Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 10:11:100345.
doi: 10.1016/j.ijregi.2024.02.005. eCollection 2024 Jun.

A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL)

Deolindo Ximenes  1 , Gustodio de Jesus  2 , Antonio Scfc de Sousa  1   3 , Caetano Soares  2 , Luciana C Amaral  2 , Tessa Oakley  1 , Lucsendar Alves  1 , Salvador Amaral  1 , Nevio Sarmento  1 , Helio Guterres  4 , José António de Deus Cabral  5 , Flavio Boavida  2 , Jennifer Yan  1 , Joshua R Francis  1 , Nelson Martins  1 , Paul Arkell  1
Affiliations

A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL)

Deolindo Ximenes et al. IJID Reg. .

Abstract

Objectives: Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting.

Methods: Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections.

Results: A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed.

Conclusions: Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.

Keywords: Acute febrile illness (AFI); Blood culture; Dengue; Diagnosis; Polymerase chain reaction; Timor-Leste.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interest to declare.

Figures

Figure 1
Figure 1
Flow of individuals through recruitment and study participation. AFI, acute febrile illness; ED, emergency department; HNGV, Hospital Nacional Guido Valadares; PCR, polymerase chain reaction.
Figure 2
Figure 2
Patient pathway during the study. ED, emergency department; PCR, polymerase chain reaction.
Figure 3
Figure 3
Kaplan–Meier chart showing survival of participants with or without dengue during the study.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Shrestha P, Dahal P, Ogbonnaa-Njoku C, Das D, Stepniewska K, Thomas NV, et al. Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from southern Asia and South-Eastern Asia, 1980–2015. BMC Med. 2020;18:299. doi: 10.1186/s12916-020-01745-0. - DOI - PMC - PubMed
    1. Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements ACA. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review. BMC Infect Dis. 2019;19:577. doi: 10.1186/s12879-019-4185-y. - DOI - PMC - PubMed
    1. Robinson ML, Manabe YC. Reducing uncertainty for acute febrile illness in resource-limited settings: the current diagnostic landscape. Am J Trop Med Hyg. 2017;96:1285–1295. doi: 10.4269/ajtmh.16-0667. - DOI - PMC - PubMed
    1. Bhaskaran D, Chadha SS, Sarin S, Sen R, Arafah S, Dittrich S. Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review. BMC Infect Dis. 2019;19:970. doi: 10.1186/s12879-019-4589-8. - DOI - PMC - PubMed
    1. Grundy BS, Houpt ER. Opportunities and challenges to accurate diagnosis and management of acute febrile illness in adults and adolescents: a review. Acta Trop. 2022;227 doi: 10.1016/j.actatropica.2021.106286. - DOI - PMC - PubMed

LinkOut - more resources