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0INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE "STATUS AND DEVELOPMENT PROSPECTS OF FUNDAMENTAL AND APPLIED MICROBIOLOGY: THE VIEWPOINT OF YOUNG SCIENTISTS" _25-26 SEPTEMBER, 2024_
STUDY OF ACUTE FEBRILE ILLNESS CASES IN A TERTIARY CARE HOSPITAL - A CROSS SECTIONAL STUDY
1Areena Hoda Siddiqui, 2Sandipika Dubey
1Professor and Head, Dept of Microbiology, IIMSR, Integral University 2Research Scholar, Dept of Microbiology, IIMSR, Integral University https://doi.org/10.5281/zenodo.13828326 Affiliation: Integral Institute of Medical Sciences Research, Department of Microbiology, Lucknow, Uttar Pradesh, India.
Key words: Acute Febrile illness, Dengue, Leptospirosis
INTRODUCTION:
Acute febrile illness (AFI) is characterised by an abrupt increase in body temperature exceeding 38° C (100.4 ° F) that lasts for 2-14 days without any particular cause, that remains unidentified even after basic examinations. [1]. The presensation to hospital is very vague i.e. fever, headache, joint pain, myalgia and splenomegaly; without any focal point of infection, making its diagnosis and management a challenging affair [2]in the developing countries, the etiologies of AFI includes potentially significant infections such as malaria, enteric fever, rickettsiosis, leptospirosis, brucellosis, dengue fever, chikungunya and Japanese encephalitis.(3,4).Therefore establishing the epidemiology and prevalence of the microorganisms causing the illness is essential for creating empirical antibiotic treatment guideline. Access to diagnostic tests is limited in resource-constrained environments; fever may be self-treated or managed empirically. Therefore, in order to focus clinical work up and treatment, knowledge of the incidence of illnesses in a certain area is essential [5].The goal of the current study was to determine the cause of AFI in patients who were receiving care at tertiary care institution.
MATERIAL AND METHOD:
Study Design and period: This cross-sectional prospective study was carried out from January 2024 to June 2024 in a tertiary care hospital.
Ethical clearance: This study received ethical clearance from the Institutional Research Committee and Institutional Ethical Committee on 27th March 2024 (IEC/nMSR/2024/66).
Inclusion Criteria:
All individuals with febrile illnesses who have had symptoms for more than five days and an axillary temperature >37.5°C were included.
Exclusion Criteria:
All lipemic and hemolytic blood samples; incorrect labeling; insufficient sample quantity; and individuals who decline to agree for the study and whose age is less than one year have been excluded in the study.
Data Collection: IPD details for patients were collected from the case sheet, whereas OPD patients' complete history was obtained through the patient proforma.
Data Analysis and Interpretation:
Data analysis was performed by using MS Excel, SPSS software and presented in number and percentage using graphs as well as tables.
Laboratory Methods: A total of 210 samples of patients from OPD and IPD were processed in the Department of Microbiology, IIMSR and an analysis was conducted to identify
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE "STATUS AND DEVELOPMENT PROSPECTS OF FUNDAMENTAL AND APPLIED MICROBIOLOGY: THE VIEWPOINT OF YOUNG SCIENTISTS" _25-26 SEPTEMBER, 2024_
AFI. Dengue NS1, IgM, and IgG were tested using Capture ELISA Test System (J.Mitra Co. & Pvt. Ltd). Malaria was identified using Rapid antigen test (ADVANTAGE MALCARD immunochromatography testing technology, J.Mitra Co. &Pvt.Ltd).This was followed by confirmation using smear microscopy of a peripheral blood smear. Typhoid was tested using Widal test and a Tydal kit (Tulip Diagnostics). Titres of O>1: 80, H>1:160, or a four-fold rise in titres were considered significant. The Rapid Test (CTK BioTEC) was used to identify typhoid IgM antibodies. Scrub Typhus was detected using an immunochromatography testing method (J.Mitra Co. & Pvt.Ltd.'s Rapidcard).
