Table 1.

New approaches to traditional microbiology laboratory practices for diagnosing acute febrile illness

Traditional technique	New approach	Benefit over traditional technique				Performance against ref test*			Evaluated in RLS	Ref
		Less hands-on time	Smaller/portable	Faster result	Other	Reference test	Sensitivity (%)	Specificity (%)
Parasite blood smear	Mobile phone microscopy	✓	✓			Filaria blood smear	100	94	Yes	53,54
	Transdermal hemozoin detection	✓			Needle-free	Malaria smear	100†	100†	No	55,56
ELISA and agglutination tests	Lateral flow assays	✓	✓	✓	Instrument-free, multiplex possible	Trypanosomiasis card agglutination test	89	95	Yes	57
	Viral phage display library				Highly multiplex	HIV ELISA	95	100	No	58
Bacterial culture and identification	Culture with on-chip microscopy	✓	✓	✓		Not reported in clinical samples			No	59
	Nanoscale droplet culture	✓				Not reported in clinical samples			No	60,61
Antimicrobial susceptibility testing	Single cell analysis	✓		✓		Standard bacterial culture	92% agreement		No	62
	Microtiter plates	✓	✓	✓		TB drug susceptibility on Middlebrook agar	≥ 92% agreement		Yes	63

ELISA = enzyme-linked immunosorbent assay; Ref = reference; RLS = resource-limited setting; TB = tuberculosis.

^*For tests that can identify more than one pathogen, one reference pathogen was selected.

^†Test described in only one patient with malaria and four without.