Vector-Borne Disease is a Common Cause of Hospitalized Febrile Illness in India

Matthew L. Robinson Johns Hopkins University School of Medicine, Baltimore, Maryland;
Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Dileep Kadam Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Sandhya Khadse Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Usha Balasubramanian Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Priyanka Raichur Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Chhaya Valvi Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Ivan Marbaniang Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Savita Kanade Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Jonathan Sachs Tulane University School of Medicine, New Orleans, Louisiana;

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Anita Basavaraj Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Renu Bharadwaj Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Anju Kagal Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Vandana Kulkarni Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Jonathan Zenilman Johns Hopkins University School of Medicine, Baltimore, Maryland;

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George Nelson Vanderbilt University School of Medicine, Nashville, Tennessee

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Yukari C. Manabe Johns Hopkins University School of Medicine, Baltimore, Maryland;

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Aarti Kinikar Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;
Byramjee Jeejeebhoy Government Medical College, Pune, India;

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Amita Gupta Johns Hopkins University School of Medicine, Baltimore, Maryland;
Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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Vidya Mave Johns Hopkins University School of Medicine, Baltimore, Maryland;
Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India;

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DOI:
https://doi.org/10.4269/ajtmh.17-0571
Volume/Issue:
Volume 98: Issue 5
Page(s):
1526–1533
Restricted access
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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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Author Notes

Address correspondence to Amita Gupta, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 540, Baltimore, MD 21287. E-mail: agupta25@jhmi.edu

Financial support: This work was supported by the Ujala Foundation, Gilead Foundation, Wyncote Foundation, UJMT Fogarty Global Health Fellows Program (National Institutes of Health [NIH] Research Training Grant R25 TW009340), NIH training grant T32 AI007291, NIH Fogarty International Center grant D43TW009574, and the NIH/NIAID Johns Hopkins Baltimore-Washington-India Clinical Trials Unit (BWI CTU) UM AI069465. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Authors’ addresses: Matthew L. Robinson, Jonathan Zenilman, and Yukari C. Manabe, Johns Hopkins University School of Medicine, Baltimore, MD, E-mails: mrobin85@jhmi.edu, jzenilma@jhmi.edu, and ymanabe@jhmi.edu. Dileep Kadam, Sandhya Khadse, Chhaya Valvi, Renu Bharadwaj, Anju Kagal, and Aarti Kinikar, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, and Byramjee Jeejeebhoy Government Medical College, Pune, India, E-mails: deelipkadam@gmail.com, sandhyakhadse@yahoo.com, chhayavalvi@gmail.com, renu.bharadwaj@gmail.com, kagalanju@gmail.com, and aarti.kinikar63@gmail.com. Usha Balasubramanian, Priyanka Raichur, Ivan Marbaniang, Savita Kanade, and Vandana Kulkarni, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, E-mails: usha.kbs5@gmail.com, dr.priyanka.a.k@gmail.com, ivanmarb@gmail.com, savita_kanade@hotmail.com, and vandanakulkarni_5@hotmail.com. Jonathan Sachs, Phoenix Children’s Hospital/Maricopa Medical Center, Phoenix, AZ, E-mail: jsachs@phoenixchildrens.com. Anita Basavaraj, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, and Government Medical College Miraj, Miraj, India, E-mail: anita.basavaraj@rediffmail.com. George Nelson, Vanderbilt University School of Medicine, Nashville, TN, E-mail: george.nelson@vanderbilt.edu. Amita Gupta and Vidya Mave, Johns Hopkins University School of Medicine, Baltimore, MD, and Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, E-mails: agupta25@jhmi.edu and vidyamave@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2018
Received:
18 Jul 2017
|
Accepted:
27 Jan 2018
|
Published Online:
26 Mar 2018
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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