Towards improving point-of-care diagnosis of non-malaria febrile illness : a metabolomics approach

Decuypere, Saskia and Maltha, Jessica and Deborggraeve, Stijn and Rattray, Nicholas J. W. and Issa, Guiraud and Bérenger, Kaboré and Lompo, Palpouguini and Tahita, Marc C. and Ruspasinghe, Thusitha and McConville, Malcolm and Goodacre, Royston and Tinto, Halidou and Jacobs, Jan and Carapetis, Jonathan R. (2016) Towards improving point-of-care diagnosis of non-malaria febrile illness : a metabolomics approach. PLOS Neglected Tropical Diseases, 10 (3). e0004480. ISSN 1935-2727

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    Introduction: Non-malaria febrile illnesses such as bacterial bloodstream infections (BSI) are a leading cause of disease and mortality in the tropics. However, there are no reliable, simple diagnostic tests for identifying BSI or other severe non-malaria febrile illnesses. We hypothesized that different infectious agents responsible for severe febrile illness would impact on the host metabololome in different ways, and investigated the potential of plasma metabolites for diagnosis of non-malaria febrile illness. Methodology: We conducted a comprehensive mass-spectrometry based metabolomics analysis of the plasma of 61 children with severe febrile illness from a malaria-endemic rural African setting. Metabolite features characteristic for non-malaria febrile illness, BSI, severe anemia and poor clinical outcome were identified by receiver operating curve analysis. Principal Findings: The plasma metabolome profile of malaria and non-malaria patients revealed fundamental differences in host response, including a differential activation of the hypothalamic-pituitary-adrenal axis. A simple corticosteroid signature was a good classifier of severe malaria and non-malaria febrile patients (AUC 0.82, 95% CI: 0.70–0.93). Patients with BSI were characterized by upregulated plasma bile metabolites; a signature of two bile metabolites was estimated to have a sensitivity of 98.1% (95% CI: 80.2–100) and a specificity of 82.9% (95% CI: 54.7–99.9) to detect BSI in children younger than 5 years. This BSI signature demonstrates that host metabolites can have a superior diagnostic sensitivity compared to pathogen-detecting tests to identify infections characterized by low pathogen load such as BSI. Conclusions: This study demonstrates the potential use of plasma metabolites to identify causality in children with severe febrile illness in malaria-endemic settings.

    ORCID iDs

    Decuypere, Saskia, Maltha, Jessica, Deborggraeve, Stijn, Rattray, Nicholas J. W. ORCID logoORCID:, Issa, Guiraud, Bérenger, Kaboré, Lompo, Palpouguini, Tahita, Marc C., Ruspasinghe, Thusitha, McConville, Malcolm, Goodacre, Royston, Tinto, Halidou, Jacobs, Jan and Carapetis, Jonathan R.;