Persistent febrile illnesses in Nepal

Koirala, Kanika Deshpande; Chappuis, François; Verdonck, Kristien; Rijal, Suman; Boelaert, Marleen

doi:10.4103/ijmr.ijmr_505_18

Cited by 9 publications

(3 citation statements)

References 54 publications

(117 reference statements)

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“…Typhus-infected scrub chiggers are prevalent in locations with dense scrub vegetation throughout the summer. The rainy season (therefore, the illness is sometimes known as river/flood fever) time of mite egg-laying [17] is often from June to November [18]. The vegetation that was present led to the usage of the term "scrub", which supports the chigger-mammal interaction despite the presence of rodents and mites in other areas.…”

Section: An Unusual Cause Of Aufi: Scrub Typhusmentioning

confidence: 99%

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness

Khairkar,

Vagha,

Deotale

2023

Cureus

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One of India's predominant public health issues is acute undifferentiated fever illness (AUFI), a typical response to an infectious agent. Diagnosis becomes challenging when the disease has been reported with fever as the primary symptom. Among the cases presenting at a tertiary care hospital in central India, 88% had an acute undifferentiated fever, the most common being dengue infection. In India, rural communities are at more risk from AUFI than cities. Most of those in danger are those who reside in remote areas, and one of the most significant risks is for those who reside close to forests. AUFI is a complex condition for physicians to deal with and is one of the most frequent clinical conditions for which empirical treatment is required. Nowadays, AUFI can be managed by a syndromic approach with the judicial use of antibiotics.Symptoms of AUFI, along with myalgia, headache, and anorexia, can be caused by various illnesses. Patients are recommended to undertake a battery of investigations, which may delay the therapy and increase expenses because many diseases may present with the same symptoms. In the developed world, viral illness is the primary cause of AUFI. However, in developing countries like India, it can also be brought on by potentially curable but life-threatening conditions such as malaria, leptospirosis, hantavirus infection, and Japanese encephalitis. Lack of knowledge of the locally prevalent illnesses, which might be the cause of AUFI, and lack of preliminary screening and diagnostics at the point of care to identify the etiologies make it difficult to control these generally curable causes of the burden of AUFI, especially in tropical and subtropical countries. A deeper understanding of AUFI is required to develop better diagnostics and cures for various etiologies, especially scrub typhus.

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Section: An Unusual Cause Of Aufi: Scrub Typhusmentioning

confidence: 99%

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness

Khairkar,

Vagha,

Deotale

2023

Cureus

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“…Guidance for diagnostic work-up of fever of unknown origin often includes complex investigations such as imaging studies including CT, MRI, and PET-scans, bone-marrow examinations, multi-site cultures, and various serological and molecular tests [ 9 ]. These guidelines are therefore of limited use in the rural tropics where more sophisticated laboratory and radiological tools are not available or difficult to access [ 8 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Neglected etiologies of prolonged febrile illnesses in tropical and subtropical regions: A systematic review

Musumeci,

Kruse,

Chappuis

et al. 2024

PLoS Negl Trop Dis

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Background Febrile illnesses that persist despite initial treatment are common clinical challenges in (sub)tropical low-resource settings. Our aim is to review infectious etiologies of “prolonged fevers” (persistent febrile illnesses, PFI) and to quantify relative contributions of selected neglected target diseases with limited diagnostic options, often overlooked, causing inadequate antibiotic prescriptions, or requiring prolonged and potentially toxic treatments. Methods We performed a systematic review of articles addressing the infectious etiologies of PFI in adults and children in sub-/tropical low- and middle-income countries (LMICs) using the PRISMA guidelines. A list of target diseases, including neglected parasites and zoonotic bacteria (e.g., Leishmania and Brucella), were identified by infectious diseases and tropical medicine specialists and prioritized in the search. Malaria and tuberculosis (TB) were not included as target diseases due to well-established epidemiology and diagnostic options. Four co-investigators independently extracted data from the identified articles while assessing for risk of bias. Results 196 articles from 52 countries were included, 117 from Africa (33 countries), 71 from Asia (16 countries), and 8 from Central and -South America (3 countries). Target diseases were reported as the cause of PFI in almost half of the articles, most frequently rickettsioses (including scrub typhus), relapsing fever borreliosis (RF-borreliosis), brucellosis, enteric fever, leptospirosis, Q fever and leishmaniasis. Among those, RF-borreliosis was by far the most frequently reported disease in Africa, particularly in Eastern Africa. Rickettsioses (including scrub typhus) were often described in both Africa and Asia. Leishmaniasis, toxoplasmosis and amoebiasis were the most frequent parasitic etiologies. Non-target diseases and non-tropical organisms (Streptococcus pneumoniae, Escherichia coli, and non-typhoidal Salmonella spp) were documented in a fifth of articles. Conclusions Clinicians faced with PFI in sub-/tropical LMICs should consider a wide differential diagnosis including enteric fever and zoonotic bacterial diseases (e.g., rickettsiosis, RF-borreliosis and brucellosis), or parasite infections (e.g., leishmaniasis) depending on geography and syndromes. In the absence of adequate diagnostic capacity, a trial of antibiotics targeting relevant intra-cellular bacteria, such as doxycycline or azithromycin, may be considered.

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“…[14][15][16] These febrile illness cases, characterized by high body temperature, are suspected to be salmonella enterica serovar typhi and paratyphi-A 14,16 and treated as per 14,17 Most of the cases of febrile illness are mostly treated based on the clinical suspicion rather than the epidemiological studies and identification of causative pathogens. 14,[18][19][20][21] Chances exist that the possible reason behind those febrile illnesses could be rickettsial infection of spotted fever group or typhus group type (scrub typhus) or mixed infection of both. These two forms of rickettsial infection (spotted fever group and scrub typhus) have varying degree of clinical manifestations.…”

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confidence: 99%

Scrub typhus: A serious public health issue in Nepal

Acharya¹,

Adhikari

Tariq

2020

Clinical Epidemiology and Global Health

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The agro-climatic conditions, socio-economic situation, poor sanitation, low hygiene and health standards in Nepal are major contributing factors to the emergence of scrub typhus in Nepal. These outbreaks, along with poor diagnostic facilities, can lead to severe economic losses in a resource-limited country like Nepal. Diseases like avian influenza, leptospirosis, brucellosis, tuberculosis and rabies, that cause heavy socio-economic burden, have received huge attention of Government of Nepal and hence are among the top ten priority diseases. However, until now, scrub typhus is not considered a priority disease in Nepal, despite having severe outbreaks time to time. In order to diagnose and treat scrub typhus infection, low budget diagnostic tests such as Weil Felix are less efficient and poor in screening, and highly advanced & efficient tests are less likely to be available and are expensive. Nepal needs to explore appropriate and applicable test settings in primary health centers and referral laboratories in the country. Moreover, focus should be made on effective surveillance programs and public awareness campaigns, mice/rat control strategies, and improving sanitation, public health and hygiene measures for the people at most risk. In addition, health workers and professionals should be trained on early case detection, personal protection, proactive rodent control strategies, habitat destruction and good sanitation and hygiene practices.

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Persistent febrile illnesses in Nepal

Cited by 9 publications

References 54 publications

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness

Neglected etiologies of prolonged febrile illnesses in tropical and subtropical regions: A systematic review

Scrub typhus: A serious public health issue in Nepal

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