Major aetiologies of acute undifferentiated fever in 2013 and 2014: an experience in retrospect
Keywords:AUF, Chikungunya, Dengue, Malaria
Background: Major aetiologies of acute undifferentiated fever (AUF) show wide variations, especially in developing countries including India. A better understanding of ‘AUF causes’ helps in better management of such cases with attendant reduction in morbidity and mortality. The present analytical study, retrospective in nature, estimates burden of the AUF in the years 2013 and 2014 with some useful information and conclusions.
Methods: Important pathogens ‘investigated for’ either as a ‘direct or indirect evidence’ included - Malaria parasite, Dengue virus, Salmonella typhi and paratyphi A and Chikungunya virus. Malaria testing included examination of peripheral blood smear with Giemsa stain and also immuno-chromatographic test to detect lactate dehydrogenase (LDH) for Plasmodium falciparum and Plasmodium vivax and also HRP2 for detection of Plasmodium falciparum infections. For dengue and chikungunya virus infections - specific IgM antibodies - were detected by ELISA test. Enteric fever was diagnosed by detecting IgM and IgG antibodies using enzyme immunoassay. For Widal test, agglutinating antibodies against the O and H antigens of S. typhi and “H” antigens of ‘S. paratyphi A’ were undertaken. All the test procedures, including sample collections, were performed as per manufacturer’s recommendations, and, as per ‘standard operating procedures (SOPs)’.
Results: Of the 10,670 samples received for dengue investigations, 3646 i.e. 34.17% tested seropositive for dengue cases. Percentage seropositivity for chikungunya was 18.6 (8/48). For dengue, 1193 (43.92%) and 488/577 (84.57%) samples were positive in the year 2013 and 2014 respectively in Delhi alone. Annual peak in months of September to November was observed for dengue while a bi-annual pattern was observed for malaria with two peaks occurring in months of May-June and August-September respectively for the year (s) i.e. 2013 and 2014. Enteric fever was present throughout the year with no specific distribution pattern. Majority of patients were from Delhi and adjoining Haryana followed by Western Uttar Pradesh. Co-infection of dengue with enteric fever was observed in only four cases.
Conclusions: Dengue, chikungunya, malaria and enteric fever were the most important major causes of AUF in the year 2013 and 2014. Improved interactions with clinician counterparts generating awareness about major aetiologies of AUF would help in timely detection of such illnesses and hence better management reducing morbidity and mortality in the long run.
Neeraja M, Lakshmi V, Dash PK, Parida MM, Rao PVL. The clinical, serological and molecular diagnosis of emerging dengue infection at a tertiary care institute in Southern. India J Clin Diagn Res. 2013;7(3):457-61.
National Vector Borne Disease Control Programme. Dengue/ dengue haemorrhagic fever, 2013. Available at http://www.nhp.gov.in/nvbdcp Accessed on 16 March 2014.
Neeraja M, Lakshmi V, Teja VD, Umbala P, Subbalakshmi MV. Serodiagnosis of dengue virus infection in patients presenting to a tertiary care hospital. Indian J Med Microbiol. 2006;24(4):280-2.
Cecilia D. Current status of dengue and chikungunya in India. WHO South- East Asia. J Public Health. 2014;3(1):22-7.
Arora BS, Chugh S, Gupta B, Aggarwal KC. Dengue and chikungunya virus fever outbreaks in Delhi, Ig M serology status: a recent experience. Nat J Basic Med Sci. 2012;2(4):336-40.
Joshi R, Colford JM, Reingold AL, Kalantri S. Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents. Am J Trop Med Hyg. 2008;78(3):393-9.
Chakravarti A, Kumar A, Matlani M. Displacement of dengue virus type 3 and type 2 by dengue virus type 1 in Delhi during 2008. Indian J Med Microbiol. 2010;28:412.
Malaria situation. National Vector Borne Disease control Programme. Available at http://nvbdcp.gov.in/Doc/mal_situation_Jan2015.pdf.
Kanungo S, Dutta S, Surrender D. Epidemiology of typhoid and paratyphoid fever in India. J Infect Dev Ctries. 2008;2(6):454-60.
Katyal R, Singh K, Kumar K. Seasonal variations in A. aegypti population in Delhi, India. Dengue Bull. 1996;20:78-81.
Banerjee T, Shukla BN, Filgona J, Anupurba S, Sen MR. Trends of typhoid fever seropositivity over ten years in North India. Indian J Med Res. 2014;140(2):310-3.
Susilawati TN, McBride WJ. Acute undifferentiated fever in Asia: a review of the literature. Southeast Asian J Trop Med Public Health. 2014;45(3):719-26.
Thangarasu S, Natarajan P. A protocol for emergency department management of acute undifferentiated febrile illness in India. Int J Emer Med. 2011;4:57.
Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors: an experience from a tertiary care hospital in South India. Trop Doctor. 2010;40(4):230-4.
Singh R, Singh SP, Ahmad N. A study of aetiological pattern in an epidemic of acute febrile illness during monsoon in a tertiary health care institute of Uttarakhand, India. J Clin Diagn Res. 2014;8(6):MC01-03.
Gopalakrishnan S, Arumugam B, Kandasamy S, Rajendran S, Krishnan B. Acute undifferentiated febrile illness among adults - a hospital based observational study. J Evolut Med Dent Sci. 2013;2(14):2305-19.
Kashinkunti MD, Gundikeri SK, Dhananjaya M. Acute undifferentiated febrile illness- clinical spectrum and outcome from a tertiary care teaching hospital of north Karnataka. Int J Biol Med Res. 2013;4(2):3399-402.
Jena B, Prasad MNV, Murthy S. Demand pattern of medical emergency services for infectious diseases in Andhra Pradesh - A geo-spatial temporal analysis of fever cases. Indian Emerg J. 2010;1(5):821.
Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, et al. The aetiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal. Am J Trop Med Hyg. 2004;70(6):670-5.
Sripanidkulchai R, Lumbiganon P. Aetiology of obscure fever in children at a university hospital in northeast Thailand. Southeast Asian J Trop Med Public Health. 2005;36:1243-6.
Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S. Aetiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai. 2004;87:464-72.
Ellis RD, Fukuda MM, McDaniel P, Welch K, Nisalak A, Murray CK, et al. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg. 2006;74:108-13.