Abstract
Context: Acute undifferentiated febrile illness (AUFI) is characterized by a sudden onset of raised body temperature and is a common cause of hospital admission though not recognized as a disease state by the World Health Organization. Epstein-Barr virus (EBV) is reported to account for a significant occurrence of AUFI cases.Aim: To know the role of EBV infection as a cause of acute undifferentiated febrile illness (AUFI).Settings and design: We have used the combination of EBV serological assays to establish the role of the Epstein-Barr virus as the cause of acute undifferentiated febrile illness.Methods and material: A total of 721 suspected cases of acute undifferentiated febrile illness which were tested negative for other common causes of acute febrile illness were selected for the study. Serum samples collected from these cases were tested for the presence of the EBV viral capsid antigen (VCA) IgM antibody. All positive serum samples were tested for the presence of EBV Epstein-Barr nuclear antigen (EBNA) IgG.Statistical analysis used: Statistical analysis was performed with the help of Microsoft Excel software (Microsoft Corporation, Redmond, USA). Results: Out of 721 suspected AUFI cases tested for EBV VCA IgM antibodies, 117 samples were positive and 604 were negative. All these 117 samples were tested for EBV EBNA IgG antibodies in which 88 were positive and 29 were negative. In our study, we found that around 4% (positive for VCA IgM and negative for EBNA IgG) of AUFI cases can be attributed to primary acute EBV infection.Conclusions: EBV infection should be considered particularly in AUFI cases of less than five years of age even in those who do not meet the typical presentation of fever, lymphadenopathy and sore throat. Our study should help to raise awareness regarding the possibility of EBV infection particularly in AUFI cases. A high index of suspicion and timely diagnosis will definitely help clinicians to avoid a battery of investigations and misuse of antibiotics in cases of AUFI.
Highlights
Acute undifferentiated febrile illness (AUFI) is characterized by a sudden onset of raised body temperature without an apparent aetiology for two weeks duration and is a most frequent cause of hospital admission though not considered as a serious illness by the World Health Organization (WHO)
We found that around 4% of AUFI cases can be attributed to primary acute Epstein-Barr virus (EBV) infection
EBV infection should be considered in AUFI cases of less than five years of age even in those who do not meet the typical presentation of fever, lymphadenopathy and sore throat
Summary
Acute undifferentiated febrile illness (AUFI) is characterized by a sudden onset of raised body temperature without an apparent aetiology for two weeks duration and is a most frequent cause of hospital admission though not considered as a serious illness by the World Health Organization (WHO). Typhoid, dengue, typhus and acute bacterial infections such as pneumonia are the major causes in resource-poor countries. We could make out that around 20%-30% of AUFI cases remain undiagnosed. Epstein-Barr virus (EBV) infection is a significant cause of AUFI cases though asymptomatic mostly [8,9]. The extent to which EBV causes AUFI remains unexplored. Using serological parameters like viral capsid antigen (VCA) IgM and Epstein-Barr nuclear antigen 1 (EBNA-1) IgG, acute and past EBV infections in immunocompetent individuals can be
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