Point-of-care laboratory of pathogen diagnosis in rural Senegal.

Cheikh Sokhna,Didier Raoult,Jean-François Trape,Hubert Bassene,Georges Diatta,Michel Drancourt,Adama Tall,Florence Fenollar,Oleg Mediannikov,Janet Foley

doi:10.1371/journal.pntd.0001999

Abstract

BackgroundIn tropical Africa, where the spectrum of the bacterial pathogens that cause fevers is poorly understood and molecular-based diagnostic laboratories are rare, the time lag between test results and patient care is a critical point for treatment of disease.Methodology/Principal FindingsWe implemented POC laboratory in rural Senegal to resolve the time lag between test results and patient care. During the first year of the study (February 2011 to January 2012), 440 blood specimens from febrile patients were collected in Dielmo and Ndiop villages. All samples were screened for malaria, dengue fever, Borrelia spp., Coxiella burnetii, Tropheryma whipplei, Rickettsia conorii, R. africae, R. felis, and Bartonella spp.Conclusions/SignificanceWe identified DNA from at least one pathogenic bacterium in 80/440 (18.2%) of the samples from febrile patients. B. crocidurae was identified in 35 cases (9.5%), and R. felis DNA was found in 30 cases (6.8%). The DNA of Bartonella spp. was identified in 23/440 cases (4.3%), and DNA of C. burnetii was identified in 2 cases (0.5%). T. whipplei (0.2%) was diagnosed in one patient. No DNA of R. africae or R. conorii was identified. Among the 7 patients co-infected by two different bacteria, we found R. felis and B. crocidurae in 4 cases, B. crocidurae and Bartonella spp. in 2 cases, and B. crocidurae and C. burnetii in 1 case. Malaria was diagnosed in 54 cases. In total, at least one pathogen (bacterium or protozoa) was identified in 127/440 (28.9%) of studied samples. Here, the authors report the proof of concept of POC in rural tropical Africa. Discovering that 18.2% of acute infections can be successfully treated with doxycycline should change the treatment strategy for acute fevers in West Africa.

Highlights

Each year in sub-Saharan Africa, more 11 million people die [1], and, for the majority of individuals, the causes of death are largely uninvestigated
Among the 7 patients co-infected by two different bacteria, we found R. felis and B. crocidurae in 4 cases, B. crocidurae and Bartonella spp. in 2 cases, and B. crocidurae and C. burnetii in 1 case
Access to reliable diagnostic testing is severely limited in sub-Saharan Africa, and misdiagnosis commonly occurs, the diagnosis is essential to the prevention and treatment of disease [2]

Summary

Introduction

Each year in sub-Saharan Africa, more 11 million people die [1], and, for the majority of individuals, the causes of death are largely uninvestigated. These uninvestigated deaths are generally attributed to infectious diseases. Dielmo and Ndiop are two Senegalese rural villages where a longitudinal study of malaria for long-term investigations of hostparasite relationships and the mechanisms of protective immunity has been conducted since 1990 and 1993, respectively [3,4]. The small and stable populations of Dielmo and Ndiop are closely followed by a research partnership between Dakar Pasteur Institute, Institut de Recherche pour le Developpement (IRD). In tropical Africa, where the spectrum of the bacterial pathogens that cause fevers is poorly understood and molecular-based diagnostic laboratories are rare, the time lag between test results and patient care is a critical point for treatment of disease

Methods

Results

Discussion

Conclusion