Cases Of Acute Febrile Illness Research Articles

Clinical Evaluation of Hospitalized Cases of Acute Febrile Illness with Thrombocytopenia in North - West Zone of Rajasthan

Background: Thrombocytopenia has been recognized as an important manifestation of acute febrile illness caused by various types of. Early diagnosis of aetiology is very important to reduce morbidity and mortality. This study was planned to evaluate clinical profile, aetiology, differential diagnosis, clinical course and outcome of such patients. Methods: Present prospective cross-sectional study was conducted on 400 consecutive patients of fever with thrombocytopenia admitted during 1st May 2022 to 31st October 2022 in the Department of Medicine, S.P. Medical College & Associated Group of P.B.M. Hospitals, Bikaner. All patients were evaluated as per proforma including detail clinical history and physical examination. Laboratory evaluation including CBC, RFT, LFT, blood sugar, LDH, Rapid diagnostic test for malaria, PBF for MP, test for dengue, HBsAg, Anti HCV, HIV, PBF detail, Blood culture, D–dimer, test for Scrub typhus and leptospirosis, Ultrasonography and chest X-Ray was done in all cases. Other investigations were done as per requirement. All patients were treated as per guidelines and followed-up during hospitalization. Results: Out of 400 patients 227 were males (age ranging 15-87 years, mean 35.46 ±15.63) and 173 females (age ranging 15-92 years, mean 39.75 ± 17.36). Dengue fever was found to be the commonest cause (29.5%) followed by Malaria, COVID-19 infection (0.75%) and one each HIV and Hepatitis B. In 54.25% of the cases definite etiological diagnosis could not be ascertained. 14.25% patients were having life threatening thrombocytopenia, 45% severe grade, 21.75% moderate and 19% mild thrombocytopenia. Severity of thrombocytopenia was associated with longer duration of illness (p<0.02). Bleeding manifestations were observed in 5.75% but did not corelated with severity of thrombocytopenia. Mean duration of hospital stay was found to be inversely proportion to total platelet count on admission. Conclusion: Acute Febrile illness patients should be investigated for platelet count irrespective of the bleeding manifestations as decreased platelet count could be severe without external manifestations and could be an indicator of bad prognosis.

Changing Trends in the Clinical Suspicion of Scrub Typhus in Acute Febrile Illness Patients

Abstract Introduction: Scrub typhus is an important and widespread cause of acute febrile illness (AFI), which can be diagnosed easily by serological assay. Methods: All cases of AFI were sent for Scrub Typhus serology by rapid Enzyme Linked Immuno-Sorbent Assay (ELISA) method. Anyone found positive was admitted for further evaluation. Results: In this series 80 % had liver abnormality, 80 % had ARDS, 40 % had renal failure, 40 % had eschar and 80 % of them had MODS. Only 20 % had clinical features of encephalitis with MRI brain haemorrhagic transformation of infarct. All patients responded well to treatment with Doxycycline with hospitalization of around 7-10 days. Conclusion: This case series highlights the importance of keeping a high index of clinical suspicion to exclude scrub typhus in all AFI patients.

Outbreak investigation of acute febrile illness from the Himalayan foothills: Solving the puzzle of fever.

In September 2022, Panchkula Civil Hospital reported an outbreak of acute febrile illness (AFI) in Pinjore, located in the Himalayan foothills, Haryana, North India. There was an upsurge of fever cases. Blood samples were taken from suspected patients (n = 58) with AFI and subjected to serology of dengue, chikungunya, Japanese encephalitis, leptospira and scrub typhus. The samples were also screened for West Nile & Zika virus RNA using real-time PCR. Viral strains were characterized by sequencing. Of the 58 cases of AFI, Dengue could be identified in 45 (77.58%) followed by JE and Chikungunya in 2 cases each (3.44%), respectively. Among Dengue positive cases, 44 had monoinfection (97.77%) and 1 patient had dengue and JE. None were positive for Zika, West Nile, Scrub typhus, and Leptospira with the testing protocol. Four patients developed dengue with warning signs, such as abdominal pain in one patient and recurrent vomiting in the remaining three. The dengue serotype could be determined in 17 samples and revealed serotype 2. Molecular evolution analysis based on the complete envelope gene revealed that all DENV-2 strains (n = 13) circulated in the outbreak area belonged to the DENV-2 cosmopoliton genotype. In the early stages of infection, relying only on clinical manifestations is ineffective, so both molecular and serological assays along with clinical diagnosis are noteworthy for determining the aetiology of AFI.

