Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy
| Autor: | Ashita Singh, Sara Chandy, Anil Henry, Dilip Mathai, George Vasanthan Antony, Cijoy Kuriakose, Joel Nesaraj, Anand Manoharan, Nina Langeland, Siby Jacob Kurian, Suvarna Patil, Bjørn Blomberg, Kristine Mørch, Gerardo Alvarez-Uria, Christel Gill Haanshuus, Novin Chacko |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Bacteremia Scrub typhus medicine.disease_cause Dengue fever Dengue 0302 clinical medicine Diagnosis Prevalence Blood culture 030212 general & internal medicine Chikungunya Child Aged 80 and over Leptospira Rapid diagnostic test medicine.diagnostic_test biology Coinfection Middle Aged Leptospirosis Infectious Diseases Child Preschool Female Research Article Adult medicine.medical_specialty Adolescent Fever 030231 tropical medicine India lcsh:Infectious and parasitic diseases 03 medical and health sciences Internal medicine parasitic diseases medicine Humans lcsh:RC109-216 Aged business.industry Diagnostic Tests Routine medicine.disease biology.organism_classification bacterial infections and mycoses Virology Malaria Chikungunya Fever Bacteraemia business |
| Zdroj: | BMC Infectious Diseases, Vol 17, Iss 1, Pp 1-11 (2017) BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| DOI: | 10.1186/s12879-017-2764-3 |
| Popis: | Background The objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods. Methods During April 2011–November 2012, 1564 patients aged ≥5 years with febrile illness for 2–14 days were consecutively included in an observational study at seven community hospitals in six states in India. Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals. Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available. Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR. Results Malaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test. Conclusions Malaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India. |
| Databáze: | OpenAIRE |
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