Identifying pathogens in febrile patients using gene expression

FEBRILE ADULTS- INCLUSION CRITERIA

* Age greater than or equal to 15 years and less than or equal to 65 years
* Participant is willing and they and/or an appropriate guardian/relative/representative is able to give informed consent for participation in the study and a follow-up (telephone) discussion at 14 days
* And either:

  1. Febrile illness without localising features (see 'exclusion criteria' and 'screening' sections) where fever is defined as:

     * documented tympanic/rectal temperature of ≥ 38°C or an axillary/oral temperature of ≥ 37.8°C, or a reported fever within the last 24 hours and
     * Reported duration of fever 3-14 days or
  2. Recently confirmed blood culture indicating enteric fever (confirmed within the previous 5 days)
* They may have had recent exposure to antimicrobials.

FEBRILE ADULTS- EXCLUSION CRITERIA

* The participant may not enter the study if ANY of the following apply:
* Unable to provide informed consent and no next of kin is willing and able to provide informed consent.
* For patients with febrile illness (included in (1) above): Any history or clinical suspicion of:

  * Rheumatological or connective tissue disorder (e.g. Rheumatoid arthritis)
  * Autoimmune condition (e.g. Autoimmune Hepatitis)
  * Malignancy
  * Active treatment with immunomodulating medications, or for tuberculosis (pulmonary or extrapulmonary) or any other chronic infection.
* Pregnancy (breast feeding mothers will NOT be excluded)
* No hospitalisation for more than 48 hours in the last 4 weeks
* Vaccination within 4 weeks prior to current admission
* Localising signs or symptoms of infection sufficient to diagnose the likely cause of acute febrile illness and thus prevent it from being 'undifferentiated.'

CONTROLS- INCLUSION CRITERIA

* Participant is willing and they are (and in 15-18 year olds, a guardian is) able to give informed consent for participation in the study
* Age greater than or equal to 15 years and less than or equal to 65 years
* They live outside of the normal/local catchment area for each hospital site
* Afebrile (as defined by no reported fever and temperature ≤ 38°C or an axillary/oral temperature of ≤ 37.8°C).

CONTROLS- EXCLUSION CRITERIA

* The participant may not enter the study if ANY of the following apply:
* Unable to provide informed consent and no next of kin (or parent/guardian in the case of a minor) is willing and able to provide informed consent.
* Current treatment for or prior history, or clinical suspicion of:

  * Rheumatological or connective tissue disorder
  * Autoimmune condition
  * Malignancy
  * Active treatment for tuberculosis (pulmonary or extrapulmonary) or clinical suspicion of active tuberculosis. Previous completed treatment is not a reason for exclusion.
  * Active treatment with immunomodulating medications or any other chronic infection.
* Pregnant (breast feeding mothers will NOT be excluded)
* Hospitalisation within 4 weeks of recruitment
* Vaccination within 4 weeks prior to recruitment
* Antimicrobial use within 4 weeks of recruitment
* Participant reports feeling more unwell than usual on the day of enrolment.

EXPLORATORY AIMS- PAEDIATRIC CRITERIA; INCLUSION CRITERIA

* Age greater than or equal to 2 years and less than 15 years
* As above for adult participants.

EXPLORATORY AIMS- PAEDIATRIC CRITERIA; EXCLUSION CRITERIA

* Parent/guardian is unwilling, and/or patient aged 8 to 14 years is unwilling to assent to provide informed consent.
* As above for adult participants.