1921
Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Acute febrile illnesses (AFIs) in children from the developing world can have varying etiologies. Awareness of local epidemiology helps in prioritizing investigations and empiric treatment. This prospective study was carried out in a tertiary care center in North India, aiming to determine the burden, etiology, and outcome of AFI other than pneumonia and diarrhea in hospitalized children. A total of 613 consecutive children aged 3 months to 12 years with febrile illness of < 7 days during four selected months of 2014 representing different seasons were screened for eligibility. Those with acute respiratory diseases ( = 175, 28.5%) and diarrheal illness ( = 46, 7.5%) were excluded and 217 children were enrolled. Mean (standard deviation) age was 4.8 (3.4) years. Nearly half ( = 91, 41.9%) presented in post-monsoon season. Diagnosis could be established in 187 (86.2%) children. Acute central nervous system infections were the most common ( = 54, 24.8%). Among specific infections, scrub typhus was the most frequent ( = 23, 10.5%) followed by malaria ( = 14, 6.4%), typhoid ( = 14, 6.5%), and viral hepatitis ( = 13, 6.0%). Blood culture had a low (6.5%) yield; ( = 6) and ( = 5) were the common isolates. Serological tests were helpful in 50 (23%) cases. In multivariate analysis, hepatomegaly and/or splenomegaly independently predicted scrub typhus. Mortality rate was 10.1%. We conclude that AFI other than pneumonia and diarrhea are a significant burden and follow a seasonal trend. Scrub typhus has emerged as an important etiology of childhood AFIs in northern India. Periodic review of regional epidemiology will help in understanding the changing pattern of infectious diseases.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0056
2018-07-09
2019-07-17
Loading full text...

Full text loading...

/deliver/fulltext/14761645/99/3/tpmd180056.html?itemId=/content/journals/10.4269/ajtmh.18-0056&mimeType=html&fmt=ahah