Evaluation of Clinical Significance of Vitamin D3 Status in Hospitalized Cases of Acute Febrile Illness with Thrombocytopenia in North-West Zone of Rajasthan

Evaluation of Clinical Significance of Vitamin D3 Status in Hospitalized Cases of Acute Febrile Illness with Thrombocytopenia in North-West Zone of Rajasthan

Gender and zoonotic pathogen exposure pathways in a resource-limited community, Mpumalanga, South Africa: A qualitative analysis.

The Mnisi community is a livestock-dependent community neighboring the Great Limpopo Transfrontier Conservation Area in South Africa. Here, zoonotic pathogens contribute to as many as 77% of cases of acute febrile illness. Previous gender-disaggregated analysis in the community has shown that men and women have different risks of zoonotic illness, suggesting that exposure routes for zoonotic infections should be further explored to inform gender-sensitive risk mitigation strategies. Using a One Health approach and ethnographic methodology, we examined interactions between community residents, domestic animals, and the built and natural environment to investigate potential exposure pathways for zoonotic infections from a gendered perspective. We combined data from direct household observations and focus group discussions on previously identified gendered tasks such as domestic animal care, water collection, and food preparation, and how and by whom these tasks were performed. We noted gender differences for household tasks, animal care duties, and environmental exposure. Both men and women access grazing land but for different tasks (water collection-females, cattle grazing-males), and both men and women experience more time in the bush in recent years due to decreased water availability. From observations, it was noted that men wore covered protective work clothes (such as long trousers and closed-toe shoes) more commonly than women did; women did not often wear these for household duties including water collection in the bush. We recommend that these gender-typed roles serve as critical control points for zoonotic pathogen exposure. For example, tick-bite exposure prevention should be directed at both men and women based on their daily activities, but prevention in men should target exposure from cattle and prevention in women should focus on personal protective measures during water and firewood collection. These findings can contribute to a more detailed understanding of the role of human behavior and critical control points for zoonotic disease-a significant contributor to acute febrile illness in this rural, resource-limited setting.

A study on acute undifferentiated febrile illness in children (Age 2 Months to 18 Years)

: Acute Undifferentiated Febrile Illness (AUFI) is a common cause of patients seeking healthcare in India. Appropriate diagnosis is essential for proper management of children, since failure to identify the nature of the causative pathogen results in increased morbidity and mortality due to diseases either being untreated or treated with inappropriate antimicrobials, Also there is waste of medicines and increased resistance to antimicrobials, which has a major public health threat worldwide.: To study clinical profile of children admitted with AUFI and to find out common causes of AUFI in Children (2 months to 18 years of age) and their seasonal trends. : A prospective study was carried out over 200 children of age 2 months to 18 months admitted in Balchikitsalaya MBGH Hospital with Acute Undifferentiated Febrile Illness of less than 7 days duration over a period of 12 months from November 2021 to October 2022. : Majority of the patients were in the age group of 10-15 years (32.5%). Out of 200 AUFI patients, majority had undifferentiated illness (53%) followed by Malaria (16.5%), UTI (12.5%), Dengue(11%), Scrub Typhus(5%) and Enteric Fever(2.5%). Higher incidence of AUFI was seen from August to November. : More than 50% cases of Acute Febrile Illness were due to Undifferentiated Illnesses, hence it can be concluded that provided the cause of undifferentiated illness is found, the irrational use of antibiotics and antimalarial should be prevented.

An Emerging Infection “Scrub Typhus”– A Detailed Clinical Profile and Complications among Children in a Tertiary Hospital

Objectives: To study the clinical profile and complications of Scrub typhus in children.Methods: This descriptive study conducted in Siddhartha Medical college, Vijayawada, among children less than12 years for a period of one year(December 2020-November 2021).A total of 49 children who are serologically/clinically diagnosed cases of Scrub typhus.Results: Scrub typhus mainly occurred in school going children with male predominance. Fever being the singlemost clinical presentation in most of the cases(95.9%) associated with pallor, hepatosplenomegaly. Co infectionwas documented in 14.2% cases with 85.7% cases showing increased morbidity and mortality. Mortality rate ismore in infants.Conclusions: Among cases of Acute febrile illness, Scrub typhus accounts for 9.8% of cases. Main clinical featureswere persistent fever, hepatosplenomegaly, thrombocytopenia, anemia along with capillary leak signs like edemawith or without eschar.Infants are at high risk for complications and mortality.

