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Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome.
J Glob Infect Dis 2016 Oct-Dec; 8(4):147-154JG

Abstract

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/mm3 (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/mm3 (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.

Authors+Show Affiliations

Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India.Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27942194

Citation

Abhilash, Kundavaram Paul Prabhakar, et al. "Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome." Journal of Global Infectious Diseases, vol. 8, no. 4, 2016, pp. 147-154.
Abhilash KP, Jeevan JA, Mitra S, et al. Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome. J Glob Infect Dis. 2016;8(4):147-154.
Abhilash, K. P., Jeevan, J. A., Mitra, S., Paul, N., Murugan, T. P., Rangaraj, A., ... Varghese, G. M. (2016). Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome. Journal of Global Infectious Diseases, 8(4), pp. 147-154.
Abhilash KP, et al. Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome. J Glob Infect Dis. 2016;8(4):147-154. PubMed PMID: 27942194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome. AU - Abhilash,Kundavaram Paul Prabhakar, AU - Jeevan,Jonathan Arul, AU - Mitra,Shubhanker, AU - Paul,Nirvin, AU - Murugan,Thimiri Palani, AU - Rangaraj,Ajay, AU - David,Sandeep, AU - Hansdak,Samuel George, AU - Prakash,John Antony Jude, AU - Abraham,Asha Mary, AU - Ramasami,Prakash, AU - Sathyendra,Sowmya, AU - Sudarsanam,Thambu David, AU - Varghese,George M, PY - 2016/12/13/entrez PY - 2016/12/13/pubmed PY - 2016/12/13/medline KW - Acute undifferentiated febrile illness KW - South India KW - dengue fever KW - etiology KW - scrub typhus SP - 147 EP - 154 JF - Journal of global infectious diseases JO - J Glob Infect Dis VL - 8 IS - 4 N2 - 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/mm3 (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/mm3 (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. SN - 0974-777X UR - https://www.unboundmedicine.com/medline/citation/27942194/Acute_Undifferentiated_Febrile_Illness_in_Patients_Presenting_to_a_Tertiary_Care_Hospital_in_South_India:_Clinical_Spectrum_and_Outcome_ L2 - http://www.jgid.org/article.asp?issn=0974-777X;year=2016;volume=8;issue=4;spage=147;epage=154;aulast=Abhilash DB - PRIME DP - Unbound Medicine ER -