Febrile illness mapping—much of the world without data and without evidence-based treatments

Newton, Paul N.; Guérin, Philippe J.

doi:10.1186/s12916-020-01747-y

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…We concur with others [2, 4] and argue that there is an urgent need to standardize AFI study protocols to make sure that we can compare results from different studies and pool their results to develop national, regional, or global burden of fever estimates. Such consensus in AFI research would allow better comparisons, translate evidence to practice, and inform treatment policy.…”

Section: Textsupporting

confidence: 76%

“…Most antipyretic takers consumed one class (85.9%), and the median number of doses taken was 2 [IQR 1 -3]. Of these 249 subjects, 167/249 (67%) reported the last dose administered at a mean of 2 [2][3][4][5] hours before hospital presentation. Subjects who were treated with an antipyretic drug before arrival did not differ from untreated ones regarding the temperature at arrival at the ED visit (37 ± 0.99 vs. 36.8 ± 0.86, p = 0.20) or the documented Tmax before the ED arrival (38.8 ± 0.79 vs. 38.4 ± 0.60, p = 0.29).…”

Section: 6%)mentioning

confidence: 99%

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The time is ripe to harmonize global acute febrile illness etiologic investigations

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Fernando-Carballo

Escadafal

et al. 2022

Preprint

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Acute febrile illness (AFI) is common for people seeking care globally and represents a spectrum of infectious and non-infectious etiologies with significant geographical variations. However, AFI research follows a heterogeneous methodology and reporting, making it challenging for individual fever studies interpretation and comparison and thus generating evidence-based decisions. Herein, we aim to conduct a pilot study investigating the impact of considering different case definitions of fever as inclusion criteria among febrile patients attending two Emergency Departments (ED) in Rio de Janeiro, Brazil, from October 28, 2018, to March 29, 2019. Secondarily, we explored the impact of the recent use of antipyretics in measured temperature at the arrival of the EDs. A prospective study was conducted, and we screened all consecutive non-severe patients who presented to the EDs. The inclusion criterion was the self-report of fever regardless of the temperature measured. A logistic regression model was built to investigate the factors associated with a febrile presentation at the arrival of EDs. We triaged 1551 subjects, and 374 [24.1% (95% CI 22-26)] had a history of fever, of whom 248 (66.3%), 115 (30.7%), and 11 (2.9%) had a temperature < 37.5 °C, ≥ 37.5 °C, and no temperature measurement registered at arrival, respectively. 198/374 (53%) had a suspicion of infection, and the site of infection varied according to the height of temperate at presentation. The antibiotic prescription was more likely in those who had a temperature ≥37.5 °C compared to those with a temperature <37.5 °C [crude OR: 2 (95% 1.1-3.5)]. 249/374 (66.6%) subjects reported self-administering an antipyretic within 2h [IQR 2-6] before EDs. Recent antipyretic uptake did not influence the measured temperature at presentation. In conclusion, we suggest harmonizing the case definition of fever in AFI research for a history of fever regardless of temperature cut-off would enable a complete picture of the different clinical fever phenotypes, thus improving our understanding of the global burden of febrile illness.

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Section: Textsupporting

confidence: 76%

Section: 6%)mentioning

confidence: 99%

The time is ripe to harmonize global acute febrile illness etiologic investigations

Moreira

Fernando-Carballo

Escadafal

et al. 2022

Preprint

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“…Laboratory diagnostics are poorly performing and generally unavailable in resource poor settings. This leads to a situation where the known prevalence is underreported, with downstream impacts on funding and public health decisions [ 21 ]. In a circular manner, the difficulties in diagnoses have led to a lack of investment which could have enabled the development of improved diagnostic tools and a greater recognition of the incidence of these diseases.…”

