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Biswas U, Bhattacharjee A, Seth S, Ghosh R, Singh AK, Sohrab A, Benito-León J. Etiological spectrum and diagnostic challenges of short-duration fever in West Bengal (India). A cross-sectional tertiary care study. Rev Clin Esp 2024; 224:466-473. [PMID: 38906399 DOI: 10.1016/j.rceng.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
INTRODUCTION The scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making. Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal, India. METHODS We conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital (West Bengal, India). We performed comprehensive clinical assessments, including microbiological, serological, and other specific investigations, to identify the causes of the fever. RESULTS The demographic profile predominantly included individuals aged 21-40 years, with a male-to-female ratio of 1.9:1; 60.7% of participants were from rural areas. The primary etiological agents identified were scrub typhus (25.3%), dengue (15.3%), and enteric fever (13.3%). Notably, 80% of patients presented with non-localizing symptoms, while 14.7% had respiratory symptoms. Blood cultures pinpointed Salmonella typhi and Staphylococcus aureus in a minority of cases (3.3%); malaria, primarily Plasmodium vivax, was diagnosed in 12% of the cases. CONCLUSION Our findings highlight the complexity of diagnosing short-duration fevers, dominated by a wide range of etiological agents, with a notable prevalence of scrub typhus. These results underscore the urgent need for enhanced diagnostic facilities, including the availability of scrub typhus testing at primary healthcare centers. We recommend empirical doxycycline therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses. This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use.
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Affiliation(s)
- U Biswas
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - A Bhattacharjee
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - S Seth
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - R Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - A K Singh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - A Sohrab
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - J Benito-León
- Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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Nimmagadda N, Khillare KM, Satpathy PK, Gowda BS, Narayana V, Gopal P, Tripathy S, Athavale PV. The Clinical and Laboratory Profiles of Immunocompetent Patients With Short-Duration Fever With Neutropenia in a Tertiary Care Hospital in Pune, India. Cureus 2023; 15:e34818. [PMID: 36923173 PMCID: PMC10008769 DOI: 10.7759/cureus.34818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Background Management of a febrile patient is based on understanding the pathophysiology of an abnormal temperature and temperature regulation, impacts of fever, and its treatment. In the current study, we aimed to characterize and compare the epidemiological, etiologic, microbiological, serological, clinical, and outcome traits of febrile patients with acute neutropenia admitted to a tertiary care center in Western Maharashtra. Methods Adult patients with a history of fever of less than two weeks' duration and without any immunosuppressive state were screened with predefined inclusion and exclusion criteria. General and demographic information (age and gender), and clinical examinations (type and duration of fever) were recorded. Biochemical, hematologic (total and differential cell counts), and immunologic measurements (rapid malaria, dengue, Leptospira, and viral hepatitis antigen antibodies) were performed. Data were analyzed using an appropriate statistical package. Results A total of 403 (214 males) young adults (aged: 29±11 years) with clinical presentation of fever were studied. The majority (n=361, 89.6%) had low-grade continuous fever with an average duration of 3±1 (mean±standard deviation (SD)) days. Headache and myalgia were the common symptoms present, and patients had an average hospital stay of 4±1 days. Dengue (55%) was the most common cause of febrile neutropenia, and all patients recovered well without antibiotics and granulocyte colony-stimulating factor. The mean C-reactive protein (CRP) level was 61.4±4.4 mg/L. CRP and procalcitonin (PCT) were directly correlated with the degree of neutropenia and inversely correlated with total leucocyte count (TLC). Conclusions It was highlighted from this study that antibiotics are not necessary for viral infections that have been diagnosed to stop the development of secondary bacterial infections. A clinician should be aware of "when not to use antibiotics," or the world will soon have to deal with superbugs.
