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-
1.
Keitel K 2017. A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): a randomized, controlled non-inferiority trial. PLoS Med 14: e1002411.
-
2.
World Health Organization, 2015. Guidelines for the Treatment of Malaria. Geneva, Switzerland: WHO Press.
-
3.
World Health Organization, 2013. WHO Informal Consultation on Fever Management in Peripheral Health Care Settings: A Global Review of Evidence and Practice. Geneva, Switzerland: WHO Press.
-
4.
Escadafal C, Nsanzabana C, Archer J, Chihota V, Rodriguez W, Dittrich S, 2017. New biomarkers and diagnostic tools for the management of fever in low- and middle-income countries: an overview of the challenges. Diagnostics (Basel) 7: 44.
-
5.
World Health Organization, 2014. Antimicrobial Resistance: Global Report on Surveillance 2014. Geneva, Switzerland: WHO Press.
-
6.
Dupuy AM 2013. Role of biomarkers in the management of antibiotic therapy: an expert panel review: I–currently available biomarkers for clinical use in acute infections. Ann Intensive Care 3: 22.
-
8.
Kosack CS, Page AL, Klatser PR, 2017. A guide to aid the selection of diagnostic tests. Bull World Health Organ 95: 639–645.
-
9.
Kapasi AJ, Dittrich S, Gonzalez IJ, Rodwell TC, 2016. Host biomarkers for distinguishing bacterial from non-bacterial causes of acute febrile illness: a comprehensive review. PLoS One 11: e0160278.
-
10.
Aabenhus R, Jensen J, Jørgensen K, Hróbjartsson A, Bjerrum L, 2014. Biomarkers as point‐of‐care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev 11: CD010130.
-
11.
Van den Bruel A, Thompson MJ, Haj-Hassan T, Stevens R, Moll H, Lakhanpaul M, Mant D, 2011. Diagnostic value of laboratory tests in identifying serious infections in febrile children: systematic review. BMJ 342: d3082.
-
12.
Rutter CM, Gatsonis CA, 2001. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20: 2865–2884.
-
13.
Rutter CM, Gatsonis CA, 1995. Regression methods for meta-analysis of diagnostic test data. Acad Radiol 2 (Suppl 1): S48–S56 ; discussion S65–S67, S70–S71 pas.
-
14.
Althaus T 2019. Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar: an open-label, randomised, controlled trial. Lancet Glob Health 7: e119–e131.
-
15.
Wangrangsimakul T, Althaus T, Mukaka M, Kantipong P, Wuthiekanun V, Chierakul W, Blacksell SD, Day NP, Laongnualpanich A, Paris DH, 2018. Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand. PLoS Negl Trop Dis 12: e0006477.
-
16.
Mahende C, Ngasala B, Lusingu J, Martensson T, Lushino P, Lemnge M, Mmbando B, Premji Z, 2017. Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania. Pan Afr Med J 26: 51.
-
17.
Hildenwall H, Muro F, Jansson J, Mtove G, Reyburn H, Amos B, 2017. Point-of-care assessment of C-reactive protein and white blood cell count to identify bacterial aetiologies in malaria-negative paediatric fevers in Tanzania. Trop Med Int Health 22: 286–293.
-
18.
Phommasone K 2016. Accuracy of commercially available C-reactive protein rapid tests in the context of undifferentiated fevers in rural Laos. BMC Infect Dis 16: 61.
-
19.
Lubell Y, Althaus T, Blacksell SD, Paris DH, Mayxay M, Pan-Ngum W, White LJ, Day NP, Newton PN, 2016. Modelling the impact and cost-effectiveness of biomarker tests as compared with pathogen-specific diagnostics in the management of undifferentiated fever in remote tropical settings. PLoS One 11: e0152420.
-
20.
Lubell Y 2015. Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in southeast Asia. BMC Infect Dis 15: 511.
-
21.
Dittrich S 2016. Target product profile for a diagnostic assay to differentiate between bacterial and non-bacterial infections and reduce antimicrobial overuse in resource-limited settings: an expert consensus. PLoS One 11: e0161721.
