A Combined Syndromic Approach to Examine Viral, Bacterial, and Parasitic Agents among Febrile Patients: A Pilot Study in Kilombero, Tanzania

Hercik, Christine; Cosmas, Leonard; Mogeni, Ondari D.; Wamola, Newton; Kohi, Wanze; Houpt, Eric; Liu, Jie; Ochieng, Caroline; Onyango, Clayton; Fields, Barry; Mfinanga, Sayoki; Montgomery, Joel M.

Recent epidemiological data suggest that because of the adoption of aggressive vector control measures, there has been a stark decline in malaria incidence across sub-Saharan Africa, particularly in Tanzania. [1] [2] [3] [4] [5] [6] In Tanzania's South-Central region, data regarding the cause of nonmalarial febrile illness are currently lacking. At present, the malaria rapid diagnostic test is the only diagnostic tool used to direct febrile patient management in this region. [7] [8] [9] Thus, when a patient presents with fever and tests negative for malaria, clinical care providers must rely upon symptomatic conditions alone to define provisional diagnoses and determine appropriate treatment regimens. [10] [11] [12] Stakeholders have therefore recognized the need to improve knowledge surrounding the etiology of febrile illness, to optimize care, and to improve clinical outcomes. 3, 13, 14 In the regions of sub-Saharan Africa where viral, bacterial, and parasitic infections are not well-quantified, pathogenspecific diagnostic approaches to syndromic surveillanceevaluating only one or few pathogens-are inadequate. Most of these pathogen-specific studies have solely targeted malaria, and thus failed to consider other causative agents of febrile illness. [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] Given that multiple coinfections may contribute to morbidity, the detection of a single agent may not provide a complete understanding of disease etiology.