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Affiliation(s)
- Nikitha Nimmagadda
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Kishor M Khillare
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Prasanna Kumar Satpathy
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Bharath S Gowda
- Gastroenterology and Hepatology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Varun Narayana
- Internal Medicine, Mahavir Institute of Medical Sciences, Vikarabad, IND
| | - Prashant Gopal
- Gastroenterology, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Srikanth Tripathy
- Central Research Facility, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
| | - Prachi V Athavale
- Microbiology, Dr. Dnyandeo Yashwantrao (DY) Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, IND
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Parai D, Pattnaik M, Kshatri JS, Rout UK, Peter A, Nanda RR, Sahoo SK, Mansingh A, Choudhary HR, Dash GC, Praharaj I, Bhattacharya D, Pati S. Scrub typhus seroprevalence from an eastern state of India: findings from the state-wide serosurvey. Trans R Soc Trop Med Hyg 2023; 117:22-27. [PMID: 35947959 DOI: 10.1093/trstmh/trac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Scrub typhus is a mite-borne infectious disease caused primarily by the obligate intracellular bacteria Orientia tsutsugamushi, which is transmitted by chigger mites. The objective of this study was to determine the prevalence of scrub typhus among adults in Odisha, an eastern state of India. METHODS A descriptive cross-sectional study was conducted to analyse 1840 serum samples from five districts (Khordha, Cuttack, Ganjam, Malkangiri and Sundargarh) of Odisha collected during 2020-2021. Both immunoglobulin G (IgG) and IgM antibodies against scrub typhus were tested using commercial enzyme-linked immunosorbent assay kits. Point estimates of the 95% confidence interval and adjusted odds ratio were calculated. RESULTS Of 1840 participants, the prevalence of IgG positivity was 1034 (56.19%) and that of IgM was 523 (28.42%). The majority of participants were in the 18-45 y age group (53.7%). Cuttack had the highest IgG positivity (64.54%) and Malkangiri had the lowest (29.32%). The highest and lowest positivity for IgM were found in Malkangiri (40.84%) and Cuttack (25.30%), respectively. CONCLUSIONS With an increasing number of infections detected in the state, scrub typhus is emerging as a public health threat. Increasing awareness among the general public and healthcare professionals through health education campaigns regarding scrub typhus is essential. Early detection of the disease through the establishment of a laboratory surveillance system is required to control the transmission of scrub typhus.
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Affiliation(s)
- Debaprasad Parai
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Matrujyoti Pattnaik
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Jaya Singh Kshatri
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Usha Kiran Rout
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Annalisha Peter
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Rashmi Ranjan Nanda
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Subrat Kumar Sahoo
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Asit Mansingh
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Hari Ram Choudhary
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Girish Chandra Dash
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Ira Praharaj
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Debdutta Bhattacharya
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Sanghamitra Pati
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
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Prakash R, Negi SS, Bhargava A, Sharma K, Jagzape T, Wasnik P. Evaluation of an in-house PCR for diagnosing scrub typhus along with a preliminary study of genotypic characterization of Orientia tsutshugamushi circulating in Chhattisgarh: A prospective clinico-microbiological study. Indian J Med Microbiol 2022; 40:510-515. [PMID: 36050139 DOI: 10.1016/j.ijmmb.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Scrub typhus, caused by Orientia tsutsugamushi (O. tsutsugamushi) present nonspecific clinical features during manifestation of acute undifferentiated febrile illness (AUFI) to render its early diagnosis difficult. Accordingly, this study was undertaken to assess an in-house groEL PCR versus IgM ELISA for the diagnosis of scrub typhus and to genotypically characterise the randomly selected scrub typhus positive cases. METHODS Blood samples, collected from two hundred twenty one (221) AUFI cases were subjected to groEL PCR and IgM ELISA for diagnosis of scrub typhus. Eleven randomly selected PCR positive cases were processed for DNA sequencing to determine the genetic diversity of O. tsutsugamushi in Chhattisgarh. RESULTS Scrub typhus prevalence of 35.2% were detected among AUFI cases using both in-house groEL PCR and IgM ELISA. PCR alone showed sensitivity, specificity, positive and negative predictive values of 66.6% (CI: 55.08-76.94), 100% (CI: 90 to 100),100% (CI: 93.15 to 100) and 57.37% (CI: 44.05 to 69.96) while for IgM ELISA, these parameters were 62.8% (CI: 51.13-73.50), 100% (CI: 90 to 100), 100% (CI: 92.75 to 100) and 54.68% (CI: 41.75 to 67.18) respectively. PCR and ELISA could detect scrub typhus in 37.2% and 33.3% cases, when tested alone. groEL PCR detected the O. tsutsugamushi throughout the course of infection. Phylogenetic analysis depicted 5 of 11 positive cases belonged to Kuroki, Japan strain of O. tsutsugamushi, followed by Gilliam and Karp strain in 4 and 2 cases respectively. CONCLUSION Scrub typhus should be considered in differential diagnosis of AUFI. groEL PCR may aid on to IgM ELISA test for optimum laboratory diagnosis of scrub typhus by its implementation especially in seronegative cases. Predominance of Kuroki-like strain followed by Gillian and Karp strains of O. tsutsugamushi in Chhattisgarh confirm variable geographical distribution of O. tsutsugamushi and provide the baseline epidemiological data which will eventually be used to help the researchers for developing better diagnostic tests and vaccine covering the predominant genotypes.
