Rapid Diagnostic Tests for a Coordinated Approach to Fever Syndromes in Low-Resource Settings

Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Clinical Infectious Diseases (Impact Factor: 8.89). 05/2012; 55(4):610-1; author reply 611-2. DOI: 10.1093/cid/cis466
Source: PubMed
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Available from: Cedric P Yansouni, Dec 12, 2013
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    • "The present case illustrates the need for microbiological surveillance also at the peripheral level in remote African settings, as multiresistance is emerging and unusual pathogens may also be recovered. Coordinated research efforts should be relentlessly expanded to comprehensively document the aetiologies of febrile illnesses in the most neglected tropical populations [15]. "
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    ABSTRACT: The recent roll-out of rapid diagnostic tests (RDTs) for malaria has highlighted the decreasing proportion of malaria-attributable illness in endemic areas. Unfortunately, once malaria is excluded, there are few accessible diagnostic tools to guide the management of severe febrile illnesses in low resource settings. This review summarizes the current state of RDT development for several key infections, including dengue fever, enteric fever, leptospirosis, brucellosis, visceral leishmaniasis and human African trypanosomiasis, and highlights many remaining gaps. Most RDTs for non-malarial tropical infections currently rely on the detection of host antibodies against a single infectious agent. The sensitivity and specificity of host-antibody detection tests are both inherently limited. Moreover, prolonged antibody responses to many infections preclude the use of most serological RDTs for monitoring response to treatment and/or for diagnosing relapse. Considering these limitations, there is a pressing need for sensitive pathogen-detection-based RDTs, as have been successfully developed for malaria and dengue. Ultimately, integration of RDTs into a validated syndromic approach to tropical fevers is urgently needed. Related research priorities are to define the evolving epidemiology of fever in the tropics, and to determine how combinations of RDTs could be best used to improve the management of severe and treatable infections requiring specific therapy.
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