title: Fever in the tropics: aetiology and case-fatality - a prospective observational study in a tertiary care hospital in South India.
abstract: BACKGROUND
  The objective of this study was to describe aetiology and case fatality of fever among inpatients in a tertiary care hospital in South India.
  
  
  METHODS
  This was an observational, prospective study conducted in a tertiary care hospital in Vellore, Tamil Nadu, India. Between July 2nd 2007 and August 2nd in 2007, adult patients admitted to the hospital with temperature ≥ 38.0°C were included consecutively and followed during the hospitalisation period. Demographic and clinical data were collected and analysed for each patient. Associations were sought between death and various clinical and demographic variables.
  
  
  RESULTS
  One hundred patients were included, 61 male and 39 female. Mean age was 37.5 (range: 16 to 84) years. Mean fever duration was 5.4 (range: 0.1 to 42.9) weeks.The following infectious aetiologies were recorded: tuberculosis (19%), lower respiratory infection (11%) including three with sepsis, urinary tract infection (10%) including three with E. coli sepsis, Plasmodium falciparum malaria (5%) including three patients with mixed P. vivax infection, scrub typhus (5%), typhoid fever (4%), cryptococcal meningitis (4%) including three HIV positive patients, endocarditis (3%) including two patients with Staphylococcus aureus sepsis, spleen abscess (2%), amoebic liver abscess (2%), sepsis undefined focus (1%), HIV infection (1%), hepatitis B (1%), rubella (1%), peritonitis (1%) and cholecystitis (1%).Non-infectious causes of fever were diagnosed in 15%, including systemic lupus erythematosus in four and malignancy in six patients. Cause of fever remained unknown in 13%.Case fatality during hospitalisation was 7% (7/100). Six of those who died were male. Five fatalities had bacterial sepsis, one spleen abscess and malignancy, and one had lymphomalignant disorder.Diabetes and increasing age were significant risk factors for fatal outcome in unadjusted analyses, but only increasing age was a risk factor for death in adjusted analysis.
  
  
  CONCLUSIONS
  A high number of tuberculosis and bacterial infections and a high case fatality rate from sepsis were found in this cohort, underlining the importance of microbiological diagnostics and targeted antimicrobial treatment in the management of fever. P. falciparum was identified in all malaria cases, and this rapidly fatal infection should be considered in patients with acute undifferentiated fever in India.
authors.affiliation: Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.
authors.forename: Siri Kratter
authors.initials: SK
authors.lastname: Abrahamsen
authors.forename: Cathrine Nødtvedt
authors.initials: CN
authors.lastname: Haugen
authors.forename: Priscilla
authors.initials: P
authors.lastname: Rupali
authors.forename: Dilip
authors.initials: D
authors.lastname: Mathai
authors.forename: Nina
authors.initials: N
authors.lastname: Langeland
authors.forename: Geir Egil
authors.initials: GE
authors.lastname: Eide
authors.forename: Kristine
authors.initials: K
authors.lastname: Mørch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D063128:Tertiary Health Care; D014329:Tropical Climate
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