Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review

Abstract

Background: Acute undifferentiated febrile illness (AUFI) is caused by a multitude of diverse pathogens, with significant morbidity and mortality in the developing world. The objective of this review was to characterise the diversity and relative importance of common infectious aetiologies of AUFI in South and Southeast Asia. Methods: We conducted a comprehensive literature review to identify common aetiologies of AUFI in Asian countries. Four medical and life sciences databases including PubMed, Medline, Embase and Cochrane Central, and Google Scholar were searched for articles published from January 1998 to March 2019. Results: Forty-three studies met the inclusion criteria. Among AUFI cases, viral aetiologies at 18.5% (14888) were more common than bacterial aetiologies (12.9% [10384]). From 80,554 cases, dengue fever was the most common aetiology (11.8%, 9511), followed by leptospirosis (4.4%, 3549), typhoid (4.0%, 3258), scrub typhus (4.0%, 3243) and influenza other than H1N1 (3.1%, 2514). In both adults and children: dengue fever was the leading cause of AUFI with 16.6% (1928) and 18.7% (1281) of the total cases. In admitted patients, dengue fever was the main cause of AUFI at 16.4% (2377), however leptospirosis at 13.9% (2090) was the main cause of AUFI for outpatients. In South Asia, dengue fever was the main cause of AUFI, causing 12.0% (6821) of cases, whereas in Southeast Asia, leptospirosis was the main diagnosis, causing 12.1% (2861) of cases. Conclusions: In this study the most common causes of AUFI were viral, followed by bacterial and protozoal (malaria) infections. Dengue was the commonest virus that caused AUFI while leptospirosis and typhoid were important bacterial infectious causes. Therefore, it is imperative to maintain a sound epidemiological knowledge of AUFI so that evidence-based diagnostic criteria and treatment guidelines can be developed.

Serological evidence indicates widespread distribution of rickettsioses in Myanmar

“…Rickettsial infections are among the most important causes of non-malarial fever in Southeast Asia (Acestor et al, 2012;Wangdi et al, 2019). Rickettsial bacteria are obligate intracellular Gram-negative coccobacilli that are transmitted to humans through bites of infected fleas, mites, ticks and lice (Trung et al, 2017).…”

Rickettsial Diseases: Not Uncommon Causes of Acute Febrile Illness in India

“…Therefore, diagnosis of these RDs is missed, as seen in 66.5% of scrub typhus cases [1] and in 57.9% of Mediterranean spotted fever (MSF) cases [2]. Among acute undifferentiated febrile illness (AUFI/AFI) cases from Asia, 4% of cases were caused by RD overall and among adults 12.5% of AFI cases [3]. Among the pediatric population, AFI due to RD occurred in 0.4 to 7.4% in East Africa, 2 to 17% in South Asia, 0.5 to 20.1% in SE Asia, and 7.5% in Latin America [4].…”

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System

“…A change in disease pattern has indeed been documented elsewhere, 27,28 and it has been found that dengue comes with a wider spectrum of symptoms than previously observed. [29][30][31] To overcome the diagnostic challenges mentioned, a solid system must be in place, which gives the clinicians the best possible prerequisites for making the correct diagnosis and, thus, the health authorities a correct picture of the disease burden. This includes a standardized regulatory framework for diagnostics and case reporting, access to the best diagnostic tools, staff with proper qualifications, and a well-functioning leadership and governance.…”

“…A change in disease pattern has indeed been documented elsewhere, 27 , 28 and it has been found that dengue comes with a wider spectrum of symptoms than previously observed. 29 – 31 …”