Vector-borne disease is a common cause of hospitalized febrile illness in India

Matthew Robinson, Dileep Kadam, Sandhya Khadse, Usha Balasubramanian, Priyanka Raichur, Chhaya Valvi, Ivan Marbaniang, Savita Kanade, Jonathan Sachs, Anita Basavaraj, Renu Bharadwaj, Anju Kagal, Vandana Kulkarni, Jonathan Mark Zenilman, George Nelson, Yukari C Manabe, Aarti Kinikar, Amita Gupta, Vidya Mave

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1526-1533
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume98
Issue number5
DOIs
StatePublished - Jan 1 2018

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Disease Vectors
India
Fever
Pneumonia
Central Nervous System Infections
Dengue
Bacteremia
Culicidae
Meningitis
General Hospitals
Malaria
Uncertainty
Morbidity
Mortality
Infection

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

Cite this

Vector-borne disease is a common cause of hospitalized febrile illness in India. / Robinson, Matthew; Kadam, Dileep; Khadse, Sandhya; Balasubramanian, Usha; Raichur, Priyanka; Valvi, Chhaya; Marbaniang, Ivan; Kanade, Savita; Sachs, Jonathan; Basavaraj, Anita; Bharadwaj, Renu; Kagal, Anju; Kulkarni, Vandana; Zenilman, Jonathan Mark; Nelson, George; Manabe, Yukari C; Kinikar, Aarti; Gupta, Amita; Mave, Vidya.

In: American Journal of Tropical Medicine and Hygiene, Vol. 98, No. 5, 01.01.2018, p. 1526-1533.

Research output: Contribution to journalArticle

Robinson, M, Kadam, D, Khadse, S, Balasubramanian, U, Raichur, P, Valvi, C, Marbaniang, I, Kanade, S, Sachs, J, Basavaraj, A, Bharadwaj, R, Kagal, A, Kulkarni, V, Zenilman, JM, Nelson, G, Manabe, YC, Kinikar, A, Gupta, A & Mave, V 2018, 'Vector-borne disease is a common cause of hospitalized febrile illness in India', American Journal of Tropical Medicine and Hygiene, vol. 98, no. 5, pp. 1526-1533. https://doi.org/10.4269/ajtmh.17-0571
Robinson, Matthew ; Kadam, Dileep ; Khadse, Sandhya ; Balasubramanian, Usha ; Raichur, Priyanka ; Valvi, Chhaya ; Marbaniang, Ivan ; Kanade, Savita ; Sachs, Jonathan ; Basavaraj, Anita ; Bharadwaj, Renu ; Kagal, Anju ; Kulkarni, Vandana ; Zenilman, Jonathan Mark ; Nelson, George ; Manabe, Yukari C ; Kinikar, Aarti ; Gupta, Amita ; Mave, Vidya. / Vector-borne disease is a common cause of hospitalized febrile illness in India. In: American Journal of Tropical Medicine and Hygiene. 2018 ; Vol. 98, No. 5. pp. 1526-1533.
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AU - Robinson, Matthew

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 Mark

AU - Nelson, George

AU - Manabe, Yukari C

AU - Kinikar, Aarti

AU - Gupta, Amita

AU - Mave, Vidya

PY - 2018/1/1

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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.

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