Up Close: Matthew Robinson
Looking for Causes of Fever in India
“The most common reason Indians go to the doctor is for fever. The list of potential causes for fever in India and other low and middle income countries in tropical settings is extensive.” Matt Robinson, MD, is a Clinical Fellow whose research in India aims to help clinicians narrow down the causes of fever in their patients.
“Most of the time, care providers do not have the time or the technology to make an exact diagnosis for the cause of fever, so in almost every case, they prescribe antibiotics. But frequently the cause of fever is not a disease that can be treated with antibiotics, or it may be a disease better treated by an antibiotic other than the one prescribed. This leads to overuse of antibiotics for conditions that do not require them, and in some cases the wrong choice of antibiotics.”
Robinson is interested in strategies that provide clinicians in low and middle income countries with information that improves the accuracy of diagnosing patients with fever, and in the process helps lessen the incidence of antibiotic misuse, a major contributing factor in antimicrobial resistance, widely regarded as one of today’s most significant threats to human health. “Myriad solutions have been offered, but the general consensus is that antibiotics have to be used less often and more carefully.”
Dr. Robinson is using established diagnostic techniques and exploring the promise of new technologies to improve speed and accuracy. “Currently clinician investigators use two general approaches to reduce diagnostic uncertainty when faced with patients who have fever. One is to extensively study the causes of fever in a population similar to patients they see, to look for specific diseases to expect. Another is to develop new technologies that can be used in resource limited settings to make the diagnosis of the cause of fever in individual patients."
For two and a half years, the team did a battery of tests on more than 1,700 adults and children who were admitted with fever to a hospital in Pune, India, to help determine which diseases were common in Pune. "Some of the techniques we used are more than 100 years old," Robinson remarked. Going forward, new technologies will be applied that look directly for the presence of the genetic material comprising the pathogens of interest in order to more sensitively diagnose diseases that cause fever.
What led Robinson to this point? “I have always been interested in cultures other than my own. Study of infectious disease in global health perfectly fits this interest, as the interface of culture and environment determines human disease. I have previously done research on infectious diseases in Peru, China, and the US. My clinical experiences abroad have been mostly in East Africa – Rwanda and Uganda. Serving as a clinician educator in Uganda, I have stood at the foot of the bed countless times, looking at a patient lying there sweaty and miserable with fever. Patient after patient, I found myself at a loss trying to explain to my students which disease was to blame. The experience of admitting to students that we do not have the tools to diagnose the cause of fever has prompted my interest in studying the epidemiology of acute febrile illness and developing novel diagnostics for deployment in resource limited settings.”
Matthew Robinson, MD, is an infectious diseases fellow who joined the Center for Clinical Global Health Education in summer 2015. He’s working with Dr. Amita Gupta and Dr. Vidya Mave, Clinical Research Site Director for the Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Research Group, and their team, splitting his time between Johns Hopkins in East Baltimore and Pune, India.