LEPTOSPIROSIS: A NEGLECTED DISEASE FROM NORTH INDIA

Introduction: Leptospirosis is a zoonotic disease caused by Leptospira interrogans and has been reported from various countries worldwide. As very few studies were conducted on leptospirosis from north India, this study was conducted to know the status of this disease in this region. This retrospective hospital Material & Methods: based study was conducted in the Department of Microbiology of a tertiary care super specialty teaching institute from north India for a period of two consecutive years. Blood specimens from acute febrile illness cases were tested for presence of IgM antibodies against Leptospira interrogans by rapid card (Leptocheck from TULIP) testing and ELISA (Leptospira IgM ELISA from PanBio). Out of total 216 samples Results: collected and included in this study, 40 were found to be positive for presence of IgM antibodies against Leptospira interrogans. Seropositivity for leptospirosis was observed to be 19%. Maximum number of patients were from economically productive age groups, 31-40 years of age group followed by 21-30 and 41-50 years of age groups. CONCLUSION: Leptospirosis was found to be a major cause of acute febrile illness from north India. It is neglected and under reported from most of the regions of India due to lack of clinician's suspicion. More studies with more samples are required on leptospirosis from this region to reach on nal conclusion.

False-positive typhidot IgM assay in COVID-19 patients: A potential public health problem in tropical countries during COVID-19 endemic phase

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reports of false-positive serological test results were reported in COVID-19 patients. Typhidot IgM test is reported in a few studies to give false-positive results in various viral illnesses in the past. The aim of this study was to estimate the typhidot IgM positivity rate in reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients. MATERIALS AND METHODS: The present study was a cross-sectional study conducted at a tertiary care hospital. All symptomatic patients having fever that were admitted between April 1, 2021, and July 15, 2021, with a confirmed RT-PCR-positive result for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were included in the study. Serological testing was done by typhoid IgM/IgG rapid diagnostic test for all SARS-CoV-2 RT-PCR-positive patients. The primary outcome studied was to estimate the typhidot IgM positivity rate among RT-PCR-confirmed COVID-19 patients. The secondary outcome studied was to determine the correlation between SARS-CoV-2 RT PCR cycle threshold (CT) value and typhidot-positive result. RESULTS: Three hundred and five (17.99%) out of 1695 samples of confirmed COVID-19 patients were positive for typhoid serology by typhidot IgM test. However, upon performing Point-Biserial correlation analysis (P = 0.832, r = 0.021), no correlation was seen between RT-PCR CT value and typhidot result. CONCLUSIONS: Typhidot test is a nonspecific diagnostic test for typhoid fever which can be false positive in COVID-19 patients. Hence, physicians should take this into consideration to avoid misdiagnosis and delay in accurate treatment of acute febrile illness cases, especially in the present scenario of COVID-19 endemicity.

Clinical profile and biochemical abnormalities in Scrub Typhus: A cross-sectional study.

Scrub Typhus (ST) is an acute febrile illness caused by obligate intracellular bacteria of the family Rickettsia. It is often unrecognized and neglected but prevalent in tropical regions of endemic areas. The tragedy behind this diagnostic dilemma is non-specific clinical signs and symptoms, limited awareness, unavailability of diagnostic facilities, and low index of suspicion among the physicians. To address the knowledge gap, we tried to find out a proper panel of laboratory investigations to diagnose the disease and predict its progression because of the uncertainty of the course of the disease in a tertiary care hospital in western Nepal. This is a hospital laboratory-based prospective study conducted at Gandaki Medical College- Teaching Hospital (GMC-TH) for a period of two years. Among 988 cases of acute febrile illness, 40 seropositive cases of ST were enrolled in the study. We excluded those who did not give consent for the participation, those who were under 17 years of age, and those who had preexisting liver dysfunctions and other co-morbidities and dual seropositive with other infectious etiologies. We used descriptive statistics to analyze the data in terms of demography, clinical features, and laboratory parameters. Out of 988 febrile patients, we included 40 confirmed cases of ST aged between 17 and 70 years during the study-period. Maximum seropositive cases were from Tanahun district 14 (35%), with predominance among the women (70%). The cases were prevalent in the age group 30-60 years, 19 (47.5%), and in the month of October 15 (37.5%). The commonest complaints were fever in 40 (100%), headache in 20 (50%), eschar in 11 (27.5%). Laboratory parameters showed anemia in 22 (55%), hypoalbuminemia in 11 (27.5%), leukopenia in 5 (12.5%), leukocytosis in 9 (22.5%), thrombocytopenia in 13 (32.5%), raised transaminase levels, SGPT in 21 (52.5%) and SGOT in 14 (26%) ST patients. We found clinical and laboratory profiles in patients with ST were varied and nonspecific. However, knowledge of these findings may evoke the recognition of ST and give a clue to the progression of the disease.

