The patient viewed for the first time at the hospital and suspected of leptospirosis received a probabilistic antibiotherapy

When the leptospirosis is confirmed ( PCR Leptospirosis positive) the pobabilistic antibiotherapy is switched to a prophylactic antibiotherapy with Amoxicillin or Doxycycline.

Mild Leptospirosis

Reduce at 3 days of antibiotherapy for the treatment of mild leptospirosis

3 days of antibiotherapy

Centre Hospitalier Andrée Rosemond (CH de Cayenne)

University Hospital of Guadeloupe

Centre Hospitalier Universitaire de Martinique

Centre Hospitalier de Mayotte

Centre Hospitalier Universitaire Sud Réunion

Comparing Two Antibiotic Therapy Periods (3 Versus 7 Days) in Patients With Mild Leptospirosis and Seen at the Hospital in 5 French Overseas Departments (Martinique, Guadeloupe, French Guiana, Reunion, Mayotte)

Multicenter, Randomized, Open-label Non-inferiority Trial, Comparing Two Antibiotic Therapy Periods (3 Versus 7 Days) in Patients With Mild Leptospirosis and Seen at the Hospital in 5 French Overseas Departments (Martinique, Guadeloupe, French Guiana, Reunion, Mayotte)

occurrence of a complication:
Hemodynamic failure with onset of septic shock defined by persisting hypotension requiring vasopressor amines to maintain mean arterial pressure ≥65 mm Hg and blood lactates >2 mmol/L despite adequate volume resuscitation
hematologic failure with hemoglobin <7 g / L requiring red blood cell transfusion or platelets < 20 G / L requiring platelet transfusion
Ventilatory failure defined by PaO2 / Fi O2 ratio <300 mmHg or resort to mechanical ventilation
Renal failure defined by serum creatinine > 301 μmol / L or resort to renal dialysis
Hepatic failure defined by total bilirubinemia> 101 μmol / L or
continued fever (body temperature >38°C) 5 days after the start of antibiotic therapy, or fever reappearance (body temperature >38°C) observed 24 hours after initial apyrexia (body temperature <38°C). Both cases exclude fever due to a cause not attributable to leptospirosis infection. or
death

measure of body temperature
assessment of functional signs
no evolution of infection at 21 days from start of antibiotic therapy)
Absence of clinical symptoms (jaundice, nausea, abdominal pain, myalgia, and arthlagia)
Normalization of biological parameters (creatinine, bilirubin, platelets, hemoglobin)
Quality of life criteria evaluated by the EQ5D questionnaire

Absence of clinical symptoms such as jaundice, nausea, abdominal pain, myalgia, and arthlagia Normalization of biological parameters (creatinine, bilirubin, platelets, hemoglobin)

Quality of life criteria evaluated by the EQ5D questionnaire (scale from 0 to 100 with 0 means worst imaginable health state; 100 means best imaginable health state

quantitative leptospiremia (blood) at start of antibiotic therapy

quantitative leptospiremia (blood) at 3 days from start of antibiotic therapy

Tolerance to treatment assessed by the occurrence of Jarisch-Herzheimer reactions, as well as adverse event reporting based on a standardized and internationally recognized toxicity table for adults

University Hospital Center of Martinique

Centre Hospitalier de Cayenne

Centre Hospitalier Universitaire de la Réunion

Hôpital de Mayotte

The Prevalence of Scrub Typhus

A transfer pipette or loop will be used to transfer 10 µL of whole blood from a finger prick to the sample pad area on the scrub typhus test strip and the test will be performed on site according to the manufacturer's instructions. Tests will be read by two independent readers and results recorded as positive, negative or invalid.
In patients with a skin eschar a sterile surgical blade will be used to gently scrape the surface of the eschar. Scrapings will be stored in a cryotube containing 95% ethanol and stored at -80°C for future analysis (PCR genotyping ± whole genome sequencing) to confirm the presence of Orientia tsutsugamushi.

Scrub Typhus RDT Test

No.20, 100 Bedded Military Hospital,

No.2, 1000 Bedded Military Hospital

Scrub Typhus RDT Study

A Multicentre Observational Study to Describe the Prevalence of Scrub Typhus Defined as a Positive Rapid Diagnostic Test Among Selected Patients Presenting With Fever to Clinics in Myanmar

Proportion of patients with a positive RDT result

Ease- of- use of the test (scored on blood safety, quality of instructions, number of timed steps to perform test, ease of interpretation, user satisfaction)

Proportion of patients with fever/symptom resolution at one week

Myanmar Oxford Clinical Research Unit

University of Oxford

Medical Action Myanmar (MAM)

Yae Township Hospital, Mon State

Swiss Tropical & Public Health Institute

Defence Services Medical Academy (DSMA), Myanmar

The health care provider will manage the patient using standard guidelines. No CRP will be measured onsite

CRP will be measured by a study nurse onsite and the result will be communicated to the health care provider.

Fever

No CRP will be measured onsite

Health care worker will be given an advice to prescribe antibiotic to patient who has CRP lever < 20mg/L.

CRP cut-off of 20mg/L.

Health care worker will be given an advice to prescribe antibiotic to patient who has CRP lever < 40mg/L.

CRP cut-off of 40mg/L.

Chiangrai Clinical research Unit

The Impact of C-reactive Protein Testing

The Impact of C-reactive Protein Testing on Antibiotic Prescription in Febrile Patients Attending Primary Care in Low-resource Settings

The proportion of recruited patients prescribed an antibiotic at the health centre on or between their enrolment and the first follow-up visit (on day 5 +/- 1 day).

