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Alabi A, Musangomunei FP, Lotola-Mougeni F, Bie-Ondo JC, Murphy K, Essone PN, Kabwende AL, Mahmoudou S, Macé A, Harris V, Ramharter M, Grobusch MP, Yazdanbakhsh M, Fernandez-Carballo BL, Escadafal C, Kremsner PG, Dittrich S, Agnandji ST. Performance evaluation of a combination Plasmodium dual-antigen CRP rapid diagnostic test in Lambaréné, Gabon. Infection 2024:10.1007/s15010-024-02366-y. [PMID: 39177882 DOI: 10.1007/s15010-024-02366-y] [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: 12/24/2023] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The consequent use of malaria rapid diagnostic tests (RDTs) preceding a treatment decision has improved the global management of malaria. A combination RDT, including an inflammation marker to potentially guide antibiotic prescription, could improve the management of acute febrile illness (AFI). METHODS We performed a prospective, cross-sectional study in Gabon evaluating the STANDARD Malaria/CRP DUO (S-DUO) RDT. Participants aged 2 to 17 years with fever at presentation and/or a history of fever < 7 days were enrolled. Expert microscopy, SD Bioline Malaria Ag P.f/Pan test for malaria detection, and NycoCard CRP device for CRP were used as comparators. AFI cases were classified on a spectrum encompassing bacterial vs. non-bacterial infection. RESULTS 415 participants with AFI were enrolled. S-DUO RDT sensitivity and specificity for malaria detection vs. microscopy were 99·1% (95·2-100%) and 72·7% (64·3-80·1%); and for CRP detection (20 mg/L and above) 86·9% (80-92%) and 87% (79·2-92·7%), respectively. The difference in CRP levels between bacterial infection (mean = 41·2 mg/L) and other causes of fever, measured from our study population using the Nycocard device, was statistically significant (p < 0·01); CRP precision-recall AUC to distinguish bacterial infection class vs. non-bacterial classifications was 0·79. CONCLUSION S-DUO RDT is suitable for malaria detection in moderate-to-high malaria transmission settings such as in Lambaréné; however, a CRP band detection limit > 40 mg/L is more adequate for indication of antibiotic prescription for AFI cases in Gabon.
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Affiliation(s)
- Ayodele Alabi
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen and German Centre for Infectious Diseases Research (DZIF), Tübingen, Germany
- Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | - Fungai P Musangomunei
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | - Fabrice Lotola-Mougeni
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | - Juste C Bie-Ondo
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | - Kristin Murphy
- London School of Hygiene and Tropical Medicine, London, UK
| | - Paulin N Essone
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | - Anita L Kabwende
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | - Saidou Mahmoudou
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
| | | | | | - Michael Ramharter
- Department of Tropical Medicine, Department of Internal Medicine I, Bernhard Nocht Institute for Tropical Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam University Medical Centres, location Amsterdam, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Yazdanbakhsh
- Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Peter G Kremsner
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen and German Centre for Infectious Diseases Research (DZIF), Tübingen, Germany
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institut of Technology, European Campus Rottal-Inn, Deggendorf, Germany
| | - Selidji T Agnandji
- Biomedicine and Social Sciences research group, Department of Biologicals and Therapeutics, Centre de Recherches Médicales de Lambaréné, CERMEL, BP 242, Lambaréné, Gabon.
- Institut für Tropenmedizin, Universitätsklinikum Tübingen and German Centre for Infectious Diseases Research (DZIF), Tübingen, Germany.
- Institute of Medical Microbiology, University Hospital Münster, 48149, Domagkstraße 10, Münster, Germany.
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Gebremariam TT, Schallig HDFH, Kurmane ZM, Danquah JB. Increasing prevalence of malaria and acute dengue virus coinfection in Africa: a meta-analysis and meta-regression of cross-sectional studies. Malar J 2023; 22:300. [PMID: 37803381 PMCID: PMC10557169 DOI: 10.1186/s12936-023-04723-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Malaria and dengue fever are the leading causes of acute, undifferentiated febrile illness. In Africa, misdiagnosis of dengue fever as malaria is a common scenario. Through a systematic review of the published literature, this study seeks to estimate the prevalence of dengue and malaria coinfection among acute undifferentiated febrile diseases in Africa. METHODS Relevant publications were systematically searched in the PubMed, Cochrane Library, and Google Scholar until May 19, 2023. A random-effects meta-analysis and meta-regression were used to summarize and examine the prevalence estimates. RESULTS Twenty-two studies with 22,803 acute undifferentiated febrile patients from 10 countries in Africa were included. The meta-analysis findings revealed a pooled prevalence of malaria and dengue coinfection of 4.2%, with Central Africa having the highest rate (4.7%), followed by East Africa (2.7%) and West Africa (1.6%). Continent-wide, Plasmodium falciparum and acute dengue virus coinfection prevalence increased significantly from 0.9% during 2008-2013 to 3.8% during 2014-2017 and to 5.5% during 2018-2021 (p = 0.0414). CONCLUSION There was a high and increasing prevalence of malaria and acute dengue virus coinfection in Africa. Healthcare workers should bear in mind the possibility of dengue infection as a differential diagnosis for acute febrile illness, as well as the possibility of coexisting malaria and dengue in endemic areas. In addition, high-quality multicentre studies are required to verify the above conclusions. Protocol registration number: CRD42022311301.
