Infectious Fevers: Clinical Profile of 500 cases

INTRODUCTION: Infections are one of the leading cause of morbidity and mortality in our country. The changing profile of infections need to be determined in order to focus on specific investigative and therapeutic measures. This study was undertaken to evaluate the changing profile in patients presenting with infectious fevers. AIM OF THE STUDY: To study the clinical and laboratory profile of patients with infectious fever in the medical wards of Government Stanley Medical College and Hospital. The groups analysed were : 1. Fever of less than 5 days with; a. Organ dysfunction, b. Temperature >40°C. 2. Fever of more than 5 days with or without organ dysfunction. OBJECTIVES: 1. To study the clinical profile like age, sex, fever duration and associated systemic symptoms in patients with infectious fever. 2. To study the most common cause of infectious fever. 3. The study the various organ dysfunction and the causes for organ dysfunction in patients with infectious fever. 4. To analyse the causes of mortality in patients with infectious fever. 5. To compare and analyse with the etiological profile of the previous study done at our hospital in 2002 - 2003. MATERIALS AND METHODS: Patients getting admitted to medical wards of Government Stanley Medical College and Hospital, Chennai, with fever and satisfying the below criteria were taken up for study. Patients of age group more than 12 years, both male and female were included. Inclusion Criteria: I. The following patients were included with number of days of fever less than 5 days and temperature >40°C or following organ dysfunction. a. With altered sensorium, seizures, signs of meningitis. b. Clinical signs suggestive of pneumonic consolidation. c. Signs suggestive of pleural effusion. d. Polyarthralgia. e. Rash. f. Purpura / ecchymoses. g. Oliguria or serum creatinine > 1.5 mg/dl. h. Jaundice or serum total bilirubin > 1.5 mg/dl. II. Fever of more than 5 days with or without organ dysfunction. Exclusion Criteria: 1. HIV seropositivity. 2. Non - infectious causes of fever like hematological malignancy. connective tissue disorders and solid tumours were excluded from the study. SUMMARY: 1. 500 patients were analysed, 64.8% were males and 35.2% were females. 2. Etiology of febrile illness could be diagnosed in 85.8% cases. 3. The common causes of infectious fever were malaria (27.2%), leptospirosis (16.8%) tuberculosis (14.4%) and pneumonia (8.2%). Other causes were chikungunya (3.8%), urinary tract infection (1.6%) liver abscess (1.6%), rheumatic fever (1%) and enteric fever (1%). 4. Plasmodium vivax formed 88% of malaria cases while plasmodium falciparum occured in 12%. 5. Common complications of malaria were Cerebral malaria (11.02%), jaundice (10.29%) and renal failure (10.29%). 6. Anicteric leptospirosis (81%) was the most common presentation and renal failure occurred in 14% of the cases. 7. The most common presentation of tuberculosis was pulmonary tuberculosis (62.5%). Extrapulmonary tuberculosis occured in 37.5% 8. Klebsiella was the most common organism isolated in cases of pneumonia (53.7%) followed by pneumococci and Staphylococcus aureus. 9. Co-infection with malaria and leptospirosis occurred in 22 (4.4%) patients. Among the cases of malaria, co-infection with leptospirosis occurred in 14% cases. 10. Chikungunya fever occurred in 18(3.8%) patients. 11. Rheumatic fever and enteric fever occurred in 5(1%) cases each. 12. Bronchiectasis, suppurative lung diseases and sepsis occurred in less than 1% cases.. 13. Jaundice with fever occurred in 48(9.6%) patients. Leptospirosis contributed to 34% and malaria to 30%. 14. Fever with renal failure occurred in 52(10.4%) patients. Malaria contributed to 30% and leprospirosis to 23%. 15. Malaria was the most common cause of neurological dysfunction contributing to 53% of cases. 16. Mortality was 21(4.2%) cases in the study, malaria contributing to 7 cases and pneumonia to 4 cases. 17. Comparing this study with the previous study carried out in Chennai in 2002 - 2003, there is increase in incidence of malaria and leptospirosis with lesser number cases of tuberculosis, probably due to increased diagnostic facilities. There is also a increase in percentage of diagnosed cases from 54% in 2002 to 86% in the present study. CONCLUSION: 500 admitted febrile patients were evaluated. Etiology of febrile illnesses could be diagnosed in 86% of the cases. This was much higher than the previous study (54%). This is probably due to the availability of better diagnostic facilities. Malaria, leptospirosis, tuberculosis and pneumonia were the common causes of infectious fevers in this study. Availability of simple diagnostic facilities will improve the reporting of these illness and thereby reducing the mortality associated with infectious diseases