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.