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John A. Crump, Reply to Yansouni et al, Clinical Infectious Diseases, Volume 55, Issue 4, 15 August 2012, Pages 611–612, https://doi.org/10.1093/cid/cis468
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Tothe Editor—The syndrome of fever is among the most common reasons for persons to seek healthcare in the developing world, yet burden of disease estimates are not available for the syndrome overall nor for many of its individual etiologies, fueling neglect. Yansouni and colleagues [1] highlight challenges and pitfalls associated with managing febrile patients in low-resource areas, where epidemiologic and diagnostic information is limited. They point to the potential for rapid diagnostics tests (RDTs) to inform management decisions and improve patient outcomes. Malaria RDTs with robust performance characteristics are available [2] and, if widely used and applied, could have a major influence on how febrile patients are managed and how antimalarial drugs are prescribed. Indeed, in a shift away from clinical diagnosis of malaria, the World Health Organization has recently recommended that use of antimalarial medications now be based on the results of a malaria diagnostic test [3]. However, once malaria is ruled out using a reliable malaria RDT or by microscopy, clinicians in resource-limited areas are faced with a large and growing proportion of febrile patients without malaria [4] and few tools to guide further management.
