Acute Undifferentiated Febrile Illness Among Adults – A Hospital Based Observational Study

Abstract

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 infections were done according to study protocol. The patients were followed up until clinical recovery and convalescence. The data were entered in MS excel and analyzed using Epi-info software 2008 version. RESULTS: A total of 403 patients were included in the study . The distribution of AUFI included Malaria 133[33%], Typhoid 83[20.59%], Dengue 42[10.4%], Leptospirosis 25[6.2%], and other causes 36[8.9%] and unknown cause 84[20.84%].Malaria patients were significantly associated with jaundice, altered mentation, travel outside the district, elevated AST/ALT levels, thrombocytopenia and splenomegaly. Typhoid fever was associated with longer fever duration, abdominal pain, coated tongue, relative bradycardia, normal platelet counts and low leucocyte count. Dengue fever could be predicted by rash, pruritis, petechiae ,retro-orbital pain and low platelet counts. Leptospirosis patients showed significant association with conjunctival suffusion, muscle tenderness and subconjunctival hemorrhage. Weil's disease was noticeably rare. Conclusion: Post monsoon upsurge of AUFI should be anticipated and preventive measures at personal and community levels planned. Clinical prediction of AUFI is possible with proper physical examination and judicious use of laboratory.

Etiological Spectrum and Prevalence of Acute Undifferentiated Febrile Illness (AUFI) in Fever Cases Attending our Tertiary Care Centre

“…Unlike other studies such as Gopalakrishnan et al, (2013), there were no associations with rash and petechiae.…”

“…Typhoid was the commonest cause of AUFI in 28(24.14%) followed by Dengue 12(10.35%). The present study revealed that Typhoid and Dengue were the common causes of AUFI followed by Malaria 6(5.17%), and scrub typhus 2(1.72%), as observed in the previous studies by Thangarasu et al, (2011), Mittal et al, (2015, Singh et al, (2014), Anugrah Chrispal et al, (2010), Rani et al, (2016) and Gopalakrishnan et al, (2013) where the most common causes of AUFI were dengue, Typhoid, Malaria and scrub typhus. In the present study there were 63(54.31%) patients with undiagnosed febrile illness, their clinical outcomes were studied.…”

“…Thus knowledge of local prevalence of infections is critical in order to target clinical work up and treatment as shown in Mittal et al, (2015) and Chaturvedi et al, (2009). Studies from Tamilnadu by Anugrah Chrispal et al, (2010), Rani et al, (2016), Gopalakrishnan et al, (2013) and Kerala by Andrews et al, (2014) showed most of the AUFI are treatable and reduction in mortality if they were diagnosed earlier.…”

Clinical & etiological profile of acute undifferentiated fever in patients admitted to a teaching hospital in Pondicherry

“…Various studies conducted particularly in South India by Chrispal et al, Gopalakrishnan et al, and Kashinkunti et al, have also showed similar results [22,22,23]. In the miscellaneous group of our study, no definite cause was found in 23.7% (64) and was presumed to be of viral origin.…”

Major aetiologies of acute undifferentiated fever in 2013 and 2014: an experience in retrospect

“…In countries like Thailand, Malaysia and Nepal -dengue, malaria, scrub typhus, leptospirosis and enteric fever have been identified as main causes of AUF. [16][17][18][19][20][21][22] Apart from these four major aetiologies, Abrahamsen et al from South India, in a cohort study, showed that bacterial infections (38%), TB (19%) were also significant common causes of AUF. 19 A study from East India reported that TB (53%), neoplasms ((17%) and Collagen vascular disorders (11%) were also very important causes of fevers.…”