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Affiliation(s)
- Rishika Prakash
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Sanjay Singh Negi
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India.
| | - Anudita Bhargava
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Kuldeep Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Tushar Jagzape
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Preetam Wasnik
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Raipur, India
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Grundy BS, Houpt ER. Opportunities and challenges to accurate diagnosis and management of acute febrile illness in adults and adolescents: A review. Acta Trop 2022; 227:106286. [PMID: 34953775 PMCID: PMC8920774 DOI: 10.1016/j.actatropica.2021.106286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
Acute febrile illnesses are common reasons to seek healthcare globally. They can be caused by diverse infectious diseases which require complex diagnostics. Current clinical guidelines provide guidance on how to manage severe illness, common localizing infections like pneumonia and urinary tract infections, as well as malaria. How to manage other cases of acute febrile illness is less clear and is the focus of this review. Without an etiologic diagnosis, clinicians frequently prescribe empiric antibiotics that may be unnecessary or inadequate. We reviewed recent studies on the etiology of acute febrile illnesses in adults and adolescents that employed multiple diagnostic modalities, including rapid diagnostic tests, serologies, and polymerase chain reaction. Although studies and etiologies were heterogenous, we enumerated the causes of febrile illness in these studies. Possible improvements in clinical decision-making algorithms are discussed.
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Affiliation(s)
- Brian S Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States of America.
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States of America.
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Bhowmick IP, Pandey A, Subbarao SK, Pebam R, Majumder T, Nath A, Nandi D, Basu A, Sarkar A, Majumder S, Debbarma J, Dasgupta D, Borgohain A, Chanda R, Das M, Gogoi K, Gogoi K, Joshi PL, Kaur H, Borkakoti B, Ranjan Bhattacharya D, Khan AM, Sen S, Narain K. Diagnosis of Indigenous Non-Malarial Vector-Borne Infections from Malaria Negative Samples from Community and Rural Hospital Surveillance in Dhalai District, Tripura, North-East India. Diagnostics (Basel) 2022; 12:362. [PMID: 35204453 PMCID: PMC8871021 DOI: 10.3390/diagnostics12020362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
The aetiology of non-malaria vector-borne diseases in malaria-endemic, forested, rural, and tribal-dominated areas of Dhalai, Tripura, in north-east India, was studied for the first time in the samples collected from malaria Rapid Diagnostic Kit negative febrile patients by door-to-door visits in the villages and primary health centres. Two hundred and sixty serum samples were tested for the Dengue NS1 antigen and the IgM antibodies of Dengue, Chikungunya, Scrub Typhus (ST), and Japanese Encephalitis (JE) during April 2019-March 2020. Fifteen Dengue, six JE, twelve Chikungunya, nine ST and three Leptospirosis, and mixed infections of three JE + Chikungunya, four Dengue + Chikungunya, three Dengue + JE + Chikungunya, one Dengue + Chikungunya + ST, and one Dengue + ST were found positive by IgM ELISA tests, and four for the Dengue NS1 antigen, all without any travel history. True prevalence values estimated for infections detected by Dengue IgM were 0.134 (95% CI: 0.08-0.2), Chikungunya were 0.084 (95% CI: 0.05-0.13), Scrub were 0.043 (95% CI: 0.01-0.09), and Japanese Encephalitis were 0.045 (95% CI: 0.02-0.09). Dengue and Chikungunya were associated significantly more with a younger age. There was a lack of a defined set of symptoms for any of the Dengue, Chikungunya, JE or ST infections, as indicated by the k-modes cluster analysis. Interestingly, most of these symptoms have an overlapping set with malaria; thereby, it becomes imperative that malaria and these non-malaria vector-borne disease diagnoses are made in a coordinated manner. Findings from this study call for advances in routine diagnostic procedures and the development of a protocol that can accommodate, currently, in practicing the rapid diagnosis of malaria and other vector-borne diseases, which is doable even in the resource-poor settings of rural hospitals and during community fever surveillance.
