Abstract
BackgroundAcute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India.MethodsA scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management.ResultsThe review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated the use of 5–22 tests per patient for the evaluation of AFI. Among 25 studies evaluating possible causes of AFI, 96% tested for malaria followed by 80% for dengue, 72% for scrub typhus, 68% for typhoid and 60% for leptospirosis identifying these as commonly suspected causes of AFI. 54% studies diagnosed malaria with smear microscopy while others diagnosed dengue, scrub typhus, typhoid and leptospirosis using antibody or antigen detection assays. 39% studies used the Weil-Felix test (WFT) for scrub typhus diagnosis and 82% studies used the Widal test for diagnosing typhoid.ConclusionsThe review demonstrated the use of five or more pathogen-specific tests in evaluating AFI as well as described the widespread use of suboptimal tests like the WFT and Widal in fever evaluation. It identified the need for the development of better-quality tests for aetiological diagnosis and improved standardised testing guidelines for AFI.
Highlights
Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics
The key variables assessed in all studies were: Types of AFI investigated Type of diagnostic tests used for AFI evaluation The number of diagnostic tests used per patient in reaching a diagnosis of aetiology of AFI The setting of the studies: Public or private sector
Etiological studies and outbreak studies that documented the diagnostic approach to AFI were included. 124 articles were analysed using abstracts from which 54 articles were excluded based on publication type, setting
Summary
Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, low-income countries like India. AFI can be classified based on aetiology as fever caused by malaria and non- malarial acute febrile illness (NMAFI) caused by other pathogens. Bhaskaran et al BMC Infectious Diseases (2019) 19:970 world has led to the development of high-quality pointof-care testing (POCT) and rapid diagnostic tests (RDT) that aid in early diagnosis and timely therapeutic management of this illness. These developments have unmasked the under-recognized burden of NMAFI [1, 8,9,10]. India surpassed China and Pakistan with an increase from 3.3 billion defined daily doses (DDD) of antibiotic consumption in 2000 to 6.5 billion DDD in 2015 (103%) compared to 79 and 65% increase in antibiotic consumption in China and Pakistan respectively [21]. 51–69% patients diagnosed with dengue in Chennai, who do not require antibiotics, were prescribed antimicrobial therapy-mostly cephalosporins and fluoroquinolones [12]
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