Study of acute febrile illness: A 10-year descriptive study and a proposed algorithm from a tertiary care referral hospital in rural Kerala in southern India (original) (raw)
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Tropical Doctor, 2018
Acute febrile illness with varied aetiology but similar symptoms is common in tropical countries. This prospective, multicentre study was conducted in selected centres in the province of Kerala in India principally to analyse the aetiology of acute febrile illnesses in adult patients over the course of one year. Overall, 1324 patients were included in the study. The most common cause was dengue in 576 patients (43.5%). In 396 (29.9%), the exact aetiology could not be identified. Other causes, in order, were leptospirosis, enteric fever, malaria, respiratory tract infection, urinary tract infection and typhus. When such a wide variation with a significant number of 'indeterminate' cases exists, especially in such a small area and with limited resources, the onus is on public health authorities to draw up an 'easy-to-use algorithm' to tackle epidemics of febrile illness, particularly in the monsoon season.
Journal of clinical and diagnostic research : JCDR, 2015
Acute undifferentiated febrile illness (AUFI) is a common clinical entity in most of the hospitals. The fever can be potentially fatal if the aetiology is not recognized and appropriately treated early. To describe the aetiology of fever among patients in a tertiary care hospital in Northern India. A one-year retro-prospective, observational study was conducted in adults (age>18years) presenting with undifferentiated febrile illness (of duration 5-14 days). Diagnosis was confirmed by suitable laboratory tests after exhaustive clinical examination. A total of 2547 patients with AUFI were evaluated. Of these, 1663 (65.3%) were males and 884 (34.7%) were females. Dengue (37.54%); enteric fever (16.5%); scrub typhus (14.42%); bacterial sepsis (10.3%); malaria (6.8%); hepatitis A (1.9%); hepatitis E (1.4%); leptospirosis (0.14%); were the main infections while no specific diagnosis could be delineated in 11%. Mixed infections were noted in 48 (1.9%) patients. A good clinical acumen su...
Acute Undifferentiated Febrile Illness Among Adults – a Hospital Based Observational Study
2013
BACKGROUND: Fever is a burning issue in the tropics and the most common cause of morbidity. Quite frequently this fever goes undiagnosed because of many reasons like the lack of diagnostic facilities, insufficient epidemiological data available on causes of fever, and so on. This research study was aimed to find out the etiology and clinical markers of Acute Undifferentiated Febrile Illness [AUFI] among the rural population of Southern India. METHODOLOGY: This prospective, observational study was conducted at Government Villupuram Medical College and Hospital, a rural tertiary care centre in Tamil Nadu, India. Consecutive hospitalised adult patients [>16 years] with AUFI[5-14 days fever] were enrolled into the study from August 2010 to February 2012 [18 months].Upon enrollment, detailed history was recorded, physical examination done and basic blood tests including biochemical examination, smear study for malaria, blood cultures and serology for the commonly encountered infection...
Journal of Population and Therapeutics and Clinical Pharmacology, 2023
INTRODUCTION: The acute undifferentiated febrile illness (AUFI) connotes fever of <14 days duration without any evidence of organ or system specific aetiology. In the majority of hospitals, acute undifferentiated febrile illness (AUFI) is a prevalent clinical condition. If the cause of the fever is not identified and treated effectively as soon as possible, it could be fatal. AIM AND OBJECTIVES: To study the Prevalence of Aetiologies acute undifferentiated febrile illnesses of the patients at a tertiary care centre in Uttar Pradesh, India. MATERIAL AND METHODS: This was a Hospital based cross sectional study conducted in the department of Microbiology at Rama Medical College Hospital & Research Centre, Mandhana, Kanpur. The study was carried out during the monsoon and post monsoon of the year 2022 for a period of 6 months from July 2022 to December 2022. A total of the 1520 clinical samples were recorded out of which there were 106 suspected cases. Sampling method was used and all in-patients fulfilling the AUFI definition were included. All in-patients with <14 days of fever with no localising source of infection were included in the study. The suspected cases was tested for various serological tests. Diagnosis was confirmed by suitable laboratory tests after exhaustive clinical examination. RESULTS: In the present study the ratio of Male 60 (56.6%) was found to be more as compared to that of Female 46 (43.3%) with the maximum number of cases recorded in the age group of 20-40 years of age and least in the age group above 61 years of age. The most common cause of AUFI was the Dengue with the prevalence rate of 12.2% followed by Typhoid 7.5% , Enteric fever was found to be 7.5% Scrub typus 1.88%, and least for Malaria 0. 9%. It was also noted that there were no positive cases observed for Chikungunya and leptospira. It was also observed that the fever was the most common among all, followed by anaemia, hepatomegaly, splenomegaly with the maximum number of cases observed in the month of August to October. CONCLUSION: When prioritising clinical and diagnostic workup and starting the appropriate empirical and supportive therapy, doctors are guided by their understanding of the local aetiology of AUFI. As the prevalence of multiple infections rises, complete clinical and diagnostic investigation for likely pathogens must be taken into account in AUFI patients who are not responding to treatment. KEYWORDS: AUFI, Dengue, Leptospira, Chikungunya, Scrub typhus, Malaria, Typhoid
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Acute undifferentiated febrile illness (AUFI / AFI) is one of the most common reasons for people seeking medical care globally. Investigation into the aetiology and trends in AUFI cases are valuable public health data source. Absence of such evidence-based data may result in unintended public health consequences. Present study was undertaken to address the gap in period specific trends in AUFI cases reported from the region. METHODS A record based descriptive study was done in patients treated with AUFI from January 1st, 2015 to December 31st , 2019 in Government Medical College, Ernakulam. Universal sampling technique was adopted, and the data was entered in Microsoft Excel and analysed using Epi-Info software. Line diagram was constructed to obtain the trends in AUFI cases over the five-year period. Chisquare test was applied to find out the association between age group (paediatric and others) and causative agents of AUFI. RESULTS A total of 7998 AUFI cases were includ...
A study of pattern of acute febrile illnesses at COMS-TH, Bharatpur, Nepal
Asian Pacific Journal of Tropical Disease, 2014
Febrile illness, Multi-organ dysfunction syndrome, Mortality Objective: To study the pattern of acute febrile illnesses in Central Nepal regarding its underlying etiology and its clinical outcome. Methods: This study is a hospital based descriptive cross-sectional study during June to November, 2011 over a period of 6 months. All the febrile illnesses data were collected from medical outpatient and inpatient registried and then analysed. There were total 2 873 febrile patients, of whom 883 were inpatients whose data have been analysed. Results: The majority of febrile patients were distributed in August (788/2 873=27.43%) followed by July (708/2 873=24.64%). The age distribution ranged from 15 to 84 years with female predisposition (M:F=1:1.5). Majority of the febrile patients were in the 15-30 years age group (292/883=33.07%) followed by elderly (>60 years, 22.88%). Most of the febrile patients admitted in medical ward were diagnosed as respiratory tract infection followed by urinary tract infection, enteric fever, acute gastroenteritis. Of intensive care unit admitted febrile patients (n=187), sepsis with multi-organ dysfunction syndrome was the major diagnosis followed by acute meningoencephalitis. A total of 21 patients (2.37%) died of sepsis with multi-organ dysfunction syndrome followed by acute meningoencephalitis in 5 (0.56%), complicated malaria with acute respiratory distress syndrome in 1 (0.11%) and infective hepatitis with encephalopathy in 1 (0.11%). Conclusions: Acute febrile illnesses mostly viral in origin involving respiratory tracts are more common during monsoon months with lots of mortalities and morbidities. They pose a major threat to the public due to their endemicity as many of them remain undiagnosed or if at all, very late. Early and planned activity of the government and non-government local bodies, epidemic preparedness against susceptible outbreaks including efficient public health awareness are the keys to minimize the hazards.
