Diagnosis of Persistent Fever in the Tropics: Set of Standard Operating Procedures Used in the NIDIAG Febrile Syndrome Study.
In resource-limited settings, the scarcity of skilled personnel and adequate laboratory facilities makes the differential diagnosis of fevers complex [1-5]. Febrile illnesses are diagnosed clinically in most rural centers, and both Rapid Diagnostic Tests (RDTs) and clinical algorithms can be valuable aids to health workers and facilitate therapeutic decisions [6,7]. The persistent fever syndrome targeted by NIDIAG is defined as presence of fever for at least one week. The NIDIAG clinical research consortium focused on potentially severe and treatable infections and therefore targeted the following conditions as differential diagnosis of persistent fever: visceral leishmaniasis (VL), human African trypanosomiasis (HAT), enteric (typhoid and paratyphoid) fever, brucellosis, melioidosis, leptospirosis, malaria, tuberculosis, amoebic liver abscess, relapsing fever, HIV/AIDS, rickettsiosis, and other infectious diseases (e.g., pneumonia). From January 2013 to October 2014, a prospective clinical phase III diagnostic accuracy study was conducted in one site in Cambodia, two sites in Nepal, two sites in Democratic Republic of the Congo (DRC), and one site in Sudan (clinicaltrials.gov no. NCT01766830). The study objectives were to (1) determine the prevalence of the target diseases in patients presenting with persistent fever, (2) assess the predictive value of clinical and first-line laboratory features, and (3) assess the diagnostic accuracy of several RDTs for the diagnosis of the different target conditions.
Clinical Research Centre, Geneva University Hospitals, Geneva, Switzerland.
Emilie
E
Alirol
Clinical Research Centre, Geneva University Hospitals, Geneva, Switzerland.|Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva Switzerland.
Ninon Seiko
NS
Horie
Institute of Tropical Medicine, Antwerp, Belgium.
Barbara
B
Barbé
Institut de Recherche pour le Développement (IRD), Unité Mixte de Recherche IRD-CIRAD 177, Montpellier, France.
Veerle
V
Lejon
Institute of Tropical Medicine, Antwerp, Belgium.
Kristien
K
Verdonck
Institute of Tropical Medicine, Antwerp, Belgium.
Philippe
P
Gillet
Institute of Tropical Medicine, Antwerp, Belgium.|Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
Jan
J
Jacobs
Institute of Tropical Medicine, Antwerp, Belgium.
Philippe
P
Büscher
B.P. Koirala Institute of Health Science, Dharan, Nepal.
Basudha
B
Kanal
B.P. Koirala Institute of Health Science, Dharan, Nepal.
Narayan Raj
NR
Bhattarai
Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Sayda
S
El Safi
Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Thong
T
Phe
Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Kruy
K
Lim
Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Long
L
Leng
Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.|Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
Pascal
P
Lutumba
Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.|Département de Médecine Tropicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
Deby
D
Mukendi
Institute of Tropical Medicine, Antwerp, Belgium.
Emmanuel
E
Bottieau
Institute of Tropical Medicine, Antwerp, Belgium.
Marleen
M
Boelaert
B.P. Koirala Institute of Health Science, Dharan, Nepal.
Suman
S
Rijal
Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva Switzerland.
François
F
Chappuis
D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis*; D002006:Brucellosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D002160:Cambodia / Q000453:epidemiology; D000068598:Data Accuracy; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D058069:Neglected Diseases / Q000175:diagnosis*; D009390:Nepal / Q000453:epidemiology; D010284:Paratyphoid Fever / Q000175:diagnosis / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D011528:Protozoan Infections / Q000175:diagnosis*; D011786:Quality Control; D012061:Relapsing Fever / Q000175:diagnosis / Q000453:epidemiology; D012282:Rickettsia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D013397:Sudan / Q000453:epidemiology; D014329:Tropical Climate; D014353:Trypanosomiasis, African / Q000175:diagnosis / Q000469:parasitology; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology