Tropical fevers in Indian intensive care units: A prospective multicenter study

Abstract

Background and Aims:Infections in tropics often present as undifferentiated fevers with organ failures. We conducted this nationwide study to identify the prevalence, profile, resource utilization, and outcome of tropical fevers in Indian Intensive Care Units (ICUs).Materials and Methods:This was a multicenter prospective observational study done in 34 ICUs across India (July 2013–September 2014). Critically ill adults and children with nonlocalizing fever >48 h and onset < 14 days with any of the following: thrombocytopenia/rash, respiratory distress, renal failure, encephalopathy, jaundice, or multiorgan failure were enrolled consecutively.Results:Of 456 cases enrolled, 173 were children <12 years. More than half of the participants (58.7%) presented in postmonsoon months (August–October). Thrombocytopenia/rash was the most common presentation (60%) followed by respiratory distress (46%), encephalopathy (28.5%), renal failure (23.5%), jaundice (20%), and multiorgan failure (19%). An etiology could be established in 365 (80.5%) cases. Dengue (n = 105.23%) was the most common followed by scrub typhus (n = 83.18%), encephalitis/meningitis (n = 44.9.6%), malaria (n = 37.8%), and bacterial sepsis (n = 32.7%). Nearly, half (35% invasive; 12% noninvasive) received mechanical ventilation, a quarter (23.4%) required vasoactive therapy in first 24 h and 9% received renal replacement therapy. Median (interquartile range) ICU and hospital length of stay were 4 (3–7) and 7 (5–11.3) days. At 28 days, 76.2% survived without disability, 4.4% had some disability, and 18.4% died. Mortality was higher (27% vs. 15%) in patients with undiagnosed etiology (P < 0.01). On multivariate analysis, multiorgan dysfunction syndrome at admission (odds ratio [95% confidence interval]-2.8 [1.8–6.6]), day 1 Sequential Organ Failure Assessment score (1.2 [1.0–1.3]), and the need for invasive ventilation (8.3 [3.4–20]) were the only independent predictors of unfavorable outcome.Conclusions:Dengue, scrub typhus, encephalitis, and malaria are the major tropical fevers in Indian ICUs. The data support a syndromic approach, point of care tests, and empiric antimicrobial therapy recommended by Indian Society of Critical Care Medicine in 2014.

Influenza a H1N1 characteristics on hajj occasion 2018 Makkah Region, KSA.

“…10,15,20 So, the clinical parameters were generally similar as the earlier reported cases of influenza in KSA 10,15 and USA. 20 All patients in our study presented with fever and cough, which is almost similar to the patients in USA, 20 Japan, 21 Mexico. 22 and in KSA.…”

“…15 This can be due to patients of only KSA residents (100%), vaccination status and seasonal variation. 20 The distribution of cases by age were predominantly young (75 % <14 years), that are almost similar to the distribution of cases observed worldwide and in Saudi Arabia. 10,15,20 So, the clinical parameters were generally similar as the earlier reported cases of influenza in KSA 10,15 and USA.…”

“…More cases were seen in the fall than in the summer season in KSA in previous study. 20 In our study the number of H1N1 positive patients are less than previous years. 15 This can be due to patients of only KSA residents (100%), vaccination status and seasonal variation.…”

“…10,15 Leukopenia was observed in 50% patients and thrombocytopenia was found (0 %), that was almost similar as in earlier studies. 10,15,20 Patients found to be hypoxemic (25%) had an average oxygen saturation of 88%. Currently literature shows that clinically severity of disease can be judged by dyspnea presence.…”

“…23 In our study, the fatality rate was 0 % as almost seen in USA and the United Kingdom. 20 All our studied patients received Oseltamivir, and antibiotics on admission. Bacterial cultures in sputum or blood did not show significant growth and then antibiotics were stopped.…”