title: Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents.
abstract: Nonmalarial acute undifferentiated fever (NMAUF) refers to a febrile illness with no indication of an organ-specific disease after diagnosis of malaria has been excluded. In developing countries, the empirical treatment of NMAUFs with antimalarial drugs continues even in the era of highly specific rapid diagnostic tests (RDTs) for malaria. We carried out a retrospective review of patients with fever admitted to a rural teaching hospital in central India. We categorized patients with NMAUF into different clinical syndromes and determined their demographic profile, inhospital course, and the pattern of antimalarial use. The study sample included 1,197 adult patients who were investigated for malaria; 1,053 (88%) of them had NMAUF, and use of further diagnostics in this group was limited. Despite one or more negative tests for malaria, many patients (39.9%, 95% CI 37.0-43.3) received antimalarial drugs. These results suggest a need for guidelines and training to improve empirical treatment of NMAUF.
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, California 94720, USA. rjoshi@berkeley.edu
authors.forename: Rajnish
authors.initials: R
authors.lastname: Joshi
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
authors.forename: Shriprakash
authors.initials: S
authors.lastname: Kalantri
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D006761:Hospitals; D006801:Humans; D007194:India; D008288:Malaria; D012189:Retrospective Studies; D012423:Rural Health; D035501:Uncertainty
chemical_list: D000962:Antimalarials