Diagnosis and Management of Rickettsial Infections among Febrile Patients Attending in Inpatients and Outpatient Department in a District Hospital in Bangladesh

Abstract

Background: Numerous obligatory intracellular bacteria from the Alphaproteobacteria genus Rickettsia can cause rickettsial infection. The most prevalent newly emerging and reemerging diseases are rickettsial infections. Objectives: The aim of the study was diagnosis and management of rickettsial infections among febrile patients attending in inpatient and outpatient department in a district hospital in Bangladesh. Methods: This cross-section observational study was carried out in the 250 Beded District Hospital, Joypurhat. The duration of the period from March 2022 to February 2023. A total of 250 patients participated in the study. Both male and female with any age, patients with elevated body temperature, headache, malaise, rash, nausea, and vomiting and gave consent to be included in the study. Severely ill patients, not willing to participate were excluded from the study. Weil Felix test was used in this study and a titre of 1:80 was considered to be positive. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: The mean age of the patients was 39 ± 1.9. 8% of the patients had ≤18 years of age. 16% were within the age group of 19-29 years, 28% were within the age group of 30-39 years, 24% were within the age group of 40-49 years, 14.4% were within the age group of 50-59 years and 9.6% were ≥60 years and 52% of the patients were male. 100% of the respondents had fever, 20% had generalized weakness, 15.2% had headache, 16% had cough and cold, 24% had body ache, 8% had vomiting and abdominal pain respectively, 4% had per nasal watery discharge, 36% had rash, 16% had nausea, 24% had anorexia and 4% had other symptoms. CBC & ESR and Weil Felix test were the most common (100%) investigation among the patients, Urine R/M/E in 68%, serum creatinine in 18%, USG of W/A in 15%, CRP in 18%, PBF in 7, Urine C/S in 10%, S. Electrolytes in 4% cases. We found 90 Rickettsial Infection positive patients. Doxycycline and Paracetamol and Esomeprazole were prescribed to all patients 90(100%) and followed by Linagliptin+Metformin to 20(22.22%), Glimipiride to 19(21.11%), Azithromycin to 18(20%) and Domperidon to 10(1.11%), Montelukast 9 (10%), Pantoprazole to 8(8.89%), Rupatadine to 7(7.77%), Ondansetron to 6(6.67%), Tiemonium to 5 5.57%), Fexofenadin to4(4.44%) and other treatment along with the prescribed medicines was given to 40(44.44%) patients. Authors studied the response of Doxycycline which showed 85(94.44%) cases improved within 48 hours of start of treatment. Remaining 5(5.55%) cases showed delayed response due to late presentation. Conclusion: Rickettsial illness is inextricably linked to the sociocultural life of the majority of metropolitan residents. However, a lack of medical facilities and qualified doctors makes it challenging to identify rickettsial disease in febrile patients. It's important to make an early diagnosis when treating rickettsial illness.