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Affiliation(s)
- Ipsita Pal Bhowmick
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Apoorva Pandey
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, New Delhi 110029, India; (A.P.); (H.K.); (A.M.K.)
| | - Sarala K. Subbarao
- Formerly National Institute of Malaria Research, Indian Council of Medical Research ICMR, New Delhi 110029, India;
| | - Rocky Pebam
- North Eastern Space Applications Centre, Department of Space, Government of India Umiam, Umiam 793103, India; (R.P.); (A.N.); (A.B.)
| | - Tapan Majumder
- Department of Microbiology, Agartala Government Medical College, Agartala 799006, India; (T.M.); (A.S.); (S.M.)
| | - Aatreyee Nath
- North Eastern Space Applications Centre, Department of Space, Government of India Umiam, Umiam 793103, India; (R.P.); (A.N.); (A.B.)
| | - Diptarup Nandi
- National Institute of Biomedical Genomics, Kalyani 741251, India; (D.N.); (A.B.)
| | - Analabha Basu
- National Institute of Biomedical Genomics, Kalyani 741251, India; (D.N.); (A.B.)
| | - Apurba Sarkar
- Department of Microbiology, Agartala Government Medical College, Agartala 799006, India; (T.M.); (A.S.); (S.M.)
| | - Saikat Majumder
- Department of Microbiology, Agartala Government Medical College, Agartala 799006, India; (T.M.); (A.S.); (S.M.)
| | - Jotish Debbarma
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Dipanjan Dasgupta
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Arup Borgohain
- North Eastern Space Applications Centre, Department of Space, Government of India Umiam, Umiam 793103, India; (R.P.); (A.N.); (A.B.)
| | - Rajdeep Chanda
- Department of Forestry, Mizoram University, Aizawl 796004, India;
| | - Mandakini Das
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
- Roche Diagnostics India Pvt. Ltd., Mumbai 400069, India
| | - Karuna Gogoi
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Kongkona Gogoi
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Pyare Laal Joshi
- Formerly National Vector Borne Disease Control Program (NVBDCP), New Delhi 110054, India;
| | - Harpreet Kaur
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, New Delhi 110029, India; (A.P.); (H.K.); (A.M.K.)
| | - Biswajyoti Borkakoti
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Dibya Ranjan Bhattacharya
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
| | - Abdul Mamood Khan
- Indian Council of Medical Research (ICMR), Ramalingaswami Bhavan, New Delhi 110029, India; (A.P.); (H.K.); (A.M.K.)
| | - Satyajit Sen
- Regional Office of Health and Family Welfare, Kolkata 700106, India;
| | - Kanwar Narain
- Regional Medical Research Center-Northeast Region (RMRC-NE)-ICMR, Dibrugarh 786001, India; (J.D.); (D.D.); (M.D.); (K.G.); (K.G.); (B.B.); (D.R.B.); (K.N.)
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Kavirayani V, Madiyal M, Aroor S, Chhabra S. Clinical profile and role of serology in pediatric acute febrile illness: Experience from a tertiary care hospital in South India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Begam NN, Kumar A, Sahu M, Soneja M, Bhatt M, Vishwakarma VK, Sethi P, Baitha U, Barua K, Biswas A. Management of dengue with co-infections: an updated narrative review. Drug Discov Ther 2021; 15:130-138. [PMID: 34234061 DOI: 10.5582/ddt.2021.01027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dengue is a life-threatening mosquito borne viral disease. We are still in the era of supportive treatment where morbidity and mortality are a major concern. Dengue infection in presence of other co-infections makes this scenario rather worse. Timely recognition and raising alarm to be intensive is the need of the hour for primary care physicians practicing in the community and indoors. This review provides a comprehensive knowledge about the recent trends of coinfection in dengue as well as their management consideration which will be particularly helpful for physicians practicing in rural and remote areas of India.
