A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL)

Acute febrile illness (AFI) causes significant health-seeking, morbidity and mortality in Southeast Asia. This pilot study aimed to describe presentation, aetiology, treatment and outcomes of patients with AFI at one hospital in Timor-Leste while assessing feasibility of conducting larger studies in this setting. Patients attending Hospital Nacional Guido Valadares (HNGV) with tympanic or axillary temperature ≥37.5 degrees Celsius in whom a blood culture was being taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analysed using a real-time quantitative polymerase chain reaction (PCR) assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. Eighty-two participants were recruited. PCR testing was positive for dengue in 14/82 (17.1%) participants and blood culture identified a bacterial pathogen in three 3/82 (3.7%) participants. Follow-up was completed by 75/82 (91.5%) participants. High rates of hospital admission (58/82, 70.7%), broad-spectrum antimicrobial treatment (34/82, 41.5%), and mortality (9/82, 11.0%) were observed. Patients with AFI in Timor-Leste experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions such as enhanced diagnostic testing, clinical decision support tools or antimicrobial stewardship interventions are required and would be feasible to conduct in this setting.