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Affiliation(s)
- Tewelde T Gebremariam
- School of Graduate Studies and Research, Frantz Fanon University, Hargeisa, Somaliland.
| | - Henk D F H Schallig
- Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Zeleke M Kurmane
- School of Medical Laboratory, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jonas B Danquah
- Animal Research Institute, Animal Health Division, Accra, Ghana
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Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia. Sci Rep 2022; 12:19166. [PMID: 36357441 PMCID: PMC9649757 DOI: 10.1038/s41598-022-23641-8] [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: 04/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.
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Shimelis T, Vaz Nery S, Tadesse BT, Bartlett AW, Belay FW, Schierhout G, Dittrich S, Crump JA, Kaldor JM. Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia. BMC Infect Dis 2022; 22:434. [PMID: 35509024 PMCID: PMC9069758 DOI: 10.1186/s12879-022-07424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The management of febrile illnesses is challenging in settings where diagnostic laboratory facilities are limited, and there are few published longitudinal data on children presenting with fever in such settings. We have previously conducted the first comprehensive study of infectious aetiologies of febrile children presenting to a tertiary care facility in Ethiopia. We now report on clinicians’ prescribing adherence with guidelines and outcomes of management in this cohort. Methods We consecutively enrolled febrile children aged 2 months and under 13 years, who were then managed by clinicians based on presentation and available laboratory and radiologic findings on day of enrolment. We prospectively collected outcome data on days 7 and 14, and retrospectively evaluated prescribing adherence with national clinical management guidelines. Results Of 433 children enrolled, the most common presenting syndromes were pneumonia and acute diarrhoea, diagnosed in 177 (40.9%) and 82 (18.9%), respectively. Antibacterial agents were prescribed to 360 (84.7%) of 425 children, including 36 (34.0%) of 106 children without an initial indication for antibacterials according to guidelines. Antimalarial drugs were prescribed to 47 (11.1%) of 425 children, including 30 (7.3%) of 411 children with negative malaria microscopy. Fever had resolved in 357 (89.7%) of 398 children assessed at day 7, and in-hospital death within 7 days occurred in 9 (5.9%) of 153 admitted patients. Among children with pneumonia, independent predictors of persisting fever or death by 7 days were young age and underweight for age. Antibacterial prescribing in the absence of a guideline-specified indication (overprescribing) was more likely among infants and those without tachypnea, while overprescribing antimalarials was associated with older age, anaemia, absence of cough, and higher fevers. Conclusion Our study underscores the need for improving diagnostic support to properly guide management decisions and enhance adherence by clinicians to treatment guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07424-0.
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Affiliation(s)
- Techalew Shimelis
- Kirby Institute, University of New South Wales, Sydney, Australia. .,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Adam W Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Gill Schierhout
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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Sharma M, Gangakhedkar RR, Bhattacharya S, Walia K. Understanding complexities in the uptake of indigenously developed rapid point-of-care diagnostics for containment of antimicrobial resistance in India. BMJ Glob Health 2021; 6:e006628. [PMID: 34580070 PMCID: PMC8477250 DOI: 10.1136/bmjgh-2021-006628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
A good point-of-care diagnostic test holds a promise to reduce inappropriate use of antibiotics by enabling early detection of the pathogen and facilitating rapid testing of antimicrobial susceptibility. India has taken many initiatives in the recent past to augment the development and deployment of diagnostics in Indian health care system. Funding opportunities to promote innovation in diagnostics development were started in early 2000s through various ministries and departments. India released National Essential Diagnostics List which enlists essential tests and there is now Free Diagnostics Service Initiative of Government of India under National Health Mission that mandates to provide all essential tests free of cost. We wanted to understand how these initiatives have impacted the diagnostics that could be of use in containment of antimicrobial resistance (AMR) and whether there is a smooth process for bringing indigenously developed products relevant to AMR into the healthcare system. We conducted a longitudinal survey (January 2019 and January 2021) to understand the availability of market ready indigenous rapid diagnostics for AMR in the country and their progress towards introduction in the private market or uptake in healthcare system. We found that many innovators and developers are working towards development of rapid tests that can be useful in the containment of AMR in India. While there are many promising diagnostics on the horizon, the pathway for uptake of indigenously developed diagnostics in healthcare system remains disjointed and needs to be harmonised for the investments made towards development to translate as tangible gains. Since most of these efforts are government funded, it is incumbent upon the government to also provide a seamless pathway to make these diagnostics available in health care system. In absence of this guidance, most of these diagnostics will sit with the innovators/developers and will never be used for the purpose they were intended to serve.
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Affiliation(s)
- Monica Sharma
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Raman R Gangakhedkar
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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