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Affiliation(s)
- Nazneen Nahar Begam
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Monalisa Sahu
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Barua
- National Vector Borne Disease Control Programme (NVBDCP), Ministry of Health and Family Welfare (MOHFW), Government of India (GOI)
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci 2020; 36:1285-1290. [PMID: 32968395 PMCID: PMC7501039 DOI: 10.12669/pjms.36.6.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians.
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Affiliation(s)
- Noman Ali
- Noman Ali, Senior Instructor, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nadeem Ullah Khan
- Nadeem Ullah Khan Associate Professor, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahid Waheed
- Shahid Waheed Senior Instructor, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Mustahsan
- Syed Mustahsan Resident, Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Jayaprakash V, Vamsikrishna M, Indhumathi E, Jayakumar M. Scrub typhus-associated acute kidney injury: A study from a South Indian Tertiary Care Hospital. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 30:883-890. [PMID: 31464245 DOI: 10.4103/1319-2442.265464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infections including scrub typhus contribute to a significant proportion of community-acquired acute kidney injury (AKI) in the tropics. Scrub typhus infection now requires global attention since disease outbreaks are being reported across continents. We intended to study the clinical profile, renal involvement, and parameters predicting renal involvement in scrub typhus infection. This is a retrospective study. The medical records of all patients who were admitted and treated for scrub typhus infection for a study period of two years (from September 2015 to August 2017) were analyzed, and salient clinical features and laboratory results were collected from the hospital data. Statistical analysis was done from the collected data. Our study had 272 patients including 81 children. Adults constituted 70.96% (n = 193) and the remaining 29.04% (n = 81) were pediatric population. Among adults, females constituted 62.7% (n = 121) and males 37.3% (n = 72). The mean age of the adult population was 45.7 ± 15 years and that of pediatric patients was 8.56 ±5.1 years. 18.7% of adult cases and 3.70% of pediatric cases had AKI. Renal replacement therapy was required in 3.67% of adult cases. Mortality was 4.14% in adults and 1.23% in children. Hypotension, pulmonary involvement, central nervous system involvement, multiorgan dysfunction syndrome, increased total counts, elevated aspartate transaminase levels, and hypoalbuminemia predicted AKI in our adult population. Scrub typhus should be considered as a differential in cases presenting with fever and AKI. Outcomes of scrub typhus infection in terms of mortality seem to be improving in this region.
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Affiliation(s)
- V Jayaprakash
- Department of Nephrology, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - M Vamsikrishna
- Department of Nephrology, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - E Indhumathi
- Department of Nephrology, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - M Jayakumar
- Department of Nephrology, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Vikram K, Agarwala P, Bhargava A, Jain Y, Jagzape T, Wasnik P. Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation. Trop Doct 2019; 50:111-115. [PMID: 31779530 DOI: 10.1177/0049475519889712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1%). Patients in the age group 16-30 years were the most commonly affected. The commonest presenting symptoms were fever with headache (68.57%), extreme weakness (57.14%), myalgia/arthralgia (54.29%) and abdominal pain (51.43%). The preliminary evidence for the presence of scrub typhus in Chhattisgarh necessitates its inclusion in the panel of tests for AFI.
