TY - JOUR
T1 - Vector-borne disease is a common cause of hospitalized febrile illness in India
AU - Robinson, Matthew L.
AU - Kadam, Dileep
AU - Khadse, Sandhya
AU - Balasubramanian, Usha
AU - Raichur, Priyanka
AU - Valvi, Chhaya
AU - Marbaniang, Ivan
AU - Kanade, Savita
AU - Sachs, Jonathan
AU - Basavaraj, Anita
AU - Bharadwaj, Renu
AU - Kagal, Anju
AU - Kulkarni, Vandana
AU - Zenilman, Jonathan
AU - Nelson, George
AU - Manabe, Yukari C.
AU - Kinikar, Aarti
AU - Gupta, Amita
AU - Mave, Vidya
N1 - Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
PY - 2018
Y1 - 2018
N2 - Acute febrile illness (AFI) is a major cause of morbidity and mortality in India and other resource-limited settings, yet systematic etiologic characterization of AFI has been limited. We prospectively enrolled adults (N = 970) and children (age 6 months to 12 years, N = 755) admitted with fever from the community to Sassoon General Hospital in Pune, India, from July 2013 to December 2015. We systematically obtained a standardized clinical history, basic laboratory testing, and microbiologic diagnostics on enrolled participants. Results from additional testing ordered by treating clinicians were also recorded. A microbiological diagnosis was found in 549 (32%) participants; 211 (12%) met standardized case definitions for pneumonia and meningitis without an identified organism; 559 (32%) were assigned a clinical diagnosis in the absence of a confirmed diagnosis; and 406 (24%) had no diagnosis. Vector-borne diseases were the most common cause of AFI in adults including dengue (N = 188, 19%), malaria (N = 74, 8%), chikungunya (N = 15, 2%), and concurrent mosquito-borne infections (N = 23, 2%) occurring most frequently in the 3 months after the monsoon. In children, pneumonia was the most common cause of AFI (N = 214, 28%) and death. Bacteremia was found in 68 (4%) participants. Central nervous system infections occurred in 58 (6%) adults and 64 (8%) children. Etiology of AFI in India is diverse, highly seasonal, and difficult to differentiate on clinical grounds alone. Diagnostic strategies adapted for season and age may reduce diagnostic uncertainty and identify causative organisms in treatable, fatal causes of AFI.
AB - Acute febrile illness (AFI) is a major cause of morbidity and mortality in India and other resource-limited settings, yet systematic etiologic characterization of AFI has been limited. We prospectively enrolled adults (N = 970) and children (age 6 months to 12 years, N = 755) admitted with fever from the community to Sassoon General Hospital in Pune, India, from July 2013 to December 2015. We systematically obtained a standardized clinical history, basic laboratory testing, and microbiologic diagnostics on enrolled participants. Results from additional testing ordered by treating clinicians were also recorded. A microbiological diagnosis was found in 549 (32%) participants; 211 (12%) met standardized case definitions for pneumonia and meningitis without an identified organism; 559 (32%) were assigned a clinical diagnosis in the absence of a confirmed diagnosis; and 406 (24%) had no diagnosis. Vector-borne diseases were the most common cause of AFI in adults including dengue (N = 188, 19%), malaria (N = 74, 8%), chikungunya (N = 15, 2%), and concurrent mosquito-borne infections (N = 23, 2%) occurring most frequently in the 3 months after the monsoon. In children, pneumonia was the most common cause of AFI (N = 214, 28%) and death. Bacteremia was found in 68 (4%) participants. Central nervous system infections occurred in 58 (6%) adults and 64 (8%) children. Etiology of AFI in India is diverse, highly seasonal, and difficult to differentiate on clinical grounds alone. Diagnostic strategies adapted for season and age may reduce diagnostic uncertainty and identify causative organisms in treatable, fatal causes of AFI.
UR - http://www.scopus.com/inward/record.url?scp=85046888448&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046888448&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.17-0571
DO - 10.4269/ajtmh.17-0571
M3 - Article
C2 - 29582731
AN - SCOPUS:85046888448
SN - 0002-9637
VL - 98
SP - 1526
EP - 1533
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 5
ER -