Rapid Diagnostic Tests and Clinical/Laboratory Predictors of Tropical Diseases In Patients With Persistent Fever in Cambodia, Nepal, Democratic Republic of the Congo and Sudan (NIDIAG-Fever)
Rapid Diagnostic Tests and Clinical/Laboratory Predictors of Tropical Diseases In Patients With Persistent Fever in Cambodia, Nepal, Democratic Republic of the Congo and Sudan (NIDIAG-Fever)
Tropical fevers have been a diagnostic challenge from the antiquity. Nowadays, despite the
 availability of good diagnostic capacities, undifferentiated febrile illnesses continue to be
 a thorny problem for travel physicians. In developing countries, the scarcity of skilled
 personnel and adequate laboratory facilities makes the differential diagnosis of fevers even
 more complex. Health care workers must often rely on syndrome-oriented empirical approaches
 to treatment and might overestimate or underestimate the likelihood of certain diseases. For
 instance Neglected Tropical Diseases (NTD) contribute substantially to the burden of
 persistent (more than 1 week) fevers in the Tropics, causing considerable mortality and major
 disability. These diseases are however rarely diagnosed at primary health care (PHC) level.
 The difficulty in establishing the cause of febrile illnesses has resulted in omission or
 delays in treatment, irrational prescriptions with polytherapy, increasing cost and
 development of drug resistance.

 In resource-limited settings, clinical algorithms constitute a valuable aid to health
 workers, as they facilitate the therapeutic decision in the absence of good laboratory
 capacities. There is a critical lack of appropriate diagnostic tools to guide treatment of
 NTDs. While clinical algorithms have been developed for some NTDs, in most cases they remain
 empirical. Besides, they rarely take into account local prevalence data, do not adequately
 represent the spectrum of patients and differential diagnosis at the primary care level and
 often have not been properly validated. The purpose of the study is to develop evidence-based
 Rapid Diagnostic Test (RDT)-supported diagnostic guidelines for patients with persistent
 fever (≥ 1 week) in the Democratic Republic of the Congo (DRC), Sudan, Cambodia and Nepal.
This study is part of a large European Union (EU)-funded research project called NIDIAG that
 aims at developing integrated, evidence-based syndromic approach to improve management of
 NTD-related clinical syndromes. NIDIAG targets three non-specific clinical syndromes: the
 persistent fever, neurological, and intestinal syndrome. The objective of the project is to
 establish diagnostic guidelines for each of this syndrome, with a particular focus on severe
 and treatable neglected infectious diseases. The developed guidelines should integrate
 relevant Point-of-Care (POC)tests.

 The persistent fever syndrome targeted by NIDIAG is defined as presence of fever for at least
 one week. The list of diseases - both NTD and other Infectious Diseases (ID) - that
 frequently cause persistent (≥1 week) fever in the study countries includes: Visceral
 Leishmaniasis (VL), Human Africa Trypanosomiasis (HAT), Enteric (typhoid, paratyphoid) fever,
 Malaria, Brucellosis, Melioidosis, Tuberculosis, Amoebic liver abscess, Relapsing fever, HIV,
 Rickettsial diseases, and Leptospirosis. The study will try to identify clinical and
 laboratory predictors of these diseases as well as validate existing RDTs.
Inclusion Criteria:

 -  fever for ≥ 1 week

 -  ≥ 5 years old (18 years onward in Cambodia)

 Exclusion Criteria:

 -  unwilling or unable to give written informed consent

 -  unable in the study physician's opinion to comply with the study requirements

 -  existing laboratory confirmed diagnosis

 -  need of immediate intensive care due to shock or respiratory distress