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. 2018 Feb;98(2):625-632.
doi: 10.4269/ajtmh.17-0421. Epub 2017 Dec 21.

A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania

Christine Hercik  1 , Leonard Cosmas  2 , Ondari D Mogeni  3 , Newton Wamola  3 , Wanze Kohi  4 , Eric Houpt  5 , Jie Liu  5 , Caroline Ochieng  3 , Clayton Onyango  2 , Barry Fields  2 , Sayoki Mfinanga  4 , Joel M Montgomery  2
Affiliations

A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania

Christine Hercik et al. Am J Trop Med Hyg. 2018 Feb.

Abstract

The use of fever syndromic surveillance in sub-Saharan Africa is an effective approach to determine the prevalence of both malarial and nonmalarial infectious agents. We collected both blood and naso/oro-pharyngeal (NP/OP) swabs from consecutive consenting patients ≥ 1 year of age, with an axillary temperature ≥ 37.5°C, and symptom onset of ≤ 5 days. Specimens were analyzed using both acute febrile illness (AFI) and respiratory TaqMan array cards (Resp TAC) for multiagent detection of 56 different bloodstream and respiratory agents. In addition, we collected epidemiologic data to further characterize our patient population. We enrolled 205 febrile patients, including 70 children (1 < 15 years of age; 34%) and 135 adults (≥ 15 years of age; 66%). AFI TAC and Resp TAC were performed on 191 whole blood specimens and 115 NP/OP specimens, respectively. We detected nucleic acid for Plasmodium (57%), Leptospira (2%), and dengue virus (1%) among blood specimens. In addition, we detected 17 different respiratory agents, most notably, Haemophilus influenzae (64%), Streptococcus pneumonia (56%), Moraxella catarrhalis (39%), and respiratory syncytial virus (11%) among NP/OP specimens. Overall median cycle threshold was measured at 26.5. This study provides a proof-of-concept for the use of a multiagent diagnostic approach for exploratory research on febrile illness and underscores the utility of quantitative molecular diagnostics in complex epidemiologic settings of sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Map of study area in Kilombero district shown in dark gray in the Morogoro region inset.
Figure 2.
Figure 2.
Overlap among agent types, indicating single and multiple type codetections among enrolled febrile patients. Note: Figure 2 is not to scale. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
The box plot of cycle threshold (Ct) distributions of detected organisms among febrile patients, with the overall median Ct value (26.5) denoted by the red line. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Box plot of parasite load (Ct) by the level of parasite intensity. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

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