Section: The Public Health Burden Of Rickettsial Infectionsmentioning

confidence: 99%

Rickettsial infections: A blind spot in our view of neglected tropical diseases

et al. 2021

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Rickettsial diseases are a group of vector-borne bacterial infections that cause acute febrile illness with potentially severe or fatal complications. These vector-borne diseases are prevalent in tropical and subtropical regions worldwide and disproportionately affect poorer communities but are scientifically underrecognized. Despite this, they are not included in the World Health Organization’s list of neglected tropical diseases nor were they mentioned in Peter Hotez’s recent reflections on “What constitutes a neglected tropical disease?” in PLOS Neglected Tropical Diseases [1]. Here we present the case that rickettsial infections, as an overlooked cause of morbidity, mortality, and economic losses in marginalized populations, should be recognized as neglected tropical diseases. We describe how this oversight is the result of a number of factors and how it negatively impacts patient outcomes. We then propose measures to address the neglect of rickettsial infections in both scientific research and public health interventions.

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“…However, ascertainment of the most important infective aetiologies of fever to aid the development of relevant multiplex LF-RDTs and other diagnostic tools in South and Southeast Asia is hampered by the paucity of reliable epidemiological data covering not just incidence, but also disease burden in terms of morbidity and mortality. [11] There is, thus, a high degree of uncertainty in prioritization of pathogens for inclusion in such tests; furthermore, what little published evidence there is comes mainly from cities, rather than rural areas where most of the population live. [12] In addition, there is growing interest in augmenting pathogen-based diagnostics by assaying host biomarkers of inflammation in parallel, in particular those which can assist in the differentiation viral from non-viral infections, thus improving antimicrobial stewardship, [13] or predict or indicate severe disease, thus improving the identification of patients who require escalation of care.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

Perceptions and priorities for the development of multiplex rapid diagnostic tests for acute non-malarial fever in rural South and Southeast Asia: an international modified e-Delphi survey

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Lohavittayavikant

Mayer³

et al. 2022

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Background. Fever is a common presenting symptom in low- and middle-income countries (LMICs). It was previously assumed that malaria was the cause in such patients, but its incidence has declined rapidly. The urgent need to develop point-of-care tests for the most important causes of non-malarial acute febrile illness is hampered by the lack of robust epidemiological data. We sought to obtain expert consensus on analytes which should be prioritized for inclusion in fingerprick blood-based multiplex lateral flow rapid diagnostic tests (LF-RDTs) targeted towards four categories of patients with acute non-malarial fever in South and Southeast Asian LMICs, stratified by age (paediatric vs. adult) and care setting (primary vs. secondary care). Methodology/Principal Findings. We conducted a two-round modified e-Delphi survey. A total of 84 panellists were invited, consisting of seven each from 12 countries, divided into three regional panels (Mainland Southeast Asia, Maritime Southeast Asia, and South Asia). Panellists were asked to rank their top seven analytes for inclusion in LF-RDTs to be used in each patient category, justify their choices, and indicate whether such LF-RDTs should be incorporated into algorithm-based clinical decision support tools. Thirty-six panellists (43%) participated in the first round and 44 (52%) in the second. There was consensus that such LF-RDTs should be incorporated into clinical decision support tools. At a minimum, these LF-RDTs should be able to diagnose dengue and enteric fever in all patient categories. There was a clear preference to develop LF-RDTs for pathogens not readily detected by existing technologies, and for direct diagnosis through antigen detection. Pathogen biomarkers were prioritized over host inflammatory biomarkers, with CRP being the only one ranked consistently highly. Conclusions/Significance. Our results provide guidance on prioritizing analytes for inclusion in context-specific multiplex LF-RDTs and similar platforms for non-malarial acute febrile illness, for which there is an urgent unmet need.

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Febrile illness mapping—much of the world without data and without evidence-based treatments

Cited by 6 publications

References 14 publications

The time is ripe to harmonize global acute febrile illness etiologic investigations

The time is ripe to harmonize global acute febrile illness etiologic investigations

Rickettsial infections: A blind spot in our view of neglected tropical diseases

Perceptions and priorities for the development of multiplex rapid diagnostic tests for acute non-malarial fever in rural South and Southeast Asia: an international modified e-Delphi survey

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