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.

In addition to bloodstream pathogens, we detected a range of bacterial and viral agents present in NP/OP specimens from febrile patients. While we did not detect influenza A, we did detect four cases of influenza B. These results are consistent with findings from a recent cross-sectional study in the Kilosa District, whereby the prevalence of influenza B was higher as compared with influenza A. 32 These results differ, however, from a national-level influenza survey, whereby researchers detected a significantly higher prevalence of influenza A (7%) as compared with influenza B (1%). 35 Previous literature has suggested an association between lower Ct values and manifestation of a more severe clinical illness. [36] [37] [38] [39] For cases presenting with influenza B (4; 4%) and Plasmodium (108; 57%), we detected lower-than-average median Ct values, indicating relatively high microbial loads and further hypothesize that these agents are more likely to be contributing to disease status. We recognize that it is important to consider additional biomarkers, beyond the concentration of microbial load, to better elucidate etiology. Further study is needed to examine patient immune response, such as cytokine or other inflammatory markers as well as antibody titers, to better support etiologic determination.