Symptoms as defined by fever, any other symptom

Severity will be assessed by the nurse using a rating scale graded from 1 to 4 (#Grading 1=mild, 2=moderate, 3=severe, 4=potentially life-threatening), according to the patients' description of their symptoms, and the findings of the physical examination.

as defined by admission to hospital or death within the 14 days of follow up

Attitudes and satisfaction of health centre staff towards the CRP POC test

Key pathogens are Flavivirus, Alphavirus, Influenza A & B, Rickettsia including typhus group and spotted fever group, Leptospirosis, PCR 16s for the detection of any bacteria and malaria

Sensitivity is defined as the proportion of patients with high CRP, out of all PCR confirmed bacterial infections.

Specificity is defined as the proportion of patients with low CRP, out of all PCR confirmed viral infections.

The positive likelihood ratio is the fraction of sensitivity over (1 - Specificity) , and the negative likelihood ratio is the fraction of (1 - Sensitivity) over Specificity.

We will use the ROC, or ROC curve, as a graphical plot, in order to illustrate the performance of the CRP-testing to classify bacterial and non-bacterial infections as its discrimination threshold is varied.

Department of Medical Research, Lower Myanmar

A total of 10 RDTs will be assessed in the patients cohort for the respective target condition

Visceral Leishmaniasis

Human African Trypanosomiasis

Enteric Fever

Melioidosis

Brucellosis

Leptospirosis

Relapsing Fever

Rickettsial Diseases

Tuberculosis

Malaria

Amoebic Liver Abscess

rk28 ICT is an immunochromatographic assay intended for qualitative detection of IgG antibodies directed towards VL in human serum, plasma or whole blood. It is manufactured by EASE-Medtrend (Shanghai, China)

rk28 ICT

IT LEISH is an immuno-chromatographic test, using the recombinant antigen K39, to detect the presence of antibodies against Leishmania spp. It is manufactured by BioRad laboratories, USA.

IT LEISH (rK39)

This is a lateral flow immunochromatographic test manufactured by Standard Diagnostics (Korea) in collaboration with FIND.

Immunochromatographic HAT test

The HAT Serostrip is an immunochromatographic assay developed by Coris BioConcept, France, which is designed for remote field use in individual HAT suspects.

HAT Serostrip

The Card Agglutination Trypanosoma test (CATT) has been used for many years at large scale for mass screening of mostly asymptomatic individuals (CATT-R250). Unfortunately, its operating characteristics have only been evaluated in the context of patients with persistent fever. Although it is not strictly an RDT, the CATT is rather easily performed in remote settings, in particular since a new and more robust format (CATT-D10) allows to test a lower number of patients in peripheral health facilities. It is manufactured by the Institute of Tropical Medicine of Antwerp, Belgium.

Card Agglutination Trypanosoma Test (CATT)-10

The Typhidot M test is a dot enzyme immunoassay that detects IgM and IgG directed against Salmonella typhi. It is manufactured by Reszon Diagnostics International, Malaysia

Typhidot M

The Salmonella typhi IgG/IgM Rapid Test is an immunochromatographic assay for the qualitative differential detection of IgG and IgM antibodies to Salmonella typhi in human serum, plasma or whole blood. It is manufactured by Standard Diagnostics (Korea)

S. typhi IgM/IgG

Test-it Typhoid IgM lateral flow assay is a one-step immunochromatographic assay which uses a lipopolysaccharide (LPS) antigen derived from salmonella typhi for the detection of specific IgM antibodies. It is manufactured by Life Assay, South Africa.

Test-it Typhoid IgM

The Test-it™ Leptospira lateral flow device detects IgM antibodies in humans against Leptospira in whole blood or serum. It is manufactured by Life Assay, South Africa

Test-it Leptospirosis IgM

This test enables the differential detection of IgG and IgM antibodies to Leptospira interrogans. It is manufactured by Standard Diagnostics, Korea

Leptospira IgG/IgM

Sihanouk Hospital Center of HOPE

Reference Hospital Mosango and Kasay Health Centre

Institut National de Recherche Biomédicale

Dhankuta District hospital

BP Koirala Institute of Health Sciences

Tabarak Allah Hospital

University of Khartoum

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)

Evaluation of Rapid Diagnostic Tests (RDT) in Association With Clinical and Laboratory Predictors for the Diagnosis of Neglected Tropical Diseases (NTD) in Patients Presenting With Persistent Fever (≥1 Week) in Cambodia, Nepal, Democratic Republic of the Congo and Sudan

Number of patients diagnosed with VL, HAT and other NTDs among those presenting with persistent(≥ 1 week) fever in one of the study sites

Sensitivity, specificity, crude and adjusted likelihoods ratios (LR), and predictive values (post-test probabilities) of clinical and first-line laboratory predictors for the diagnosis of VL, HAT and other NTDs

Assessment of sensitivity, likelihood ratios and performances (diagnostic accuracy) of the novel study RDTs for VL, HAT, enteric fever and

Predictive values (post-test probabilities) of RDTs, alone and in combination, for the respective target conditions within the multi-disease approach

Unit costs of diagnostic tests for the diagnosis of HAT and other priority NTDs/IDs in the setting

leptospirosis/fever

Comparing Two Antibiotic Therapy Periods (3 Versus 7 Days) in Patients With Mild Leptospirosis and Seen at the Hospital in 5 French Overseas Departments (Martinique, Guadeloupe, French Guiana, Reunion, Mayotte)

Scrub Typhus RDT Study

The Impact of C-reactive Protein Testing

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)

Study of Intensive Care Units in India

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