Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?
Abstract Background Febrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortali...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07638-2 |
| _version_ | 1828087259030618112 |
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| author | Massa dit Achille Bonko Ibrahima Karama Francois Kiemde Palpouguini Lompo Zakaria Garba Sibidou Yougbaré Petra F. Mens Halidou Tinto Marc Christian Tahita Henk. D. F. H. Schallig |
| author_facet | Massa dit Achille Bonko Ibrahima Karama Francois Kiemde Palpouguini Lompo Zakaria Garba Sibidou Yougbaré Petra F. Mens Halidou Tinto Marc Christian Tahita Henk. D. F. H. Schallig |
| author_sort | Massa dit Achille Bonko |
| collection | DOAJ |
| description | Abstract Background Febrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics. Methods Clinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing. Results In total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment. Conclusion Combining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended. |
| first_indexed | 2024-04-11T05:09:35Z |
| format | Article |
| id | doaj.art-5767e3baca4645efb0b99c8f590e1cf8 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-11T05:09:35Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-5767e3baca4645efb0b99c8f590e1cf82022-12-25T12:06:28ZengBMCBMC Infectious Diseases1471-23342022-12-0122111010.1186/s12879-022-07638-2Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso?Massa dit Achille Bonko0Ibrahima Karama1Francois Kiemde2Palpouguini Lompo3Zakaria Garba4Sibidou Yougbaré5Petra F. Mens6Halidou Tinto7Marc Christian Tahita8Henk. D. F. H. Schallig9Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centers, Academic Medical Center at the University of AmsterdamInstitut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Institut de Recherche en Sciences de la Santé- Direction Régionale du Centre-Ouest/Unité de Recherche Clinique de Nanoro, IRSS-DRCO /URCN)Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centers, Academic Medical Center at the University of AmsterdamAbstract Background Febrile illnesses are among the most important reasons for medical consultation in sub-Saharan Africa and are frequently treated with antimicrobials due to the unavailability of appropriate diagnostic tools. This practice leads to antimicrobial resistance, with increasing mortality and morbidity as result. One of the few accessible diagnostic tools available in low resource settings is malaria rapid diagnostic tests (mRDTs) which contributed to reducing the over-prescription of anti-malarials, but cannot guide antibiotic prescriptions. To circumvent this problem, we explored whether combined testing with mRDT and c-reactive protein (CRP) could improve the diagnosis of febrile illnesses and subsequent prescription of antibiotics. Methods Clinical specimens (blood, stool and urine) collected from 396 febrile children (axillary temperature of ≥ 37.5 °C) were analyzed with rapid diagnostic tests (malaria and CRP) and microbiology culture to establish the possible cause of fever. Actual antimicrobial prescriptions given to the children were compared with those that could be given based on combined CRP-malaria testing. Results In total, 68.7% (272/396) of malaria cases were diagnosed by mRDT-Pf-HRP-2. CRP test was positive in 84.3% (334/396) of the children, but bacterial infections were confirmed in 12.4% (49/396) of them. A possible cause of fever could not be established in 20.5% (81/396) of cases. Based on the diagnostic practice in place, 265 of the children with a positive mRDT-Pf-HRP-2 received anti-malarial treatment. Furthermore, 89.5% (111/124) of negative mRDT results received antibiotic treatment and 37.1% (46/124) received antimalarial treatment. Of these 124 cases, 80 had positive CRP tests and 44 negative CRP tests. If the results of CRP testing are considered, 44 CRP/mRDT negative children would not get antibiotic treatment, resulting in a 35.5% reduction in antibiotic prescriptions. However, 2 cases with a bacterial infection would be denied appropriate treatment. Conclusion Combining mRDT-PfHRP2 with CRP testing is particularly useful in children for whom both tests are negative as it results in a reduction of antibiotics prescriptions. However, there is a risk to miss potential severe bacterial infections and a close follow-up of these cases is strongly recommended.https://doi.org/10.1186/s12879-022-07638-2Bacterial infectionsMalariamRDT-PfHRP-2C-reactive proteinFebrile children under 5Antibiotics |
| spellingShingle | Massa dit Achille Bonko Ibrahima Karama Francois Kiemde Palpouguini Lompo Zakaria Garba Sibidou Yougbaré Petra F. Mens Halidou Tinto Marc Christian Tahita Henk. D. F. H. Schallig Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? BMC Infectious Diseases Bacterial infections Malaria mRDT-PfHRP-2 C-reactive protein Febrile children under 5 Antibiotics |
| title | Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? |
| title_full | Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? |
| title_fullStr | Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? |
| title_full_unstemmed | Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? |
| title_short | Could combined rapid diagnostic testing for malaria and c-reactive protein be helpful for the diagnosis and management of febrile illnesses in children under-5 years of age in rural Burkina Faso? |
| title_sort | could combined rapid diagnostic testing for malaria and c reactive protein be helpful for the diagnosis and management of febrile illnesses in children under 5 years of age in rural burkina faso |
| topic | Bacterial infections Malaria mRDT-PfHRP-2 C-reactive protein Febrile children under 5 Antibiotics |
| url | https://doi.org/10.1186/s12879-022-07638-2 |
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