A Cross-sectional Study of Undiagnosed Fever in a Rural Population at a Tertiary Care Hospital of West Bengal

Abstract

Background: Undiagnosed fever has been a predicament to physicians all over the world for decades. This study was undertaken to evaluate the demographic and etiological pattern of a rural population in Eastern India. Objectives. 1. To study the spectrum of etiology of prolonged fever. 2. To evaluate the demographic characteristics of the patients. Methods: All patients with undiagnosed fever for more than three weeks attending the Medicine outpatient Department were included in the study. History and clinical examination were recorded in a proforma. All patients under went routine as well as relevant special investigations including RDT for Malaria, IgM ELISA for Leptospira and Chikungunya and Brucella. Blood, urine and other body fluid culture including BACTEC and CB NAAT (as required) were also done. Endoscopies, imaging studies and guided biopsies were performed where needed. Results were recorded and analysed using appropriate descriptive statistical methods using SPSS Software (version 20). Results: A total number of 110 patients were included in the study. Of them 52(47.2%) were male and 58 (52.7%) were female. The age of the patients varied from 15 years to 78 years mean age being 33.68±18.77. Conclusion: The patients were mainly from rural background, most common districts being Murshidabad (40%) followed by24 Parganas S (20%), Midnapur (14.5%) and Nadia (10.9%). Socioeconomic status of the patients varied from lower (47.2%) lower middle class (39%) to middle class(13.8%). 65.3% of the patients were literate of whom 10.9 % of the people were matriculate while 1.8% were graduates. The commonest etiology of prolonged fever were infections 76(69%) out of which Tuberculosis 44(40%), took the lions' share. Tuberculosis was followed by chronic UTI (8.2%) enteric fever(5.5%) and malaria(4.5%). This was followed by various malignancies 14(12.7%) and inflammatory disorders 12(10.9%) It was notable that while prevalence of infections were comparable in males and females the prevalence of cancers (15.3%vs10.3%) and inflammatory disorders (7.6%vs 13.8%) varied. No diagnosis could be reached in 3.6% cases.