Common Tropical fevers: Experience from a tertiary care teaching hospital of North India
Common Tropical fevers from North India
Abstract
Background - We aimed at studying the clinico-laboratory profile of tropical fever, presenting to a tertiary care hospital.
Materials and methods – The study was done after obtaining ethical clearance. In this prospective observational study, done from January 2022 to December 2022, patients fulfilling clinical criteria and confirmed positive on laboratory investigations were enrolled. They were managed and followed up during the course of hospital stay. Details were recorded, after obtaining a written informed consent from parents.
Results – A total of 118 patients who fulfilled the inclusion criteria and were finally enrolled for analysis. Mean age of presentation was 12.9 years (Range 8-16 years; SD 2.169). Majority of cases, especially those known to be transmitted by mosquitoes, were seen in the post-monsoon season (50/118 = 42.3%). Typhoid or enteric fever (39/118 = 33.0%) was the major etiology. There was an overlap in clinical findings with hepatosplenomegaly being the most common one seen in 94.0% cases and the least common finding was lymphadenopathy (5.5%) cases. A third (36/118 = 30.5%) of these patients required PICU admission sometime during the course of hospitalization. Of the patients who required admission in PICU, around 90% required inotropic/ vasoactive support, 72.8% (59% non-invasive and 13.8% invasive) required ventilator support and 14.6% patients required renal replacement therapy. One hundred and eleven (111/118 = 94.0%) patients survived and recovered completely.
Conclusion - Enteric fever was the most common etiology of Tropical Fever in this study. Majority of cases of tropical fever had an intact survival and did not require PICU admission.
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References
2. Rupali P. Introduction to Tropical Medicine. Infect Dis Clin North Am. 2019 Mar; 33(1):1-15. doi: 10.1016/j.idc.2018.10.011.
3. Lalloo DG, Shingadia D, Bell DJ, Beeching NJ, Whitty CJM, Chiodini PL et al. UK malaria treatment guidelines 2016. J Infect 2016 Jun; 72(6):635-649. doi: 10.1016/j.jinf.2016.02.001. Epub 2016 Feb 12.
4. Stewart AGA, Smith S, Binotto E, and Hanson J. Clinical Features of Rickettsial Infection in Children in Tropical Australia-A Report of 15 Cases. J Trop Pediatr 2020 Dec 1; 66(6):655-660. doi: 10.1093/tropej/fmaa015
5. Slack A. Leptospirosis. Aust Fam Physician 2010 Jul;39(7):495-8 PMID: 20628664
6. Blanton LS. Rickettsial infections in the tropics and in the traveler. Curr Opin Infect Dis 2013 Oct; 26(5):435-40. doi: 10.1097/QCO.0b013e328363811b.
7. Shaikh Z, Pathak R. Revised Kuppuswamy and BG Prasad socio- economic scales for 2016. Int J Comm Pub Health 2017;4(04): 997–999 DOI: ttp://dx.doi.org/10.18203/2394-6040.ijcmph20171313
8. The Indian Society of Critical Care Medicine Tropical fever Group; Singhi S, Chaudhary D, Varghese GM, Bhalla A, Karthi N, Kalantri S et al. Tropical fevers: Management guidelines. Indian J Crit Care Med 2014 Feb; 18(2):62-9. doi: 10.4103/0972-5229.126074.
9. Thakur K, Zunt J. Tropical Neuroinfectious Diseases. Continuum (Minneap Minn) 2015 Dec;21(6 Neuroinfectious Disease):1639-61 doi: 10.1212/CON.0000000000000248
10. Jimenez-Morillas F, Gil-Mosquera M, Garcia-Lamberechts EJ. Fever in travellers returning from the tropics. Med Clin (Barc) 2019 Sep 13; 153(5):205-212. doi: 0.1016/j.medcli.2019.03.017. Epub 2019 May 31.
11. Korzeniewski K, Gawel B, Krankowska D and Wasilczuk K. Fever of unknown origin in returning travelers Int Marit Health 2015; 66(2):77-83. doi: 10.5603/IMH.2015.0019.
12. Morch K, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S et al. Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy. BMC Infect Dis 2017 Oct 4; 17(1):665. doi: 10.1186/s12879-017-2764-3.
13. Joshi N, Rajeshwari K, Dubey AP, Singh T and Kaur R. Clinical spectrum of fever of unknown origin among Indian children. Ann Trop Paediatr 2008 Dec; 28(4):261-6. doi: 0.1179/146532808X375413.
14. Divyashree S, Nabarro LEB, Veeraghavan B and Rupali P. Enteric fever in India: current scenario and future directions. Trop Med Int Health 2016 Oct; 21(10):1255-1262. doi: 10.1111/tmi.12762. Epub 2016 Sep 8.
15. Carey ME, MacWright WR, Im J, Meiring JE, Gibani MM, Park SE et al. The Surveillance for Enteric Fever in Asia Project (SEAP), Severe Typhoid Fever Surveillance in Africa (SETA), Surveillance of Enteric Fever in India (SEFI), and Strategic Typhoid Alliance Across Africa and Asia (STRATAA) Population-based Enteric Fever Studies: A Review of Methodological Similarities and Differences. Clin Infect Dis 2020 Jul 29; 71(Suppl 2):S102-S110. doi: 10.1093/cid/ciaa367.
16. Basnyat B, Qamar FN, Rupali P, Ahmad T and Parry CM. Enteric fever. BMJ 2021 Feb 26;372: n437 doi: 10.1136/bmj.n437
17. Rao M, Atiqah N, Dasiman M and Amran F. Demographic, clinical and laboratory features of leptospirosis-malaria co-infections in Peninsular Malaysia. J Med Microbiol 2020 Mar;69(3):451-456 doi: 10.1099/jmm.0.001127.
18. Cretu C-M. [Significance of fever following a trip to a tropical region] Bacteriol Virusol Parazitol Epidemiol 2004 Jan-Jun; 49(1-2):23-31.
19. Bhatt M, Rastogi N, Soneja M. Biswas A. Uncommon manifestation of leptospirosis: a diagnostic challenge. BMJ Case Rep 2018 Oct 7; 2018:bcr2018225281 doi: 10.1136/bcr-2018-225281.
20. Huang FAS, and Schlaudecker. Fever in the Returning Traveler. Infect Dis Clin North Am 2018 Mar; 32(1):163-188. doi: 10.1016/j.idc.2017.10.009.
21. Baranwal AK, Singhi SC and Jayashree M. A 5-year PICU experience of disseminated staphylococcal disease, part 1: clinical and microbial profile. J Trop Pediatr 2007 Aug; 53(4):245-51. doi: 10.1093/tropej/fmm022. Epub 2007 May 3.
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