In this study, 210 individuals with AFI were evaluated. The etiology of AFI is presented in Fig 1. Result:
50 45 40 Si 35 " 30 S 25 'S 20 -S 15 io 5 O li y 1 L
Dengue Ivl a 1 a rl a 1 y phoïd Scrub typhus
H INIo. of Positive cases 37 47 23 1
H Percentage 17.62 22.38 13.33 0-48
Fig .1 showing Acute febrile illness aetiology
Out of 210 individuals involved in this study, 110 (51%) were female & 100 (49%) were male.The age group of 11-20 years (23%), accounted for the majority of patients in our research, followed by 21-30 years, (22%).
As shown in Table 1, co-infections were frequent; 24 individuals (11.4%) had co-
infections.
Table.1: Distribution of co- infection among AFI cases.
CO-INFECTIONS Total N= 281 PERCENTAGE (%)
Dengue/Typhoid 8 3.8%
Dengue /Malaria 6 2.8%
Malaria /Typhoid 5 2.3%
Dengue/ Malaria /Typhoid 4 1.9%
Malaria/ Scrub Typhus 1 0.47%
Total 24 11.4%
Discussion:
In the developing tropical countries, it is important to diagnose acute febrile illness as soon as possible. These various illnesses pose diagnostic issues because many of their clinical symptoms are nonspecific and overlap. A total of 210 individuals with an acute febrile fever during the research period were assessed. Microbiological tests targeting common tropical disease causative agents such as dengue, typhoid, malaria and scrub typhus were performed. Numerous investigations [7] have detected and recorded cases of acute fever in addition to tropical locations [7].
Our data revealed that 22.38% of the 47 cases of acute febrile illness were caused by malaria. In 28 cases (13.33%) typhoid, scrub typhus in 1 cases (0.48%), and dengue in 37 cases
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE "STATUS AND DEVELOPMENT PROSPECTS OF FUNDAMENTAL AND APPLIED MICROBIOLOGY: THE VIEWPOINT OF YOUNG SCIENTISTS" 25-26 SEPTEMBER, 2024
(17.6%) were identified. M0rch et al. noted a similiar result. Of these, 35% were diagnosed with Salmonella typhi or S. paratyphi, 16% (244/1564) with dengue, and 17% (268/1564) with malaria. [8]. The diagnosis of scrub typhus was made in 10% of cases. Conversely, Vidya Rani et al. discovered that dengue was the most common cause of acute febrile illness in 54 cases (27%).[9] There were two (1%), four (2%) and six (3%), respectively, cases with rickettsia, malaria and typhoid infections.
According to our research, females are more likely to have AFI. The AFI percentages of 110 female participants (51%) and 100 male participants (49%) in our study were comparable to those reported by other investigators. [6,10-13] However, males were more frequently afflicted than females, with 118 cases of acute febrile sickness, of which 37 were detected, according to Vidya Rani et al.'s report.[9] In present study, AFI disease is more common in the 11-20years age group because active individuals are more likely to be afflicted by these illnesses, which is in line with the outcomes of other studies. Patients between the ages of 20 and 40 were most affected. [11,12]
In Present study overall co-infection rate was 11.4%. Dengue and Typhoid co-infection were more common (3.8%) similar findings were reported by Sharma Y, et al. [11] Of the 659 febrile sera samples tested here, 141 (21.39%) tested positive for dengue. Of these 91 were females and 50 males. Of the dengue cases, eleven were co-infected with enteric fever (11/141= 7.8%). Conclusion:
Malaria is the most prevalent cause of acute fever disease in tropical regions, followed by Dengue and Typhoid. In a tertiary care hospital, 11.4% of patients have co-infections, which might be reduced with effective diagnosis and etiological characterization. Accurate diagnosis is critical for avoiding treatment delays and consequences. Confirmatory diagnostic testing is critical for lowering morbidity and mortality in acute febrile sickness patients. Vector control measures and public knowledge of monitoring and preventive measures should be improved in order to reduce illness loads. Sustained monitoring and investigation are necessary to have a deeper comprehension of the changing trends in AFI.
Acknowledgement: We would like to thank Integral University for funding this project.
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INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE "STATUS AND DEVELOPMENT PROSPECTS OF FUNDAMENTAL AND APPLIED MICROBIOLOGY: THE VIEWPOINT OF YOUNG SCIENTISTS" 25-26 SEPTEMBER, 2024
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