-generation sequencing is a powerful tool for such broad investigations, allowing the detection of RNA and DNA viral genomes. Here, we describe the blood virome of 816 febrile children (<5 years) presenting at outpatient departments in Dar es Salaam over one-year. We show that half of the patients (394/816) had at least one detected virus recognized as causes of human infection/disease (13.8% enteroviruses (enterovirus A, B, C, and rhinovirus A and C), 12% rotaviruses, 11% human herpesvirus type 6). Additionally, we report the detection of a large number of viruses (related to arthropod, vertebrate or mammalian viral species) not yet known to cause human infection/disease, highlighting those who should be on the radar, deserve specific attention in the febrile paediatric population and, more broadly, for surveillance of emerging pathogens.Trial registration: ClinicalTrials.gov identifier: NCT02225769.
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Affiliation(s)
- Samuel Cordey
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florian Laubscher
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mary-Anne Hartley
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Intelligent Global Health, Machine Learning and Optimization Laboratory, EPFL, Lausanne, Switzerland
| | - Thomas Junier
- Global Health Institute, School of Life Sciences, EPFL, Lausanne, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Kristina Keitel
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,Department of Paediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mylène Docquier
- iGE3 Genomics Platform, University of Geneva, Geneva, Switzerland.,Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
| | - Nicolas Guex
- Bioinformatics Competence Center, University of Lausanne and EPFL, Lausanne, Switzerland
| | - Christian Iseli
- Bioinformatics Competence Center, University of Lausanne and EPFL, Lausanne, Switzerland
| | - Gael Vieille
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Anne Gleizes
- SwissProt group, SIB Swiss Institute of Bioinformatics, Geneva, Switzerland
| | | | | | - Frank Kagoro
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - John Masimba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Zamzam Said
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Gasser H Elbanna
- Intelligent Global Health, Machine Learning and Optimization Laboratory, EPFL, Lausanne, Switzerland
| | - Caroline Tapparel
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Marie-Celine Zanella
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ioannis Xenarios
- Health2030 Genome Center, Geneva, Switzerland.,Agora Center, University of Lausanne, Lausanne, Switzerland
| | - Jacques Fellay
- Global Health Institute, School of Life Sciences, EPFL, Lausanne, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
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