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.

Our study had several limitations. First, while we wanted to combine two TAC assays to enhance broad-spectrum investigation of febrile illness, each TAC assay requires a different type of clinical specimen, thus comparing diagnostic outputs can be difficult. While organisms detected in whole blood indicate viremia, bactaeremia, and/or parasitemia, organisms detected from the pharynges may only be representative of microbial carriage. For the purposes of this study, we did not state final determination of disease etiology, but we included agents in our analyses if nucleic acid was detected and presented distributions of Ct for relative quantification of microbial loads. In addition, while AFI and Resp TAC are both validated diagnostic techniques, the specificity and sensitivity of these assays are not 100%. 27, 28 In addition, this pilot survey was limited both temporally and geographically and yielded a rather small sample size of 205 participants. Given the varying seasonal patterns of both respiratory, as well as vector-borne diseases, different results could have been obtained if this study had been conducted in another region or during another season or year. Furthermore, given resource and testing constraints of this study, we solely enrolled febrile patients meeting our enrollment criteria, and thus did not enroll community-or hospital-based controls for subsequent analyses.