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Affiliation(s)
- Kumar Vikram
- Senior Resident, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pragya Agarwala
- Senior Resident, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anudita Bhargava
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yogesh Jain
- Consultant Paediatrician, Jan Swasthya Sahyog (A hospital in rural settings), Ganiyari, Bilaspur, Chhattisgarh, India
| | - Tushar Jagzape
- Additional Professor, Department of Paediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pritam Wasnik
- Associate Professor, Department of Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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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; 19:577. [PMID: 31272417 PMCID: PMC6610835 DOI: 10.1186/s12879-019-4185-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute undifferentiated febrile illness (AUFI) is caused by a multitude of diverse pathogens, with significant morbidity and mortality in the developing world. The objective of this review was to characterise the diversity and relative importance of common infectious aetiologies of AUFI in South and Southeast Asia. METHODS We conducted a comprehensive literature review to identify common aetiologies of AUFI in Asian countries. Four medical and life sciences databases including PubMed, Medline, Embase and Cochrane Central, and Google Scholar were searched for articles published from January 1998 to March 2019. RESULTS Forty-three studies met the inclusion criteria. Among AUFI cases, viral aetiologies at 18.5% (14888) were more common than bacterial aetiologies (12.9% [10384]). From 80,554 cases, dengue fever was the most common aetiology (11.8%, 9511), followed by leptospirosis (4.4%, 3549), typhoid (4.0%, 3258), scrub typhus (4.0%, 3243) and influenza other than H1N1 (3.1%, 2514). In both adults and children: dengue fever was the leading cause of AUFI with 16.6% (1928) and 18.7% (1281) of the total cases. In admitted patients, dengue fever was the main cause of AUFI at 16.4% (2377), however leptospirosis at 13.9% (2090) was the main cause of AUFI for outpatients. In South Asia, dengue fever was the main cause of AUFI, causing 12.0% (6821) of cases, whereas in Southeast Asia, leptospirosis was the main diagnosis, causing 12.1% (2861) of cases. CONCLUSIONS In this study the most common causes of AUFI were viral, followed by bacterial and protozoal (malaria) infections. Dengue was the commonest virus that caused AUFI while leptospirosis and typhoid were important bacterial infectious causes. Therefore, it is imperative to maintain a sound epidemiological knowledge of AUFI so that evidence-based diagnostic criteria and treatment guidelines can be developed.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.
| | | | - Susana Vaz Nery
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, QLD, South Brisbane, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Chunchanur SK, Venugopal SJ, Ambica R, Dakshayani B. Phylogenetic diversity of Orientia tsutsugamushi isolates in patients with scrub typhus in Bengaluru, India. Indian J Med Microbiol 2019; 37:438-441. [PMID: 32003348 DOI: 10.4103/ijmm.ijmm_19_267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Scrub typhus has re-emerged as an important cause of acute febrile illness in India. There is a dearth of information on strain diversity of Orientia tsutsugamushi from Karnataka, India, hence the present study sought to address this issue. One hundred clinically suspected cases of scrub typhus/rickettsiosis (as per the DHR-ICMR guidelines) were included. Nested-polymerase chain reaction (PCR) for 56-kDa gene and phylogenetic analysis was performed. PCR was positive in 22 cases and phylogenetic analysis showed the presence of different strains, with predominance of clustering (57%) with Gilliam-type for the first time in Karnataka. Knowledge of genetic diversity has implications in development of diagnostics and vaccine.
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Affiliation(s)
- Sneha K Chunchanur
- Department of Microbiology, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India
| | - Shwetha J Venugopal
- Department of Microbiology, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India
| | - R Ambica
- Department of Microbiology, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India
| | - B Dakshayani
- Department of Paediatrics, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India
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Behera B, Biswal M, Das RR, Dey A, Jena J, Dhal S, Mohanty S, Mishra B, Praharaj AK. Clinico-epidemiological analysis of scrub typhus in hospitalised patients presenting with acute undifferentiated febrile illness: A hospital-based study from Eastern India. Indian J Med Microbiol 2019; 37:278-280. [PMID: 31745031 DOI: 10.4103/ijmm.ijmm_19_147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acute undifferentiated febrile illness (AUFI) constitutes the predominant cause of healthcare seeking in Odisha. This prospective study was conducted to analyse the clinical, epidemiological and laboratory profile of scrub typhus patients presenting with AUFI from January to December 2017. Four hundred and thirty-two samples were tested for dengue, malaria, scrub typhus and enteric fever. Scrub typhus was overall the most common cause of AUFI (26.3%, 114/432) followed by dengue (19.2%, 83/432). Eschar was seen in 6.1% of cases. Aetiologies of 38.6% of AUFI remained unidentified. In the present study, there was no mortality attributed to scrub typhus.
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Affiliation(s)
- Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Jayanti Jena
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Sagarika Dhal
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
| | - Ashok Kumar Praharaj
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, India
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