Koné Amadou, Kané Fousseyni, Neal Aaron, Konate Issa, Coulibaly Bintou, Dabitao Djeneba K, Diarra Bassirou, Sanogo Ibrahim, Sarro Yeya Dit Sadio, Coulibaly Tenin A, Diallo Dramane, Samake Seydou, Dicko Ilo, Diallo Mountaga, Diarra Ayouba, Coulibaly Mamadou D, Keita Daouda, Coulibaly Nadié, Koloma Isaac, Perou Mamadou, Diarra Hawa Boukary, Cisse Boubacar Elmadane, Togo Antieme Combo Georges, Coulibaly Gagni, Traoré Fah Gaoussou, Sanogo Moumine, Diakité Mahamadou, Aboulhab Jamila, Akpa Esther, Fouth-Tchos Karine, Shaw-Saliba Kathryn, Collins John, Lu Xiang-Jun, Nischay Mishra, Wickiser J Kenneth, Briese Thomas, Lipkin W Ian, Chen Ray Y, Doumbia Seydou, Dao Sounkalo
University Clinical Research Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali.
Global Alliance for Preventing Pandemics, Columbia University, New York, New York.
Am J Trop Med Hyg. 2024 Dec 24;112(3):626-635. doi: 10.4269/ajtmh.24-0449. Print 2025 Mar 5.
Unexplained fever poses significant diagnostic challenges in resource-limited settings like Bamako, Mali, where overlapping endemic diseases include malaria, HIV/AIDS, yellow fever, typhoid, and others. This study aimed to elucidate the infectious etiologies of acute febrile illnesses in this context. Acute febrile patients of any age were enrolled after informed consent or assent. Baseline clinical and demographic data were collected, and samples were analyzed by using rapid diagnostic tests, reverse transcriptase polymerase chain reaction, ELISA, and virus-targeted metagenomic sequencing (virome capture sequencing platform for vertebrate viruses [VirCapSeq-VERT]). Among 108 enrolled subjects, most were male (51.9%) and under 15 years old (56.5%). Measles virus was identified in 39.8% of cases, primarily among children. Other findings included Plasmodium spp. (12%), Salmonella spp. (13%), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 8.7%). The virome capture sequencing platform for vertebrate viruses was used for 101 subjects, corroborating many routine test results and identifying additional cases of measles virus (1), SARS-CoV-2 (5), and numerous other agents. Notably, nearly all subjects showed evidence of herpesviruses (90%) and anelloviruses (98%). Hemorrhagic fever viruses were not observed. With the inclusion of VirCapSeq-VERT, identifiable pathogens were found in 79.6% of cases, leaving 20.4% without a clear etiology. The identification of more than one concurrent pathogen was common (41.5%). Integrating metagenomic sequencing with routine laboratory diagnostic testing enhances the detection of pathogens in acute febrile illnesses, highlighting its potential value in identifying infectious etiologies in resource-limited settings.
在像马里巴马科这样资源有限的地区，不明原因发热带来了重大的诊断挑战，当地流行的重叠疾病包括疟疾、艾滋病毒/艾滋病、黄热病、伤寒等。本研究旨在阐明在此背景下急性发热性疾病的感染病因。在获得知情同意或同意后，纳入了任何年龄的急性发热患者。收集了基线临床和人口统计学数据，并使用快速诊断测试、逆转录聚合酶链反应、酶联免疫吸附测定和病毒靶向宏基因组测序（脊椎动物病毒宏基因组捕获测序平台[VirCapSeq-VERT]）对样本进行分析。在108名纳入的受试者中，大多数为男性（51.9%）且年龄在15岁以下（56.5%）。在39.8%的病例中检测到麻疹病毒，主要是儿童。其他发现包括疟原虫属（12%）、沙门氏菌属（13%）和严重急性呼吸综合征冠状病毒2（SARS-CoV-2；8.7%）。对101名受试者使用了脊椎动物病毒宏基因组捕获测序平台，证实了许多常规测试结果，并发现了更多麻疹病毒（1例）、SARS-CoV-2（5例）和许多其他病原体的病例。值得注意的是，几乎所有受试者都显示出疱疹病毒（90%）和环病毒（98%）感染的证据。未观察到出血热病毒。纳入VirCapSeq-VERT后，79.6%的病例中发现了可识别的病原体，20.4%的病例病因不明。同时发现一种以上病原体很常见（41.5%）。将宏基因组测序与常规实验室诊断测试相结合可提高急性发热性疾病中病原体的检测率，凸显了其在资源有限地区识别感染病因方面的潜在价值。
