Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy

Mørch, Kristine; Manoharan, Anand; Chandy, Sara; Chacko, Novin; Alvarez-Uria, Gerardo; Patil, Suvarna; Henry, Anil; Nesaraj, Joel; Kuriakose, Cijoy K; Singh, Ashita; Kurian, Siby; Haanshuus, Christel Gill; Langeland, Nina; Blomberg, Björn; Antony, George Vasanthan; Mathai, Dilip

doi:10.1186/s12879-017-2764-3

Cited by 90 publications

(85 citation statements)

References 49 publications

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“…Fifteen studies (34.1%) used blood film microscopy to test 10,451 participants for malaria and identified parasitemia in 4,301 (41.2%) (31,32,35,36,38,40,41,43,45,46,(60)(61)(62)(63)(64)(65). Eight studies reported malaria and BSI coinfection (31,32,43,45,(61)(62)(63)65 (62,65).…”

Section: Community-onset Bloodstream Infections Antimicrobial Agents mentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Marchello

Dale

Pisharody

et al. 2019

Antimicrob Agents Chemother

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Community-onset bloodstream infections (CO-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CO-BSI among patients hospitalized with fever. Without restriction to language or country, we searched PubMed, Web of Science, and Scopus for prospective hospital-based studies of culture-confirmed CO-BSI among febrile inpatients. We determined by study the prevalence of BSI among participants, the pathogens responsible for BSI, and the antimicrobial susceptibility patterns of pathogens causing BSI, according to place and time. Thirty-four (77.3%) of 44 eligible studies recruited 29,022 participants in Africa and Asia combined. Among participants in these two regions, the median prevalence of BSI was 12.5% (range, 2.0 to 48.4%); of 3,220 pathogens isolated, 1,119 (34.8%) were Salmonella enterica, 425 (13.2%) Streptococcus pneumoniae, and 282 (8.8%) Escherichia coli. Antimicrobial susceptibility testing was reported in 16 (36.4%) studies. When isolates collected prior to 2008 were compared to those collected in the period of 2008 through 2018, the proportions of typhoidal Salmonella and Staphylococcus aureus isolates resistant to several clinically relevant antimicrobials increased over time, while S. pneumoniae susceptibility was stable. CO-BSI remain a major cause of severe febrile illness among hospitalized patients in Africa and Asia, with S. enterica, S. pneumoniae, and E. coli predominating. There is a concerning increase in AMR among serious infections caused by community-onset pathogens. Ongoing surveillance is needed to inform empirical management and strategies to control AMR.

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Section: Community-onset Bloodstream Infections Antimicrobial Agents mentioning

confidence: 99%

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Marchello

Dale

Pisharody

et al. 2019

Antimicrob Agents Chemother

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“…Malaria, dengue, and chikungunya are the most common coinfections reported from India [17]. Scrub typhus, malaria, dengue fever, and leptospirosis coinfections have been reported from Himachal Pradesh, Uttarakhand, central India, Puducherry, and also from other parts of India [2,[18][19][20][21][22]. The prevalence of coinfections among patients with AUF was 1.39% in this study.…”

Section: Discussionmentioning

confidence: 55%

Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

Malakar¹,

Negi²,

Dutt³

et al. 2019

Recent Advances in Biology and Medicine

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India is the epicenter of tropical fever diseases. Large numbers of cases are diagnosed with scrub typhus, leptospirosis, malaria, dengue, chikungunya, and enteric fever. Coinfections as an etiology of acute undifferentiated fever (AUF) have been recently recognized. The objective of this study was to assess the prevalence of coinfections in patients admitted with AUF in a tertiary-care hospital in the rural setting of Himachal Pradesh, India. Patients with coinfections as an etiology of AUF were the subjects of the study. The clinical records of patients diagnosed with confections between July 2018 and October 2018 were analyzed retrospectively in this hospital-based cross-sectional study. Standard protocol and guidelines were followed for the case definitions. Among total patients of 1005 with AUF, 14 (1.39%) patients were found to have coinfections. The most common coinfection was scrub typhus with leptospirosis and was diagnosed in seven (50%) patients. Other coinfections were scrub typhus with dengue in four (29%) and one patient each with scrub typhus and tubercular meningitis, scrub and influenza A (H1N1/2009) infection, and scrub and malaria (P. falciparum). Scrub typhus was the most common etiological diagnosis for the AUF and was observed in 159 (15.8%) patients. All the patients with coinfections had scrub typhus as the common infection. The prevalence of coinfections among scrub typhus patients constituted 8%. In tropical regions, coinfections are not very rare. High clinical suspicion for coinfections is required. Syndromic approach in the management is justified.

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“…Our study contradicts with the common differential of nonspecific fever as a vector-borne disease like malaria, rickettsia, leptospirosis, and dengue. In a cohort study of 1258 patients in South India, scrub typhus was the most common cause of acute undifferentiated febrile illness (35.9%) followed by dengue (30.6%), malaria (10.4%), enteric fever (3.7%), and leptospirosis (0.6%) [6]. Scrub typhus and dengue were the most common cause of fever in Central India [7].…”

Section: Resultsmentioning

confidence: 99%

The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal

Kattel¹,

Agrawal²,

Pandey³

et al. 2019

J Trop Dis

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Introduction: Acute Febrile Illness (AFI) is a common clinical syndrome presenting at tropical health centers. The challenges in resource-limited set up are an undifferentiated clinical manifestation with wide differentials and inadequate laboratory diagnostic support. With this background, we conducted a study to look at the outcome of AFI spectrum presented at BP Koirala Institute of Health Sciences (BPKIHS), a referral medical school hospital in eastern Nepal. Objective: To determine the etiological diagnosis and hospital-based outcome of AFI. Methods:It was a prospective observational study of the AFI inpatient cases in the . Considering a 15% prevalence of acute febrile in patients with a 95% confidence interval and 95% power of study a sample size of 196 was calculated. Assuming 25% as a sampling error 245 patients were enrolled. The patient was diagnosed and treated as per the hospital protocol developed by Tropical and Infectious Disease Unit. Case record form was used to record and tabulated in an excel sheet. Descriptive and analytic statistics were used. Results: The incidence of AFI was 12% (557) among the 4669 inpatient cases. Among 245 enrolled cases, 61%presented as localized fever. The most common clinical diagnosis was pneumonia (29%), urinary tract infection (18%), meningitis (11%) and tropical disease (14%) that includes malaria, dengue, rickettsia, and leptospirosis. The etiological diagnosis was established among 26% (64). Among AFI cases sepsis, acute renal injury and septic shock was present in 18%, 11%, and 6% respectively. The putative diagnosis could not be made in 18% (44) of the cases and they were treated empirically with dual antibiotics (injectable 3 rd generation cephalosporin with macrolides or fluoroquinolones or aminoglycosides). Favorable outcomes in term of clinical cure were seen in 76% (186) of the cases. Conclusion: Establishment of etiological diagnosis is logistically not feasible in developing the world. Contextual guidelines for undifferentiated fever may be a possible option for improving the outcome of undifferentiated fever in Nepal.

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Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy

Cited by 90 publications

References 49 publications

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal

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