title: Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India.
abstract: Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization. Blood cultures, malarial parasites and febrile serology (acute and convalescent), in addition to clinical evaluations and basic investigations were performed. Comparisons were made between each disease and the other AFIs. A total of 398 AFI patients were diagnosed with: scrub typhus (47.5%); malaria (17.1%); enteric fever (8.0%); dengue (7.0%); leptospirosis (3.0%); spotted fever rickettsiosis (1.8%); Hantavirus (0.3%); alternate diagnosis (7.3%); and unclear diagnoses (8.0%). Leucocytosis, acute respiratory distress syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminaemia were independently associated with scrub typhus. Normal leukocyte counts, moderate to severe thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated serum transaminases were associated with malaria. Rash, overt bleeding manifestations, normal to low leukocyte counts, moderate to severe thrombocytopenia and significantly elevated hepatic transaminases were associated with dengue. Enteric fever was associated with loose stools, normal to low leukocyte counts and normal platelet counts. It is imperative to maintain a sound epidemiological database of AFIs so that evidence-based diagnostic criteria and treatment guidelines can be developed.
authors.affiliation: Department of Medicine Unit 2, Christian Medical College, Vellore, Tamil Nadu, India. anugrahchrispal@gmail.com
authors.forename: Anugrah
authors.initials: A
authors.lastname: Chrispal
authors.forename: Harikishan
authors.initials: H
authors.lastname: Boorugu
authors.forename: Kango Gopal
authors.initials: KG
authors.lastname: Gopinath
authors.forename: Sara
authors.initials: S
authors.lastname: Chandy
authors.forename: John Antony Jude
authors.initials: JA
authors.lastname: Prakash
authors.forename: Elsa Mary
authors.initials: EM
authors.lastname: Thomas
authors.forename: Asha Mary
authors.initials: AM
authors.lastname: Abraham
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: Kurien
authors.initials: K
authors.lastname: Thomas
mesh_terms: D000208:Acute Disease; D000328:Adult; D003715:Dengue; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010272:Parasitic Diseases / Q000150:complications / Q000175:diagnosis; D015995:Prevalence; D011446:Prospective Studies; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis; D055815:Young Adult