Main Article Content
AUFI, Dengue, Leptospira, Chikungunia, Scrub typhus, Malaria, Typhoid
INTRODUCTION: The acute undifferentiated febrile illness (AUFI) connotes fever of <14 days duration without any evidence of organ or system specific aetiology. In the majority of hospitals, acute undifferentiated febrile illness (AUFI) is a prevalent clinical condition. If the cause of the fever is not identified and treated effectively as soon as possible, it could be fatal.
AIM AND OBJECTIVES: To study the Prevalence of Aetiologies acute undifferentiated febrile illnesses of the patients at a tertiary care centre in Uttar Pradesh, India.
MATERIAL AND METHODS: This was a Hospital based cross sectional study conducted in the Department of Microbiology at Rama Medical College Hospital & Research Centre, Mandhana, Kanpur. The study was carried out during the monsoon and post monsoon of the year 2022 for a period of 6 months from July 2022 to December 2022. A total of the 1520 clinical samples were recorded out of which there were 106 suspected cases. Sampling method was used and allin-patients fulfilling the AUFI definition were included. All in-patients with <14 days of fever with no localising source of infection were included in the study. The suspected cases was tested for various seriological tests. Diagnosis was confirmed by suitable laboratory tests after exhaustive clinical examination.
RESULTS: In the present study the ratio of Male 60 (56.6%) was found to be more as compared to that of Female 46 (43.3%) with the maximum number of cases recorded in the age group of 20-40 years of age and least in the age group above 61 years of age. The most common cause of AUFI was the Dengue with the prevalence rate of 12.2% followed by Typhoid 7.5% , Enteric fever was found to be 7.5% Scrub typus 1.88%, and least for Malaria 0. 9%. It was also noted that there were no positive cases observed for Chikungunia and leptospira. It was also observed that the fever was the most common among all, followed by anaemia, hepatomegaly, splenomegaly with the maximum number of cases observed in the month of August to October.
CONCLUSION: When prioritising clinical and diagnostic workup and starting the appropriate empirical and supportive therapy, doctors are guided by their understanding of the local aetiology of AUFI. As the prevalence of multiple infections rises, complete clinical and diagnostic investigation for likely pathogens must be taken into account in AUFI patients who are not responding to treatment
2. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379:2151–2161.
3. Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clinical Microbiology and Infection. ClinMicrobiol Infect; 2018. pp. 827–835.
4. Gasem MH, Kosasih H, Tjitra E, Alisjahbana B, Karyana M, Lokida D, et al. An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia. PLoSNegl Trop Dis. 2020; 14: 1–17.
5. Faruque LI, Zaman RU, Gurley ES, Massung RF, Alamgir ASM, Galloway RL, et al. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh. BMC Infect Dis. 2017; 17: 141.
6. Joshi R, Colford JM, Reingold A. Nonmalarial acute undifferentiated fever in a rural hospital in central India – Diagnostic uncertainity and overtreatment with anti malarial agents. Am J Trop Med Hyg. 2008;78(3):393-99.
7. Rhee C, Kharod GA, Schaad N, Furukawa NW, Vora NM, Blaney DD, et al. Global knowledge gaps in acute febrile illness etiologic investigations: A scoping review. PLoSNegl Trop Dis. 2019; 13: e0007792.
8. Shrestha P, Dahal P, Ogbonnaa-Njoku C, Das D, Stepniewska K, Thomas N V, et al. Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Southern Asia and South-eastern Asia, 1980–2015. BMC Med. 2020; 18.
9. Elven J, Dahal P, Ashley EA, Thomas N V, Shrestha P, Stepniewska K, et al. Non-malarial febrile illness: a systematic review of published aetiological studies and case reports from Africa, 1980–2015. BMC Med. 2020; 18.
10. Chrispal A, Boorugu H, Gopinath KG, Chandy S,Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients- The disease spectrum and diagnostic predictors- An experience from a tertiary care hospital in South India. Trop Doct. 2010;40(4)230–234. doi: 10.1258/td.2010.100132
11. Chaturvedi HK, Mahanta J, Pandey A. Treatment-seeking for febrile illness in north-east India: an epidemiological study in the malaria endemic zone. Malar J. 2009;8(1):301.
12. Joshi R, Colford JM, Reingold A. Nonmalarial acute undifferentiated fever in a rural hospital in central India – Diagnostic uncertainity and overtreatment with anti malarial agents. Am J Trop Med Hyg. 2008;78(3)393-399.
13. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients- The disease spectrum and diagnostic predictors- An experience from a tertiary care hospital in South India. Trop Doct. 2010; 40(4)230– 234.
14. John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet. 2011;377(9761):252–69
15. Rammohan M.V.N.L. et al. Prevalence of acute undifferentiated febrile illnesses in a tertiary care centre in Telangana, South India. Tropical Journal of Pathology and Microbiology. 2019;5(8)
16. Mueller TC, Siv S, Khim N, Kim S, Fleischmann E, Ariey F, et al. Acute undifferentiated febrile illness in rural Cambodia: A 3-year prospective observational study. PLoS One. 2014; 9(4):e95868.
17. Jena B, Prasad MNV, Murthy S. Demand pattern of medical emergency services for infectious diseases in Andhra Pradesh – A geo-spatial temporal analysis of fever cases. Indian Emerg J. 2010; 1(5):821.
18. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, et al. The aetiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal. Am J Trop Med Hyg. 2004; 70(6):670–5.
19. Sripanidkulchai R, Lumbiganon P. Aetiology of obscure fever in children at a university hospital in northeast Thailand. Southeast Asian J Trop Med Public Health. 2005;36(5):1243–1246.
20. Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S. Aetiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai. 2004; 87(5):464–472.
21. Ellis RD, Fukuda MM, McDaniel P, Welch K, Nisalak A, Murray CK, et al. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg. 2006; 74(1):108-113.
22. Gopalakrishnan S, Arumugam B, Kandasamy S, Rajendran S, Krishnan B. Acute undifferentiated febrile illness among adults - A hospital based observational study. J Evol Med Dent Sci.2013;2(14):2305-2319.
23. Kashinkunti MD, Gundikeri SK, Dhananjaya M. Acute undifferentiated febrile illness- clinical spectrum and outcome from a tertiary care teaching hospital of north Karnataka. Int J Biol Med Res.2013;4(2):3399-3402.
24. Mittal G, Ahmad S, Agarwal RK, Dhar M, Mittal M, Sharma S. Aetiologies of acute undifferentiated febrile illness in adult patients an experience from a tertiary care hospital in Northern India. J Clin Diagn Res. 2015; 9(12):DC22–DC24.
25. Rao PN, van Eijk AM, Choubey S, Ali SZ, Dash A, Barla P, et al. Dengue, chikungunya, and scrub typhus are important etiologies of non-malarial febrile illness in Rourkela, Odisha, India. BMC Infect Dis. 2019; 19(1)572. doi: 10.1186/s12879-019- 4161-6
26. Zeller H, Van Bortel W, Sudre B. Chikungunyaits history in Africa and Asia and its spread to newregions in 2013-2014. J Infect Dis. 2016; 214(suppl 5)S436–S440.
27. Abhilash KP, Jeevan JA, Mitra S, Paul N, Murugan TP, Rangaraj A, et al. Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome. J Glob Infect Dis. 2016; 8(4):147-154.
28. Shelke YP, Deotale VS, Maraskolhe DL. Spectrum of infections in acute febrile illness in central India. Indian J Med Microbiol. 2017;35(4):480-484.
29. Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements ACA. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review. BMC Infect Dis. 2019;19(1):577.
30. Morch K, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S, Henry A, Nesaraj J, Kuriakose C, Singh A, et al. Acute undifferentiated ever in India: a multi centre study of aetiology and diagnostic accuracy. BMC Infect Dis. 2017; 17(1):665
31. Prasad N, Murdoch DR, Reyburn H, Crump JA. Etiology of severe febrile illness in low-and middle income countries: a systematic review. PLoS One. 2015;10(6): e0127962.
32. Abrahamsen SK, Haugen CN, Rupali P, Mathai D, Langeland N, Eide GE, et al. Fever in the tropics: aetiology and case fatality – a prospective observational study in a tertiary care hospital in south India. BMC Infectious Diseases. 2013;13:355.
33. Kejariwal D, Sarkar N, Chakraborti SK, Agarwal V, Roy S. Pyrexia of unknown origin: a prospective study of 100 cases. J Postgrad Med. 2001; 47(2):104-07.
34. Jena B, Prasad MNV, Murthy S. Demand pattern of medical emergency services for infectious diseases in Andhra Pradesh – A geo-spatial temporal analysis of fever cases. Indian Emergency Journal. 2010; 1(5):821.
35. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, et al. The aetiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal. Am J Trop Med Hyg. 2004; 70(6):670–75