Study of aetiology and clinical spectrum of patients with acute undifferentiated fever, in a tertiary care setting: a descriptive cross-sectional study


  • Vinay Jishtu Department of Health and Family Welfare, Himachal Pradesh, India
  • Pramod K. Jaret Department of Medicine, Indira Gandhi Medical college, Shimla, Himachal Pradesh, India
  • Prem Chand Machhan Department of Medicine, Indira Gandhi Medical college, Shimla, Himachal Pradesh, India
  • Nidhi Chauhan Department of Health and Family Welfare, Himachal Pradesh, India



Acute undifferentiated fever illness, Clinical spectrum, Hospital based, North India


Background: Acute undifferentiated fever illness (AUFI) is a common cause of morbidity and mortality in developing countries, owing to its non-specific features. The aim of the study was to delineate the causes and clinical parameters associated with AUFI.

Methods: A cross-sectional study was done among 156 patients of AUFI, admitted in the Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from November 2018 to October 2019.

Results: The mean age of the study participants was 37.37±14.2 years. The study participants admitted for acute undifferentiated febrile illness had fever with mean duration of 8.38±3.7 days before hospitalization. The most common aetiology of AUFI was found to be enteric fever (44%), followed by scrub typhus (35%). The majority of the cases presented from the month of September to December.

Conclusions: The aetiology and clinical spectrum of AUFI is wide and variable. To outline a proper algorithm to contain it, meticulous analysis of the hospital data at each level is necessary.


Joshi R, Kalantri SP. Acute Undifferentiated Fever: Management Algorithm. Upd Tropical Fever. 2021;1-14.

Joshi R, colford JM, Reigold, Kalantri S. Non malarial acute undifferentiated fever in a rural hospital in Central India: Diagnostic uncertainty and over treatment with anti-malarial agents. Am J Med Hygiene. 2008:7813:3931(9).

Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England). 2012;379(9832):2151-61.

Bell M, Archibald LK, Nwanyanwu O, Dobbie H, Tokars J, Kazembe PN, Reller LB, Jarvis WR. Seasonal variation in the etiology of bloodstream infections in a febrile inpatient population in a developing country. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2001;5(2):63-9.

Coker RJ, Hunter BM, Rudge JW, Liverani M, Hanvoravongchai P. Emerging infectious diseases in Southeast Asia: regional challenges to control. Lancet (London, England). 2011;377(9765):599-609.

Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934-9.

Abhilash KP, Jeevan JA, Mitra S, Paul N, Murugan TP, Rangaraj A, David S, Hansdak SG, Prakash JA, Abraham AM, et al. Acute undifferentiated febrile illness in patients presenting to a tertiary Care Hospital in South India: clinical Spectrum and outcome. J Global Infect Dis. 2016;8(4):147-54.

Gopalakrishnan S, Arumugam B, Kandasamy S, Rajendran S, Krishnan B. Acute undifferentiated febrile illness among adults - a hospital based observational study. J Evol Med Dent Sci. 2013;2(14):2305-19.

Gubler DJ. The global emergence/resurgence of arboviral diseases as public health problems. Arch Med Res. 2002;33(4):330-42.

Mittal G, Ahmad S, Agarwal RK, Dhar M, Mittal M, Sharma S. Aetiologies of Acute Undifferentiated Febrile illness in Adult Patients - an Experience from a Tertiary Care Hospital in Northern India. J Clin Diagn Res. 2015;9(12):DC22-DC24.

Mørch, K., Manoharan, A., Chandy, S. et al. Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy. BMC Infect Dis. 2017;17:665.

Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Flom JE, Dumler JS, Woods CW. Leptospirosis as frequent cause of acute febrile illness in southern Sri Lanka. Emerg Infect Dis. 2011;17(9):1678-84.

Raina S, Raina RK, Agarwala N, Raina SK, Sharma R. Coinfections as an aetiology of acute undifferentiated febrile illness among adult patients in the sub-Himalayan region of North India. Journal of vector borne diseases. 2018;55(2):130-6.

Andrews MA, Ittyachen AM. Aetiology of acute febrile illness: a multicentre study from the province of Kerala in southern India. Trop Dr. 2018;48(4): 322-5.

Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, Scott RM, Basnyat B, Archibald LK, Reller LB. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Med Hygiene. 2004;70(6):670-5.

Kumar R, Tripathi P, Tripathi S, Kanodia A, Pant S, Venkatesh V. Prevalence and clinical differentiation of dengue fever in children in northern India. Infection. 2008;36(5):444-9.

Ahmad S, Dhar M, Mittal G, Bhat NK, Shirazi N, Kalra V, Sati HC, Gupta V. A comparative hospital-based observational study of mono and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever. Eur J Clin Microbiol Infect Dis. 2016;35(4):705-11.

Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clinical microbiology and infection. Eur J Clin Microbiol Infect Dis. 2018;24(8):827-35.

Laras K, Cao BV, Bounlu K, Nguyen TK, Olson JG, Thongchanh S, Tran NV, Hoang KL, Punjabi N, Ha BK, et al. The importance of leptospirosis in Southeast Asia. Am J Med Hygiene. 2002;67(3):278-86.

Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9(9):e0003898.

Kamath R, Swain S, Pattanshetty S, Nair NS. Studying risk factors associated with human leptospirosis. J Global Infect Dis. 2014;6(1):3-9.






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