-
22.
Bisoffi Z 2010. Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria-attributable fever during low and high transmission season in Burkina Faso. Malar J 9: 192.
-
23.
Duran-Chavez C, Sanchez-Herrera G, Cañedo-Solares I, Perez-Ortiz B, 1994. C-reactive protein in severely malnourished children. Nutr Res 14: 967–975.
-
24.
Kortz TB, Nyirenda J, Tembo D, Elfving K, Baltzell K, Bandawe G, Rosenthal PJ, Macfarlane SB, Mandala W, Nyirenda TS, 2019. Distinct biomarker profiles distinguish Malawian children with malarial and non-malarial sepsis. Am J Trop Med Hyg 101: 1424–1433.
Usefulness of C-Reactive Protein and Other Host BioMarker Point-of-Care Tests in the Assessment of Non-Malarial Acute Febrile Illnesses: A Systematic Review with Meta-Analysis
ABSTRACT
In low- and middle-income countries, in resource-limited settings, the implementation of diagnostic tools discriminating bacterial from nonbacterial fever is a matter of primary concern. The introduction of malaria rapid diagnostic tests highlighted the need for point-of-care tests (POCTs) supporting clinical decision-making for non-malarial febrile illnesses. The purpose of this work was to review the use of host biomarker POCTs for the assessment of acute non-malarial fever in resource-constraint settings. Specific objectives were as follows: 1) to estimate the accuracy of such tests in differentiating fever of bacterial from nonbacterial origin and 2) to assess the impact of host biomarkers on antibiotic prescription and clinical outcome. We conducted a systematic review searching PubMed, Embase, the Cochrane Library, and Bireme. The protocol was registered with PROSPERO (n CRD42019141735). Data on the accuracy of C-reactive protein (CRP) for the detection of bacterial infections were meta-analyzed using the hierarchical summary receiver operating characteristic model, obtaining a summary ROC (SROC). We identified 2,192 articles, eight of which were included in the review. Among the different biomarkers evaluated, CRP was the one most frequently studied. The SROC presented an area under the curve = 0.77 (CI: 0.73–0.81), which indicates good accuracy to distinguish bacterial from nonbacterial infections. However, the optimal cutoff of CRP could not be assessed, and we found insufficient evidence about its impact on antibiotic prescription and clinical outcome. The role of CRP and other host biomarker POCTs for the assessment of acute non-malarial febrile illnesses in resource-constraint settings deserves further studies.
Author Notes
Disclosure: This work was supported by the Italian Ministry of Health “Fondi Ricerca Corrente-Linea 1, progetto 1” to IRCCS Sacro Cuore Don Calabria Hospital.
Authors’ addresses: Giulia Bertoli, Niccolò Ronzoni, Ronaldo Silva, Tamara Ursini, and Dora Buonfrate, Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy, E-mails: giulia.bertoli@sacrocuore.it, niccolo.ronzoni@sacrocuore.it, ronaldo.silva@sacrocuore.it, tamara.ursini@sacrocuore.it, and dora.buonfrate@sacrocuore.it. Michele Spinicci and Alessandro Bartoloni, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy, E-mails: michele.spinicci@unifi.it and alessandro.bartoloni@unifi.it. Chiara Perlini, Scuola di Medicina, Università degli studi di Verona, Verona, Italy, E-mail: chiaretta.perlini@gamil.com. Luca Omega, Scuola di Specializzazione in Malattie Infettive, Università degli Studi di Verona, Verona, Italy, E-mail: luca.omega1@gmail.com. Piero Olliaro, Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom, and Foundation for Innovative Diagnostics (FIND), Geneva, Switzerland, E-mail: piero.olliaro@ndm.ox.ac.uk. Zeno Bisoffi, Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy, and Infectious Diseases and Diagnostic and Public Health Department, Tropical Medicine Section, University of Verona, Verona, Italy, E-mail: zeno.bisoffi@sacrocuore.it.