Abstract:
Background: Fever is a common presenting complaint in the developing world. Due to high
prevalence of local individual diseases there is a need of differential diagnoses for acute
undifferentiated febrile illness (AFI). Acute undifferentiated febrile illness is defined as acute
onset of fever (fever more than 38 degree Celsius lasting for less than 2 weeks) and no cause
found after full history and physical examination. Objective: This study was carried out to find
out the etiology of AFI that present to a tertiary hospital in north Karnataka and to describe
disease specific clinical profiles. This was a 1 year prospective, observational study conducted
in adults (age >16 years) who presented with an undifferentiated febrile illness of duration
<15 days, requiring hospitalization. Materials and methods: The study consisted of 100
patients. Data was collected to identify sex, age range and duration of fever. The diagnosis was
done history, physical and laboratory examination. Blood cultures, malarial parasites and
febrile serology, in addition to clinical evaluations and basic investigations were performed.
Comparisons were made between each disease and the other AFIs. Results: scrub typhus
(33%), dengue (25%), enteric fever (14%), malaria (8.0%), spotted fever rickettsiosis (6.0%),
H1N1 (5.0%), and unclear diagnoses (9.0%). Leukocytosis, acute respiratory distress
syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminemia were
associated with scrub typhus and dengue. Normal leukocyte counts, moderate to severe
thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated
serum transaminases were associated with malaria. Enteric fever was associated with loose
stools, normal to low leukocyte counts and normal platelet counts. Conclusion: It is important
to maintain a proper epidemiological data of AFIs so that evidence-based diagnostic criteria
and treatment guidelines can be developed.
