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Nonmalarial Acute Undifferentiated Fever in a Rural Hospital in Central India: Diagnostic Uncertainty and Overtreatment with Antimalarial Agents

Nonmalarial acute undifferentiated fever (NMAUF) refers to a febrile illness with no indication of an organ-specific disease after diagnosis of malaria has been excluded. In developing countries, the empirical treatment of NMAUFs with antimalarial drugs continues even in the era of highly specific rapid diagnostic tests (RDTs) for malaria. We carried out a retrospective review of patients with fever admitted to a rural teaching hospital in central India. We categorized patients with NMAUF into different clinical syndromes and determined their demographic profile, inhospital course, and the pattern of antimalarial use. The study sample included 1,197 adult patients who were investigated for malaria; 1,053 (88%) of them had NMAUF, and use of further diagnostics in this group was limited. Despite one or more negative tests for malaria, many patients (39.9%, 95% CI 37.0–43.3) received antimalarial drugs. These results suggest a need for guidelines and training to improve empirical treatment of NMAUF.

Received September 12, 2007. Accepted for publication December 17, 2007.

Acknowledgments: The authors thank Santosh Chavhan, B.S.W., Prashant Raut, B.A., and Vinod Kulkarni, M.S.W., for helping with data collection and entry.

^* Address correspondence to Shriprakash Kalantri, Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram Distt. Wardha, Maharashtra, India 442102. E-mail: sp.kalantri{at}gmail.com

R.J. is a recipient of a training fellowship from the Fogarty AIDS International Training Program (AITRP), USA (grant 1-D43-TW00003-17).

Fogarty AIRTP had no role in the design, conduct, or review of this manuscript.

Authors’ addresses: Rajnish Joshi, Division of Epidemiology, 101 Haviland Hall, University of California, Berkeley, CA 94720, and Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram Distt. Wardha, Maharashtra, India 442102, Telephone: +91-988-101-8559, Fax: +91-7152-284967, E-mails: rjoshi{at}berkeley.edu and rjoshimgims{at}gmail.com. John M. Colford Jr., Division of Epidemiology, 113A Haviland Hall, University of California, Berkeley, CA 94720, Telephone: +1 (510) 642-9370, Fax: +1 (510) 228-5931, E-mail: jcolford{at}berkeley.edu. Arthur L. Rein-gold, Division of Epidemiology, 104 Haviland Hall, University of California, Berkeley, CA 94720, Telephone: +1 (510) 642-0327, Fax: +1 (510) 643-5163, E-mail: reingold{at}berkeley.edu. Shriprakash Kalantri, Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram Distt. Wardha, Maharashtra, India 442102, Telephone: +91-7152-284341, ext. 327, Fax: +191-7152-284967, E-mail: sp.kalantri{at}gmail.com.

Reprint requests: Shriprakash Kalantri, Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram Distt. Wardha, Maharashtra, India 442102, Telephone: +91-7152-284341, ext. 327, Fax: +91-7152-284967, E-mail: sp.kalantri{at}gmail.com.