A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL)

•This is the first prospective study of community-acquired acute febrile illness in Timor-Leste.•Only dengue and bacterial infections were detected, despite enhanced testing.•High rates of empiric antibiotic use, hospital admission, and mortality were observed.•Most participants were followed up for...

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Published in:	IJID regions Vol. 11; p. 100345
Main Authors:	Ximenes, Deolindo, de Jesus, Gustodio, de Sousa, Antonio SCFC, Soares, Caetano, Amaral, Luciana C., Oakley, Tessa, Alves, Lucsendar, Amaral, Salvador, Sarmento, Nevio, Guterres, Helio, Cabral, José António de Deus, Boavida, Flavio, Yan, Jennifer, Francis, Joshua R., Martins, Nelson, Arkell, Paul
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-06-2024 Elsevier
Subjects:	Acute febrile illness (AFI) Blood culture Dengue Diagnosis Original Report Polymerase chain reaction Timor-Leste Polymerase chain reaction Acute febrile illness (AFI) Diagnosis Blood culture Dengue Timor-Leste
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Summary:	•This is the first prospective study of community-acquired acute febrile illness in Timor-Leste.•Only dengue and bacterial infections were detected, despite enhanced testing.•High rates of empiric antibiotic use, hospital admission, and mortality were observed.•Most participants were followed up for 30 days with clinical and functional outcomes.•Further observational and interventional studies are feasible and required.•Blood culture and real-time quantitative polymerase chain reaction, including for dengue, Japanese encephalitis, chikungunya, and malaria. Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2772-7076 2772-7076
DOI:	10.1016/j.ijregi.2024.02.005