1. A novel diagnostic algorithm equipped on an automated hematology analyzer to differentiate between common causes of febrile illness in Southeast Asia.
- Author
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Prodjosoewojo S, Riswari SF, Djauhari H, Kosasih H, van Pelt LJ, Alisjahbana B, van der Ven AJ, and de Mast Q
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Animals, Arbovirus Infections diagnosis, Bacterial Infections diagnosis, C-Reactive Protein analysis, Diagnosis, Differential, Female, Humans, Indonesia, Male, Mice, Middle Aged, Predictive Value of Tests, Procalcitonin analysis, Prospective Studies, Sensitivity and Specificity, Young Adult, Algorithms, Automation, Laboratory methods, Blood Chemical Analysis methods, Diagnostic Tests, Routine methods, Fever of Unknown Origin diagnosis
- Abstract
Background: Distinguishing arboviral infections from bacterial causes of febrile illness is of great importance for clinical management. The Infection Manager System (IMS) is a novel diagnostic algorithm equipped on a Sysmex hematology analyzer that evaluates the host response using novel techniques that quantify cellular activation and cell membrane composition. The aim of this study was to train and validate the IMS to differentiate between arboviral and common bacterial infections in Southeast Asia and compare its performance against C-reactive protein (CRP) and procalcitonin (PCT)., Methodology/principal Findings: 600 adult Indonesian patients with acute febrile illness were enrolled in a prospective cohort study and analyzed using a structured diagnostic protocol. The IMS was first trained on the first 200 patients and subsequently validated using the complete cohort. A definite infectious etiology could be determined in 190 of 463 evaluable patients (41%), including 89 arboviral infections (81 dengue and 8 chikungunya), 94 bacterial infections (26 murine typhus, 16 salmonellosis, 6 leptospirosis and 46 cosmopolitan bacterial infections), 3 concomitant arboviral-bacterial infections, and 4 malaria infections. The IMS detected inflammation in all but two participants. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IMS for arboviral infections were 69.7%, 97.9%, 96.9%, and 77.3%, respectively, and for bacterial infections 77.7%, 93.3%, 92.4%, and 79.8%. Inflammation remained unclassified in 19.1% and 22.5% of patients with a proven bacterial or arboviral infection. When cases of unclassified inflammation were grouped in the bacterial etiology group, the NPV for bacterial infection was 95.5%. IMS performed comparable to CRP and outperformed PCT in this cohort., Conclusions/significance: The IMS is an automated, easy to use, novel diagnostic tool that allows rapid differentiation between common causes of febrile illness in Southeast Asia., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: AvV and QdM received an unrestricted research grant from Sysmex Corporation.
- Published
- 2019
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