Evaluation of prolonged febrile illness in elderly

Nirmal Chandra Sahu, Prafulla Kumar Dash, Arindam Maitra, Samarendra Nath Das, Saroj Kumar Tripathy


Background: Febrile illness in elderly patients in hospitals is a challenge to the physician for diagnosis and treatment due to high morbidity as well as mortality and it increases if the febrile illness is prolonged. So proper evaluation and effective management is necessary for a better outcome. Keeping in mind the scarcity of studies in elderly febrile illness in India this study was taken up.

Method: A prospective study was designed in medical ICU of S.C.B Medical college and Hospital, Cuttack Odisha, India. 50 patients were included in this study from July 2007 to December 2008. Institutional Ethics Committee cleared the study.

Results: In 50 elderly (Age>60 yrs) patients of prolonged febrile illness, 36 (72%) were male and 14 (28%) were female. All had fever for >21 days. Pallor was the commonest sign (62%). 30 patients had infectious etiology, 15 had malignancies. Tuberculosis was the commonest infection (28%) comprising of 46.66% of infectious etiology with Pulmonary Tuberculosis (PTB) in 20% and Extrapulmonary Tuberculosis (ETB) in 26.66%. Malignancies accounted for 30% of cases with Non-Hodgkin’s lymphoma (NHL) in 33.33% being the commonest amongst the malignancies. On follow up of 50 patients 21 (42%) got cured.

Conclusion: Febrile illness in elderly needs carefully evaluation as infections account for  most of the cases and Tuberculosis in our part of India as a major cause in these patients is treatable. Malignancies remain the second most common cause where timely intervention goes a long way in reducing morbidity and mortality.


Elderly, Malignancy, Non-infectious, Prolonged febrile illness, Tuberculosis

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Meisheri YV. Geriatric Service -need of the hour J. Postgrad Med. 1992;38:130-5.

Dhar HL. Emerging Geriatric Challenge. J Assoc Physici India. 2005 Oct;53:867-72.

Census of India 2001, 2006; Help Age India-2005 available at Elderly In India- Profile and Programmes 2006 (Second Issue), Central Statistical Organisation, Ministry of Statistics and Programme Implementation, Government Of India. Available at:

Chen Y, Zheng M, Hu X, Li Y, Zeng Y, Gu D, et al. Fever of unknown origin in elderly people: a retrospective study of 87 patients in China. J Am Geriatr Soc. 2008 Jan;56(1):182-4.

Vanderscheuren S, Knockaert D, Adriaenssens T. From prolonged fever illness to fever of unknown origin. Arch Int Med May. 2003;163:1033-41.

Saxena SR,. Clinical profile of pyrexia unknown origin in elderly population, Joshi a, Nigam O, Poster abs. Diamond APICON; 2005.

Esposito AL, Gleckman RA. Fever of unknown origin in the elderly. J Am Geriatr Society. 1978 Nov;26(11):498-505.

Knockart DC, Vannestc LJ, bobbaers HJ. Fever of unknown origin in elderly patients. J Am Geriatr soc. 1993:41(11):1187-92.

Önal İK, Cankurtaran M, Çakar M, Halil M, Ülger Z, Doğu BB, et al. Fever of unknown origin: what is remarkable in the elderly in a developing country?. Journal of infection. 2006 Jun 1;52(6):399-404.

Handa R, Singh S, Singh N, Wali JP. Fever of unknown origin: a prospective study. Tropical doctor. 1996 Oct;26(4):169-70.

Arora VK, Pulmonary Tuberculosis. In: Gupta R, Geriatric care ed in. ; Viva Books. O.P. Sharma 8th ed; 2008;150-160.

Khilnani GC, V Kumar. Tuberculosis in elderly. In Tuberculosis: Jaypee. ed Sharma SK, Mohan A; 2006:434-438.

Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004 Dec 1;39(11):1654-9.

Karchmer AW. Infective Endocarditis. In Barunwald’s Heart Disease 8th ed. Elsiver 2008:1633-1658.

Wetzler M, Byrd JC, Bloomfield CD, Acute and chronic myeloid leukaemia. In Harrison’s principles of Int. Med 17th ed Mc Graw Hill; 2008:I:677-686.