Fever projects

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Triage tests to guide treatment & referral

Evaluation of biomarkers for AFI
Multiplexed POC triage test for fever patients
RDT for malaria & bacterial infection

Demonstration of triage tests

Ensuring correct antibiotic use through CRP testing in Southeast Asia

CRP Landscape 2017

The lack of affordable and rapid diagnostic tools for non-malarial fevers has resulted in the over-prescription of antibiotics in some areas and the under-treatment of patients in others. Better targeting of antibiotics could improve immediate health outcomes while reducing drug pressure and mitigating the emergence of drug-resistant pathogens.

C-reactive protein (CRP) has been found to be a suitable marker of bacterial infection in undifferentiated fever in Southeast Asia. FIND is supporting researchers from the University of Oxford to conduct a multi-centre, three-armed randomized controlled pragmatic trial comparing CRP-guided antibiotic prescription for febrile patients to current prescribing practices to understand how the use of CRP reduces the use of antibiotic in primary health care settings. The study is currently implemented in primary care facilities in Thailand and Myanmar.

The main aim of the study is to measure the influence of CRP testing on antibiotic prescription by healthcare workers in Southeast Asia. The team will further explore the causes of fevers in these settings and the suitability of the CRP test to differentiate those correctly.

  • This project is being conducted with the support of the Australian government.

Pathogen-specific test to guide treatment

Point-of-care multiplex test for causes of acute febrile illness

While fever is the most common symptom of an infection, there is currently no point-of-care diagnostic test that can identify several causes of fever at once. Accurately diagnosing the cause of an illness is difficult because many illnesses have similar clinical symptoms, such as fever, headache, chills or muscle and joint pain. In the absence of a confirmed diagnosis, patients are often prescribed broad-spectrum antibiotics, frequently an inappropriate treatment that contributes to antimicrobial resistance and leaves the patient at risk of death. What is needed is an assay that can guide targeted antibiotic treatment for specific pathogens or public health interventions in case of outbreak-prone diseases.

FIND is collaborating with Chembio to develop a multiplex diagnostic tool aimed at identifying the pathogens commonly responsible for fever in the Asia Pacific region, including malaria (four Plasmodium species, using pLDH and HRP2), dengue virus, Zika virus, chikungunya virus, leptospirosis, Rickettsia typhi, Burkholderia pseudomallei, and Orientia tsutsugamushi.

With this simple and affordable test, health care providers would be able to quickly identify some of the common causes of fever, resulting in better clinical management and targeted treatment of patients, and reducing the development of antimicrobial resistance.

  • This project is being conducted with the support of the UK and Australian government.

Blood stream infections & sepsis diagnostic

Sepsis is a potentially life-threatening infection in the bloodstream, with the majority of cases occurring in low- and middle-income countries (LMICs). It is estimated to be the cause of over 10% of maternal deaths and 70% of neonatal and infant deaths that occur annually.

Once sepsis is diagnosed, it can be treated with targeted antibiotics. However, current diagnostic tools are time-consuming and require skilled technicians in well-resourced laboratories. Such microbiology facilities are almost non-existent in resource limited settings. Moreover, without confirmed diagnosis of the pathogen causing the infection, many patients receive broad-spectrum antibiotics, which can lead to ineffective treatment and contribute to antimicrobial resistance.

An innovative tool for sepsis diagnosis, using simplified blood culture for pathogen identification and drug susceptibility testing, is the SpecID system, developed by Specific Technologies. This test which is in early stages of development combines pathogen detection with identification in culture and provides substantial advances to existing methods, resulting in a simplified, one-step test that provides results within 12 hours.

  • This project is being conducted with the support of the UK government.

Mapping global fever pathogens

There is limited data on what pathogens cause acute febrile illness (AFI) worldwide. Available research shows that the causes of non-malarial fever vary substantially across different geographies and age groups.

In order to expand access to data on the causes of non-malarial fever, FIND, LSHTM, Worldwide Antimalarial Resistance Network (WWARN), Infectious Diseases Data Observatory (IDDO) and others conducted a systematic review of published studies from the Mekong region of Southeast Asia, and currently of Africa, South Asia, China and Latin America to record and retrospectively map causes of fever in malaria endemic regents around the world.

The result of this collaboration is an updated open-access, interactive map that is a resource for researchers and clinicians in their work.

  • This project is being conducted with the support of the Australian government.

Specimen bank for fever & biomarker diagnostics

A major hurdle to developing rapid diagnostic tests for acute febrile illness (AFI) is the lack of access to centralized, high-quality samples from patients with non-malarial febrile illness. A biorepository of such samples would accelerate the development of novel diagnostic solutions that positively impact public health in low- and middle-income countries.

FIND currently curates a specimen bank for TB, malaria and human African trypanosomiasis samples at a centralized storage facility. In order to accelerate diagnostic development of AFI point-of-care tests, FIND is extending this activity to well-characterized samples from patients with non-sever febrile illness.

The biorepository will include a range of sample types (i.e. serum, whole blood, plasma, urine) and multiple sampling time points (i.e. admission, follow-up) from patients with bacterial, viral or parasitic infections confirmed by laboratory testing and a panel of clinicians. By ensuring that samples are stored and characterized in a standardized fashion and that basic clinical and microbiologic data are available, FIND is able to support assay development of pathogen-specific tests. The first samples collected from Malawi, Ethiopia and Brazil will be stored in the biorepository by the end of 2017.

  • This project is being conducted with grants from the governments of the Netherlands and Australia.