Acute undifferentiated febrile illness in the elderly: A clinical profile

Abstract

Introduction: Geriatric patients are more prone to have serious viral or bacterial infections that may present with acute febrile illness (acute undifferentiated febrile illness [AUFI]) and have significantly increased the risk for morbidity and mortality. It is important for the community to know the clinical presentation and local etiology of AUFI. Methodology: This is a subgroup analysis of a large prospective study on determining the etiology of AUFI. We included geriatric population (>60 years) for our analysis. Results: This cohort study included 126 elderly patients who presented with AUFI, in which 56.3% were men. Scrub typhus (57.4%) was the most common cause of AUFI followed by dengue (19.1%), malaria (3.2%), enteric fever (1%), and leptospirosis (0.8%). Both scrub typhus and dengue fever peaked during the monsoon season and the cooler months, whereas no seasonality was observed with enteric fever and malaria. The requirement of supplemental oxygen, invasive ventilation, and inotropes was highest among the scrub typhus patients followed by leptospirosis and malaria. Bleeding manifestations were seen in scrub typhus (6.8%), dengue (14.2%), and malaria (25%). The overall mortality rate was 6.3% and was highest with scrub typhus 5.4%. Conclusion: The similarity in clinical presentation and diversity of etiological agents demonstrate the complexity of diagnosis and treatment of AUFI in South India. Even though respiratory tract, urinary tract, and skin infections present with acute febrile illness in the elderly, other undifferentiated causes such as scrub typhus, dengue, malaria, enteric fever, and leptospirosis should also be considered while treating the elderly, especially in developing nations. Once a clinical profile is formed, the local population can be educated to identify the possible life-threatening complications based on endemicity and seasonal trends.