The past few weeks, members of the FIEBRE study collaboration have been working together to begin study activities at the first two sites: Harare, Zimbabwe, with colleagues from the Biomedical Research and Training Institute (BRTI), and Chikwawa, Malawi, with the Malawi–Wellcome Trust team.

FIEBRE’s primary objectives are to identify the leading infectious causes of fever among patients at five sites across sub-Saharan Africa and Southeast Asia; and to determine the prevalence and spectrum of antimicrobial resistance among bacteria isolated from these patients. Fever is one of the most common symptoms leading to health care seeking and hospital admission in areas represented by FIEBRE study sites. However, many febrile illnesses present with non-specific symptoms and signs, a challenge for health care workers that is compounded by limited availability of diagnostic tools. As a result, treatable infections may be missed, or treated with inappropriate antimicrobials, on the one hand; and on the other hand, self-limiting conditions (e.g. many viral illnesses) may be over-treated with antimicrobials on the other – all with implications for the development of antimicrobial resistance (AMR).

In particular, clinical microbiology services – a mainstay of health care in well-resourced parts of the world – are rarely available in areas represented by FIEBRE study sites. This means that when managing patients, clinicians cannot confirm the presence or absence of bacterial (or fungal) infections; and that they can’t determine which antibiotics would be most appropriate for such an infection. For FIEBRE study participants, (in addition to several other diagnostic assays) blood and urine samples will be cultured at research laboratories near each study site, and antibiotic susceptibilities will be determined for any bacteria isolated. In addition, any microorganisms isolated will be cryopreserved and shipped to an international reference laboratory for confirmation of identification and antimicrobial susceptibilities. In this way, FIEBRE will contribute to clinical diagnostic capacity at each site, and also to regional AMR surveillance efforts – both during the one-year study period, and hopefully into the future.

Pilot enrolment of FIEBRE participants will begin in Zimbabwe and Malawi within the next few days, and staff training at study sites in Lao PDR, Mozambique and Myanmar is anticipated in coming weeks.

As well as using the links above, you can keep up to date with the study by following @FeverStudies on Twitter.

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