Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy

BMC Infectious Diseases

Research Article

Suvarna Patil¹  Ashita Singh²  Joel Nesaraj³  Cijoy Kuriakose⁴  Anil Henry⁵  Novin Chacko⁶  Sara Chandy⁷  George Vasanthan Antony⁷  Anand Manoharan⁷  Dilip Mathai⁷  Siby Kurian⁷  Christel Gill Haanshuus⁸  Kristine Mørch⁹  Nina Langeland⁹  Bjørn Blomberg⁹  Gerardo Alvarez-Uria^1,10 

[1] B.K.L. Walawalkar Hospital, Ratnagiri, Maharashtra, India;Baptist Christian Hospital, Tezpur, Assam, India;Bethesda Hospital, Ambur, Tamil Nadu, India;Christian Fellowship Hospital, Oddanchatram, Tamil Nadu, India;Christian Hospital, Mungeli, Chhattisgarh, India;Duncan Hospital, Raxaul, Bihar, India;Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India;National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway;National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway;Department of Clinical Science, University of Bergen, Bergen, Norway;Rural Development Trust Hospital, Anantapur, Andhra Pradesh, India;

关键词: Malaria;    Bacteraemia;    Leptospirosis;    Scrub typhus;    Dengue;    Chikungunya;    Prevalence;    India;    Diagnosis;   

DOI  :  10.1186/s12879-017-2764-3

 received in 2017-05-04, accepted in 2017-09-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods.MethodsDuring April 2011–November 2012, 1564 patients aged ≥5 years with febrile illness for 2–14 days were consecutively included in an observational study at seven community hospitals in six states in India.Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals.Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available.Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR.ResultsMalaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test.ConclusionsMalaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India.

【 授权许可】

CC BY   
© The Author(s). 2017