References

  1. Chheng K, 2013. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia. PLoS One 8: e60634. [Google Scholar]
  2. Mahende C, Ngasala B, Lusingu J, Butichi A, Lushino P, Lemnge M, Premji Z, , 2014. Aetiology of acute febrile episodes in children attending Korogwe District Hospital in north-eastern Tanzania. PLoS One 9: e104197. [Google Scholar]
  3. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE, , 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet 388: 30273035. [Google Scholar]
  4. UN Inter-agency Group for Child Mortality Estimation, 2012. Levels and Trends in Child Mortality. Available at: http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2012/en/. Accessed April 5, 2015.
  5. Bhutta ZA, Ali S, Cousens S, Ali TM, Haider BA, Rizvi A, Okong P, Bhutta SZ, Black RE, , 2008. Alma-Ata: rebirth and revision 6 interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make? Lancet 372: 972989. [Google Scholar]
  6. Shukla D, Nayak P, Mishra RN, , 2016. Burden of infectious diseases and their seasonal variation in India. IJHSR 6: 3340. [Google Scholar]
  7. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis, 2006. Diagnosis and management of bronchiolitis. Pediatrics 118: 17741793. [Google Scholar]
  8. World Health Organization, 2014. Revised WHO Classification and Treatment of Childhood Pneumonia at Health Facilities—Evidence Summaries. Available at: http://www.who.int/maternal_child_adolescent/documents/child-pneumonia-treatment/en/. Accessed May 5, 2015.
  9. Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E, , 2010. Diarrhoea: why children are still dying and what can be done. Lancet 375: 870872. [Google Scholar]
  10. Lotz A, 2010. Rapid identification of mycobacterial whole cells in solid and liquid culture media by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 48: 44814486. [Google Scholar]
  11. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD, , 2010. Diagnosis of scrub typhus. Am J Trop Med Hyg 82: 368370. [Google Scholar]
  12. Bukirwa H, , 2011. Assessing rapid diagnostic tests for malaria. Cochrane Database Syst Rev 7: ED000031. [Google Scholar]
  13. Halstead SB, , 2007. Dengue. Lancet 370: 16441652. [Google Scholar]
  14. Kundu R, Ganguly N, Ghosh TK, Yewale VN, Shah RC, Shah NK, IAP Task Force; , 2006. IAP Task Force Report: diagnosis of enteric fever in children. Indian Pediatr 43: 875883. [Google Scholar]
  15. Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG, , 2010. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 17: 999e57. [Google Scholar]
  16. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis; , 2005. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6: 28. [Google Scholar]
  17. World Health Organization. WHO Global Database on Child Growth and Malnutrition 1988–2006. Available at: http://www.who.int/nutgrowthdb/about/introduction/en/index5. Accessed May 10, 2013.
  18. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, Abraham AM, Abraham OC, Thomas K, , 2010. Acute undifferentiated febrile illness in adulthospitalized patients: the disease spectrum and diagnostic predictors—an experience from a tertiary care hospital in south India. Trop Doct 40: 230234. [Google Scholar]
  19. Ittyachen AM, Ramachandran R, , 2015. Study of acute febrile illness: a 10-year descriptive study and a proposed algorithm from a tertiary care referral hospital in rural Kerala in southern India. Trop Doct 45: 114117. [Google Scholar]
  20. Capeding MR, 2013. Dengue and other common causes of acute febrile illness in Asia: an activesurveillance study in children. PLoS Negl Trop Dis 7: e2331. [Google Scholar]
  21. Nademi Z, Clark J, Richards CG, Walshaw D, Cant AJ, , 2001. The causes of fever in children attending hospitalin the north of England. J Infect 43: 221225. [Google Scholar]
  22. Abrahamsen SK, Haugen CN, Rupali P, Mathai D, Langeland N, Eide GE, Morch K, , 2013. Fever in the tropics: aetiology and case-fatality—a prospective observational study in tertiary care hospital in south India. BMC Infect Dis 13: 355363. [Google Scholar]
  23. Pondei K, Onyaye E, Olowu K, Peterside O, , 2012. Patterns of acute febrile illness in children in a tertiary health institution in the Niger Delta Region of Nigeria. J Med Sci 3: 734740. [Google Scholar]
  24. Kwak BG, Jang HO, , 2006. Clinical analysis of febrile infants and children presenting to the pediatric emergency department. Korean J Pediatr 49: 839844. [Google Scholar]
  25. Ganesh R, Janakiraman L, Vasanthi T, Sathiyasekeran M, , 2010. Profile of typhoid fever in children from a tertiary care hospital in Chennai-south India. Indian J Pediatr 77: 10891092. [Google Scholar]
  26. Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M, , 2006. Age-related clinical and microbiological characteristics of enteric fever in India. Trans R Soc Trop Med Hyg 100: 942948. [Google Scholar]
  27. Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P, , 2012. Clinical profile of scrub typhus in children. Indian J Pediatr 79: 14591462. [Google Scholar]
  28. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S, , 2012. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health 5: 8288. [Google Scholar]
  29. Mahajan SK, Rolain JM, Sankhyan N, Kaushal RK, Raoult D, , 2008. Pediatric scrub typhus in Indian Himalayas. Indian J Pediatr 75: 947949. [Google Scholar]
  30. Verma P, Shukla US, Kalraiya A, , 2014. Retrospective study on clinical profile of severe malaria in children admitted. People’s J Scientific Res 7: 2226. [Google Scholar]
  31. World HealthOrganization, 2015. Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/atoz/9789241549127/en/. Accessed May 2, 2015.
  32. Gupta E, Ballani N, , 2014. Current perspectives on the spread of dengue in India. Infect Drug Resist 7: 337342. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0056
Loading
/content/journals/10.4269/ajtmh.18-0056
Loading

Data & Media loading...

  • Received : 21 Jan 2018
  • Accepted : 04 Jun 2018
  • Published online : 09 Jul 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error