The map data presents information from studies published in peer-reviewed journals of bacterial infection of blood or cerebral spinal fluid (CSF) in patients from Sub-Saharan Africa and Southeast Asia presenting with an infectious illness considered to be 'undifferentiated'. This is defined as patients whose diagnosis remained uncertain at the time of laboratory testing and includes but is not limited to patients with suspected meningitis or pneumonia. Specifics on laboratory methods or clinical details are obtained from the studies.

We summarise the search methodology for the literature review next.

Methodology

Two systematic reviews were used to identify these studies. The case series review retrieved case series that identify the presence of a pathogen in any patient in a particular place at a particular time. The fever series review retrieved studies that have isolated pathogens in severely sick patients – defined as pathogens isolated from blood cultures and cerebrospinal fluid taken from inpatients. While the fever series only included studies if the total number of patients tested was given, this nevertheless represents an extremely selective subgroup of the population as a whole

Study results do NOT give any indication of the overall incidence, prevalence or risk of a pathogen as a cause of febrile illness in a given geographical area. Instead, they provide evidence of a pathogen causing a febrile illness at a particular time and place that may be a potential cause of non-malarial febrile illness. Where proportions are presented, the denominator is the total number of undifferentiated febrile patients while the numerator is the number testing positive for a specific pathogen. The full inclusion and exclusion criteria are given here. Studies that were excluded as outside of the scope of this map include those:

  • focused on Malaria, TB or HIV
  • investigating respiratory viruses
  • isolating pathogens only from non-sterile sites
  • not published in a peer-reviewed journal.

There were no restrictions on organisms or pathogens isolated from sterile sites, nor on patient characteristics. Lab investigations included culture, PCR and serology assay.

Case Series systematic review – inclusion and exclusion criteria

Inclusion criteria:

  • Study conducted in an African country
  • Case series or report investigating a febrile illness
  • Data collected prospectively using samples from sterile sites (blood and CSF)
  • Study published in a peer-reviewed journal

Exclusion criteria:

  • Studies with the primary purpose of investigating HIV, malaria or TB
  • Studies involving influenza and respiratory viruses
  • Studies investigating antibiotic susceptibility, or other drug or vaccine trials
  • Opinion pieces and editorials

Fever Series systematic review – inclusion and exclusion criteria

Inclusion criteria:

  • Studies describing pathogens causing fever in inpatients 
  • Studies conducted in Africa or Southeast Asia
  • Fluid samples taken from sterile sites only (blood or CSF)
  • Number of total people tested clearly stated
  • Published in a peer-reviewed journal since 1980, with full text available

Exclusion criteria:

  • Studies with the primary purpose of investigating HIV, malaria or TB
  • Non-clinical biochemical, genetic, or drug trial studies.