Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors – an experience from a tertiary care hospital in South India

Abstract

Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization. Blood cultures, malarial parasites and febrile serology (acute and convalescent), in addition to clinical evaluations and basic investigations were performed. Comparisons were made between each disease and the other AFIs. A total of 398 AFI patients were diagnosed with: scrub typhus (47.5%); malaria (17.1%); enteric fever (8.0%); dengue (7.0%); leptospirosis (3.0%); spotted fever rickettsiosis (1.8%); Hantavirus (0.3%); alternate diagnosis (7.3%); and unclear diagnoses (8.0%). Leucocytosis, acute respiratory distress syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminaemia were independently associated with scrub typhus. Normal leukocyte counts, moderate to severe thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated serum transaminases were associated with malaria. Rash, overt bleeding manifestations, normal to low leukocyte counts, moderate to severe thrombocytopenia and significantly elevated hepatic transaminases were associated with dengue. Enteric fever was associated with loose stools, normal to low leukocyte counts and normal platelet counts. It is imperative to maintain a sound epidemiological database of AFIs so that evidence-based diagnostic criteria and treatment guidelines can be developed.

Scrub Typhus in a Tertiary Care Hospital in North India

“…The disease is a zoonosis and is transmitted to humans sojourning though scrub vegetation by the bite of trombiculid chigger mites. [1][2][3] This infection is also known to occur in diverse geographical places like deserts, rice fields, and seashores. In India, the disease was documented for the first time during the World War II among field troops in Assam and West Bengal.…”

“…Malaria, dengue, typhoid, scrub typhus, and several viral infections have been classically responsible for such outbreaks. 1 Orientia tsutsugamushi is an obligate intracellular, gramnegative bacteria causing scrub typhus. The chigger mites of the family Trombiculidae of genus Leptotrombidium are responsible for the disease transmission.…”

A study of Etiological Pattern in an Epidemic of Acute Febrile Illness During Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

“…During the rainy season it becomes the commonest presenting symptom in our hospital. Epidemics of acute febrile illness have been causing major concerns in India [1,2]. Dengue, malaria, typhoid and scrub typhus have been reported in such epidemics.…”

Contemporaneous Infection of Dengue and Typhoid: 6 Months Study at Karachi

“…There are four serotypes involved in dengue named as DEN1 DEN2 DEN3 and DEN4, the clinical manifestation of the dengue is fever with complaints like headache, diarrhea, vomiting, loss of appetite, nausea, skin spots but the confirmatory symptoms is bleeding (avoid aspirin), decrease platelets count, low blood pressure (dangerously) [4,5]. Because of the same clinical manifestations it may create difficulties to misdiagnosis the diseases for a physician [6]. Our 6 th months performed study is tried to resolve the misdiagnosis of both diseases for the physician.…”