Journal of Global Infectious Diseases, 2016
Background: Acute undifferentiated febrile illness (AUFI) may have similar clinical presentation, and the etiology is varied and region specific. Materials and Methods: This prospective observational study was conducted in a tertiary hospital in South India. All adult patients presenting with AUFI of 3-14 days duration were evaluated for etiology, and the differences in presentation and outcome were analyzed. Results: The study cohort included 1258 patients. A microbiological cause was identified in 82.5% of our patients. Scrub typhus was the most common cause of AUFI (35.9%) followed by dengue (30.6%), malaria (10.4%), enteric fever (3.7%), and leptospirosis (0.6%). Both scrub typhus and dengue fever peaked during the monsoon season and the cooler months, whereas no seasonality was observed with enteric fever and malaria. The mean time to presentation was longer in enteric fever (9.9 [4.7] days) and scrub typhus (8.2 [3.2] days). Bleeding manifestations were seen in 7.7% of patients, mostly associated with dengue (14%), scrub typhus (4.2%), and malaria (4.6%). The requirement of supplemental oxygen, invasive ventilation, and inotropes was higher in scrub typhus, leptospirosis, and malaria. The overall mortality rate was 3.3% and was highest with scrub typhus (4.6%) followed by dengue fever (2.3%). Significant clinical predictors of scrub typhus were breathlessness (odds ratio [OR]: 4.96; 95% confidence interval [CI]: 3.38-7.3), total whole blood cell count >10,000 cells/mm 3 (OR: 2.31; 95% CI: 1.64-3.24), serum albumin <3.5 g % (OR: 2.32; 95% CI: 1.68-3.2). Overt bleeding manifestations (OR: 2.98; 95% CI: 1.84-4.84), and a platelet count of <150,000 cells/mm 3 (OR: 2.09; 95% CI: 1.47-2.98) were independent predictors of dengue fever. Conclusion: The similarity in clinical presentation and diversity of etiological agents demonstrates the complexity of diagnosis and treatment of AUFI in South India. The etiological profile will be of use in the development of rational guidelines for control and treatment of AUFI.
Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review
BMC Infectious Diseases, 2019
Background Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India. Methods A scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management. Results The review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated ...
The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal
Journal of Tropical Diseases & Public Health, 2019
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 Department of Internal Medicine from 1 st January 2013 to 31 st December 2013. 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.
International Journal of Academic Medicine and Pharmacy, 2023
Background: Globally, acute febrile illness (AFI) is a common cause of hospital admission and its associated infectious causes such as respiratory tract infections, urinary tract infections, and intra-abdominal infections contribute to substantial morbidity and mortality. Acute fever, is one of the most common presenting complaints to primary care physicians in primary care in India. Materials and Methods: This was a community-based cross-sectional study conducted among 2627 individuals belonging to 1200 households of the Cherlapally area in Telangana state. The pre-designed questionnaire was used to collect relevant data on acute fever cases affected from the past month under RHTC field practice area. Socio-demographic data such as age, sex, education and socioeconomic status were collected. Collected data was represented in percentages and proportions, and a p-value of less than 0.05 was considered statistically significant. Results: The prevalence of acute fever in the rural field practice area was 8.6%. In this study males were 44.1% and females were 55.9%. The majority of the study population belongs to the age group of 46 to 65 years (38.3%) and belongs to the lower class of socioeconomic status (29.1%). Fever with cough and cold in the study population is significantly associated with a lower age group (p<0.0001) and lower socioeconomic status (p<0.002). In our study, individuals diagnosed with malaria, typhoid, and dengue (NS1) were 4%, 2.2%, and 2.2% respectively. Conclusion: Malaria was the most common cause of fever in this study. Utilizing the services of community health workers and health education about fever prevention and control and warning indicators can lessen the need for hospitalization. This research offers a newer approach to the epidemiological assessment of febrile illness in rural India.