Clinical and Aetiological Profile of Acute Febrile Illness in Adults Admitted to a Tertiary Care Hospital: a Prospective Observational Study
Keywords:
acute febrile illness, scrub typhus, leptospirosis, dengue, aetiology, tropical medicineAbstract
Background: Acute undifferentiated febrile illness (AUFI) is a common reason for medical admission in tropical India, with a region-specific aetiology dominated by treatable infections. Defining the local spectrum guides rational empirical therapy.
Objectives: To describe the clinical and aetiological profile, and immediate outcome, of adults admitted with acute febrile illness.
Methods: A prospective observational study of 100 adults with acute febrile illness recorded symptoms, laboratory parameters, aetiological testing, severity and outcome. Aetiology was assigned by standard serology, antigen, smear and culture, with diagnostic certainty graded.
Results: Patients (mean age 50.2 ± 18.1 years; mean fever duration 7.4 ± 3.8 days) presented most often with myalgia (65%), headache (64%), vomiting (29%) and cough (26%). The aetiological spectrum was leptospirosis (15%), influenza (15%), dengue (13%), scrub typhus (13%), malaria (8%), enteric fever (7%) and pneumonia syndrome (6%), with 23% undetermined; diagnosis was laboratory-confirmed in 37% and probable in 34%. Thrombocytopenia (mean platelets 181 ×10⁹/L) and transaminitis (mean AST 71 U/L) were common. Intensive care was required by 15%, vasopressors by 9% and ventilation by 4%; mean stay was 8.1 days. Overall, 92% were discharged alive, 7% referred and 1% died.
Conclusion: Adult acute febrile illness was predominantly due to treatable zoonotic, vector-borne and respiratory infections, with scrub typhus, leptospirosis, dengue and influenza prominent and a substantial undetermined fraction. The findings support syndrome-based empirical therapy covering rickettsial and leptospiral infection while awaiting confirmation
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References
1. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors — an experience from a tertiary care hospital in South India. Trop Doct. 2010;40(4):230–234. doi:10.1258/td.2010.100132
2. Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JAJ, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre — RIFLE criteria validation. Nephrol Dial Transplant. 2011;26(2):524–531. doi:10.1093/ndt/gfq477
3. Mayxay M, Castonguay-Vanier J, Chansamouth V, Dubot-Pérès A, Paris DH, Phetsouvanh R, et al. Causes of non-malarial fever in Laos: a prospective study. Lancet Glob Health. 2013;1(1):e46–e54. doi:10.1016/S2214-109X(13)70008-1
4. ten Oever J, Netea MG, Kullberg BJ. Utility of immune response-derived biomarkers in the differential diagnosis of inflammatory disorders. J Infect. 2016;72(1):1–18. doi:10.1016/j.jinf.2015.09.007
5. Sivarajan S, Shivalli S, Bhuyan D, Mawlong M, Barman R. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India. Infect Dis Poverty. 2016;5(1):91. doi:10.1186/s40249-016-0186-x
6. Abhilash KPP, Jeevan JA, Mitra S, Paul N, Murugan TP, Rangaraj A, 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. doi:10.4103/0974-777X.192966
7. Mørch K, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S, et al. Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy. BMC Infect Dis. 2017;17(1):665. doi:10.1186/s12879-017-2764-
8. Shelke YP, Deotale VS, Maraskolhe DL. Spectrum of infections in acute febrile illness in central India. Indian J Med Microbiol. 2017;35(4):480–484. doi:10.4103/ijmm.IJMM_17_33
9. Salagre KD, Sahay RN, Pazare AR, Dubey A, Marathe KK. A study of clinical profile of patients presenting with complications of acute febrile illnesses during monsoon. J Assoc Physicians India. 2017 Sep 1;65(9):37-42.
10. Grundy BS, Houpt ER. Opportunities and challenges to accurate diagnosis and management of acute febrile illness in adults and adolescents: A review. Acta tropica. 2022 Mar 1;227:106286.
11. Bhalla A, Suri V, Varma S, Sharma N, Mahi S, Singh P, Khandelwal NK. Acute febrile encephalopathy in adults from Northwest India. Journal of Emergencies, Trauma and Shock. 2010 Jul;3(3):220.
12. Abhilash KP, Jeevan JA, Mitra S, Paul N, Murugan TP, Rangaraj A, David S, Hansdak SG, Prakash JA, Abraham AM, Ramasami P. Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: clinical spectrum and outcome. Journal of global infectious diseases. 2016 Oct;8(4):147
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