In:
PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 15, No. 3 ( 2021-3-1), p. e0009187-
Abstract:
New hemocytometric parameters can be used to differentiate causes of acute febrile illness (AFI). We evaluated a software algorithm–Infection Manager System (IMS)—which uses hemocytometric data generated by Sysmex hematology analyzers, for its accuracy to detect bacteremia in AFI patients with and without malaria in Burkina Faso. Secondary aims included comparing the accuracy of IMS with C-reactive protein (CRP) and procalcitonin (PCT). Methods In a prospective observational study, patients of ≥ three-month-old (range 3 months– 90 years) presenting with AFI were enrolled. IMS, blood culture and malaria diagnostics were done upon inclusion and additional diagnostics on clinical indication. CRP, PCT, viral multiplex PCR on nasopharyngeal swabs and bacterial- and malaria PCR were batch-tested retrospectively. Diagnostic classification was done retrospectively using all available data except IMS, CRP and PCT results. Findings A diagnosis was affirmed in 549/914 (60.1%) patients and included malaria (n = 191) bacteremia (n = 69), viral infections (n = 145), and malaria-bacteremia co-infections (n = 47). The overall sensitivity, specificity, and negative predictive value (NPV) of IMS for detection of bacteremia in patients of ≥ 5 years were 97.0% (95% CI: 89.8–99.6), 68.2% (95% CI: 55.6–79.1) and 95.7% (95% CI: 85.5–99.5) respectively, compared to 93.9% (95% CI: 85.2–98.3), 39.4% (95% CI: 27.6–52.2), and 86.7% (95% CI: 69.3–96.2) for CRP at ≥20mg/L. The sensitivity, specificity and NPV of PCT at 0.5 ng/ml were lower at respectively 72.7% (95% CI: 60.4–83.0), 50.0% (95% CI: 37.4–62.6) and 64.7% (95% CI: 50.1–77.6) The diagnostic accuracy of IMS was lower among malaria cases and patients 〈 5 years but remained equal to- or higher than the accuracy of CRP. Interpretation IMS is a new diagnostic tool to differentiate causes of AFI. Its high NPV for bacteremia has the potential to improve antibiotic dispensing practices in healthcare facilities with hematology analyzers. Future studies are needed to evaluate whether IMS, combined with malaria diagnostics, may be used to rationalize antimicrobial prescription in malaria endemic areas. Trial registration ClinicalTrials.gov ( NCT02669823 ) https://clinicaltrials.gov/ct2/show/ NCT02669823
Type of Medium:
Online Resource
ISSN:
1935-2735
DOI:
10.1371/journal.pntd.0009187
DOI:
10.1371/journal.pntd.0009187.g001
DOI:
10.1371/journal.pntd.0009187.g002
DOI:
10.1371/journal.pntd.0009187.g003
DOI:
10.1371/journal.pntd.0009187.g004
DOI:
10.1371/journal.pntd.0009187.t001
DOI:
10.1371/journal.pntd.0009187.t002
DOI:
10.1371/journal.pntd.0009187.t003
DOI:
10.1371/journal.pntd.0009187.t004
DOI:
10.1371/journal.pntd.0009187.t005
DOI:
10.1371/journal.pntd.0009187.t006
DOI:
10.1371/journal.pntd.0009187.t007
DOI:
10.1371/journal.pntd.0009187.s001
DOI:
10.1371/journal.pntd.0009187.s002
DOI:
10.1371/journal.pntd.0009187.s003
DOI:
10.1371/journal.pntd.0009187.s004
DOI:
10.1371/journal.pntd.0009187.s005
DOI:
10.1371/journal.pntd.0009187.s006
DOI:
10.1371/journal.pntd.0009187.s007
DOI:
10.1371/journal.pntd.0009187.s008
DOI:
10.1371/journal.pntd.0009187.r001
DOI:
10.1371/journal.pntd.0009187.r002
DOI:
10.1371/journal.pntd.0009187.r003
DOI:
10.1371/journal.pntd.0009187.r004
DOI:
10.1371/journal.pntd.0009187.r005
DOI:
10.1371/journal.pntd.0009187.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2429704-5
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