Fever in the tropics: aetiology and case-fatality - a prospective observational study in a tertiary care hospital in South India

BMC Infectious Diseases

Kristine Mørch¹  Geir Egil Eide²  Nina Langeland⁴  Dilip Mathai³  Priscilla Rupali³  Cathrine Nødtvedt Haugen⁴  Siri Kratter Abrahamsen⁴ 

[1] Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Department of Medicine Unit 1, Christian Medical College, Vellore, Tamil Nadu, India;Institute of Medicine, University of Bergen, Bergen, Norway

关键词: Tuberculosis;    Malaria;    Sepsis;    Case-fatality;    Tropics;    Aetiology;    Fever;   

Others  :  1146629
DOI  :  10.1186/1471-2334-13-355

 received in 2012-06-28, accepted in 2013-07-17,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Abrahamsen et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO: The 10 leading causes of death by broad income group (2008). 2011.
• [2]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. BioMed Central Full Text
• [3]Chandramohan D, Jaffar S, Greenwood B: Use of clinical algorithms for diagnosing malaria. Trop Med Int Health 2002, 7(1):45-52.
• [4]Chandramohan D, Carneiro I, Kavishwar A, Brugha R, Desai V, Greenwood B: A clinical algorithm for the diagnosis of malaria: results of an evaluation in an area of low endemicity. Trop Med Int Health 2001, 6(7):505-510.
• [5]Mwangi TW, Mohammed M, Dayo H, Snow RW, Marsh K: Clinical algorithms for malaria diagnosis lack utility among people of different age groups. Trop Med Int Health 2005, 10(6):530-536.
• [6]John TJ, Dandona L, Sharma VP, Kakkar M: Continuing challenge of infectious diseases in India. Lancet 2011, 377(9761):252-269.
• [7]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):104-107.
• [8]Handa R, Singh S, Singh N, Wali JP: Fever of unknown origin: a prospective study. Trop Doct 1996, 26(4):169-170.
• [9]Sharma BK, Kumari S, Varma SC, Sagar S, Singh S: Prolonged undiagnosed fever in northern India. Trop Geogr Med 1992, 44(1–2):32-36.
• [10]Saltoglu N, Tasova Y, Midikli D, Aksu HS, Sanli A, Dundar IH: Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study. J Infect 2004, 48(1):81-85.
• [11]Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, et al.: Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 2004, 329(7476):1212.
• [12]Bajpai LB: Mortality analysis of patients of acute febrile illness during monsoon in a tertiary care hospital of Mumbai. Infect Dis Clin Pract 2008, 16(5):294-297.
• [13]Blomberg B, Manji KP, Urassa WK, Tamim BS, Mwakagile DS, Jureen R, Msangi V, Tellevik MG, Holberg-Petersen M, Harthug S, et al.: Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study. BMC Infect Dis 2007, 7:43. BioMed Central Full Text
• [14]Dhingra N, Jha P, Sharma VP, Cohen AA, Jotkar RM, Rodriguez PS, Bassani DG, Suraweera W, Laxminarayan R, Peto R: Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet 2010, 376(9754):1768-1774.
• [15]Joshi R, Colford JM Jr, Reingold AL, Kalantri S: Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents. Am J Trop Med Hyg 2008, 78(3):393-399.
• [16]Kumar A, Valecha N, Jain T, Dash AP: Burden of malaria in India: retrospective and prospective view. Am J Trop Med Hyg 2007, 77(6 Suppl):69-78.
• [17]Harris VK, Richard VS, Mathai E, Sitaram U, Kumar KV, Cherian AM, Amelia SM, Anand G: A study on clinical profile of falciparum malaria in a tertiary care hospital in south India. Indian J Malariol 2001, 38(1–2):19-24.
• [18]Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, Abraham AM, Abraham OC, Thomas K: 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.
• [19]Singh N, Kataria O, Singh MP: The changing dynamics of Plasmodium vivax and P. falciparum in central India: trends over a 27-year period (1975--2002). Vector Borne Zoonotic Dis 2004, 4(3):239-248.
• [20]Singh N, Chand SK, Mishra AK, Bharti PK, Singh MP, Ahluwalia TP, Dash AP: Epidemiology of malaria in an area of low transmission in central India. Am J Trop Med Hyg 2006, 75(5):812-816.
• [21]Rupali P, Abraham OC, Zachariah A, Subramanian S, Mathai D: Aetiology of prolonged fever in antiretroviral-naive human immunodeficiency virus-infected adults. Natl Med J India 2003, 16(4):193-199.
• [22]Kitkungvan D, Apisarnthanarak A, Plengpart P, Mundy LM: Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature. Int J STD AIDS 2008, 19(4):232-235.
• [23]Samuel PP, Thenmozhi V, Tyagi BK: A focal outbreak of dengue fever in a rural area of Tamil Nadu. Indian J Med Res 2007, 125(2):179-181.
• [24]Paramasivan R, Thenmozhi V, Kabilan L, Tewari SC, Arunachalam N, Dhananjeyan KJ, Tyagi BK: Seroepidemiology of a focal outbreak of dengue in Tamil Nadu. Indian J Med Res 2006, 124(6):718-720.
• [25]Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E: Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med Res 2007, 126(2):128-130.
• [26]Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, Raoult D: Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 2003, 990:359-364.
• [27]Natarajaseenivasan K, Boopalan M, Selvanayaki K, Suresh SR, Ratnam S: Leptospirosis among rice mill workers of Salem South India. Jpn J Infect Dis 2002, 55(5):170-173.
• [28]Chandy S, Yoshimatsu K, Ulrich RG, Mertens M, Okumura M, Rajendran P, John GT, Balraj V, Muliyil J, Mammen J, et al.: Seroepidemiological study on hantavirus infections in India. Trans R Soc Trop Med Hyg 2008, 102(1):70-74.
• [29]Chandy S, Abraham S, Sridharan G: Hantaviruses: an emerging public health threat in India? A review. J Biosci 2008, 33(4):495-504.
• [30]Bottieau E, Clerinx J, Van den Enden E, Van Esbroeck M, Colebunders R, Van Gompel A, Van den Ende J: Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions. Medicine (Baltimore) 2007, 86(1):18-25.
• [31]O'Brien D, Tobin S, Brown GV, Torresi J: Fever in returned travelers: review of hospital admissions for a 3-year period. Clin Infect Dis 2001, 33(5):603-609.