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The differential and systematic diagnosis of malaria, dengue and chikungunya in patients with fever (≥38.5°C) of undetermined etiology would allow the identification of infection by these pathogens and thus limit the inappropriate use of antibiotics (discontinuation or non-initiation) and optimize the clinical management and prognosis of patients.
The research hypotheses are as follows:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention Site | Active Comparator | In the interventional sites, bioMérieux teams provided training to raise awareness of the diagnosis of dengue, chikungunya and malaria. In addition, a VIDAS instrument was installed and dengue and chikungunya diagnostic kits were supplied so that diagnosis could be carried out systematically for each patient included. |
|
| Control Site | Placebo Comparator | In the control centres, only routine practices were observed. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| VIDAS® Dengue Antigen NS1, VIDAS® Anti-Dengue IgM, VIDAS® Anti-Dengue IgG, VIDAS® Anti-Chikungunya IgM and VIDAS® Anti-Chikungunya IgG | Diagnostic Test | For patients managed in an "intervention site", a diagnostic test for dengue and chikungunya using VIDAS® as well as a screening test for malaria will be carried out. An awareness campaign on the use of VIDAS® diagnostic tests will be implemented as well. The diagnosis will be based on the patient's clinical symptoms, the biological results of the VIDAS® tests for dengue and chikungunya, as well as the results of the tests for malaria. |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of antibiotic prescription | Rate of antibiotic prescription (discontinuation or non-initiation). | Inclusion and Day 7 |
| Measure | Description | Time Frame |
|---|---|---|
| Consumption of hospital resources | Number of days in hospital. | Day 7 |
| Consumption of hospital resources | Number of hospital visits within 7 days. |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of dengue, chikungunya and malaria | To determine the prevalence of dengue, chikungunya and malaria in patients with fever (≥38.5°C) of undetermined etiology | Inclusion, after lab results (an average of one day) |
| Clinical situations associated with inappropriate antibiotic prescription |
Inclusion Criteria:
Subjects aged ≥ 18 years
Patient with fever (≥38.5°C) and at least two of the following symptoms in the last 10 days:
Willingness and ability to provide two 4 mL blood samples
Willingness to provide one drop of blood per capillary sample
Informed and signed consent
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institut de Recherche en Sciences de la Santé | Ouagadougou | Burkina Faso | ||||
| CHU Cocody |
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This is a multicentric study which will be carried out in four hospitals, two in Burkina Faso and two in Ivory Coast. In each of these two countries, an "intervention" site and a "control" site will be included in the study. The study is interventional as the investigators collected additional blood samples than the routine practices.
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| Standard of care practices | Other | For patients managed in a "control site", the standard of care practices will be applied in the case of a febrile condition of undetermined etiology. This includes clinical diagnosis and, where appropriate, the use of routinely available diagnostic tests. At the end of the study, the collected samples will be tested using VIDAS® differential diagnosis tests to estimate the number of cases of dengue and chikungunya that have not been correctly diagnosed. |
|
| Day 7 |
| Patient satisfaction | Patient satisfaction with the health care (measured on a scale of 1 (worse) to 5 (better)). | Inclusion and Day 7 |
| Patient's quality of life | Percentage on patient's quality of life (1 (worse) to 100 (better)) + EQ-5D questionnaire. | Inclusion and Day 7 |
| Patient's loss of productivity | Questionnaire on number of working day lost. | Inclusion and Day 7 |
Number of clinical situations associated with inappropriate antibiotic prescription, including suggestive signs of bacterial infection or severe sepsis such as neurological, cardio-circulatory failure, coma or purpura fulminans |
| Inclusion and Day 7 |
| Rate of antibiotic prescription | To estimate the impact of differential diagnosis testing on the rate of antibiotic prescription in patients with dengue and/or chikungunya | Up to 7 days |
| Abidjan |
| Cocody |
| Côte d’Ivoire |
| CHU Treichville | Abidjan | Treichville | Côte d’Ivoire |
| ID | Term |
|---|---|
| D003715 | Dengue |
| D065632 | Chikungunya Fever |
| D008288 | Malaria |
| D004194 | Disease |
| ID | Term |
|---|---|
| D000096724 | Mosquito-Borne Diseases |
| D000079426 | Vector Borne Diseases |
| D007239 | Infections |
| D001102 | Arbovirus Infections |
| D014777 | Virus Diseases |
| D018177 | Flavivirus Infections |
| D018178 | Flaviviridae Infections |
| D012327 | RNA Virus Infections |
| D006482 | Hemorrhagic Fevers, Viral |
| D018354 | Alphavirus Infections |
| D014036 | Togaviridae Infections |
| D011528 | Protozoan Infections |
| D010272 | Parasitic Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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