A CLINICO-EPIDEMIOLOGICAL STUDY ON LEPTOSPIROSIS IN WEST BENGAL: A NEGLECTED CAUSE OF ACUTE FEBRILE ILLNESS

Introduction: Leptospirosis is a major neglected public health problem and is highly underreported in India. It is a common cause of the acute febrile illness (AFI), but accurate diagnosis is quite challenging and often delayed because of overlapping symptoms with many other infectious diseases, and limited access to laboratory diagnosis. The aim Aim: of the study was to assess the proportion of Leptospira infection among patients suffering from AFI in West Bengal and to analyse socio-demographic characteristics, clinical features, and laboratory parameters of leptospirosis cases. Materials and methods: Serum samples were collected from 350 hospital-admitted patients suffering from AFI (fever >five days ≤ two weeks) but without any identifiable cause and tested for Leptospira IgM using PanBio Leptospira IgM ELISA kit. Clinical features, laboratory parameters and epidemiological data were collected from each patient and analysed. 91(26%) out of 350 fever cases tested positive for Leptospira IgM ELISA. Most of them were Result: male and belonged to the age group of 31–60 years (42.85%) and 16–30 years (30.76%). Common symptoms were fever (100%) myalgia (76.92%), headache (70.32%), icterus (69.23%), vomiting (67.03%) and pain abdomen (65.93%). Conclusion: Leptospirosis is a common cause of acute undifferentiated febrile illness in West Bengal. Our findings demonstrated the importance of active surveillance of leptospirosis among cases of acute febrile illness to facilitate its early detection and prevention of complications.

Beyond arboviruses: A multicenter study to evaluate differential diagnosis of rash diseases and acute febrile illness cases in Rio de Janeiro, Brazil.

IntroductionA wide variety of viruses can cause rash diseases (RDs) or acute febrile illness (AFIs) in children, adolescents and adults; however, approximately 19% of RD cases and 40% of AFI cases remain without a defined etiology. Parvovirus B19 (B19V) and herpesvirus infection can also cause RD and/or AFI, and in some risk groups, these infections can become persistent (or latent) and may require hospital treatment. Since these infections do not have mandatory reporting, they can be hidden by other diseases, such as those caused by arboviruses (e.g., dengue virus). In this context, the aim of this study was to pursue the differential laboratory diagnoses of B19V and herpesvirus infections in patients with RD and AFI, without a defined etiology, seen in hospitals and/or reference centers for infectious diseases in Rio de Janeiro.MethodsA total of 114 participants were enrolled in the study, including 54 children and 60 adults. B19V infection was assessed by real-time PCR (qPCR) and ELISA (anti-B19V IgM and IgG). EBV was assessed through qPCR, and betaherpesviruses (HCMV, HHV-6 and HHV-7) were assessed through multiplex qPCR. Sociodemographic and clinical data were obtained from the medical record data of these participants.ResultsThe median age of children with RD was 2 years (interquartile range (IQR): 5), and 55.6% were male. Among adults with AFI, the median age was 38 years (IQR: 21), and 56.7% were female. Regarding RD patients, viral prevalence (and load) were 5.5%(104IU/mL), 3.4%(104IU/mL), 5.5%(104IU/mL) and 11.1%(105IU/mL) for B19V, EBV, HCMV and HHV-6 infection, respectively, and in AFI patients they were 6.6%(105IU/mL), 1.6%(103IU/mL), 3.3%(104IU/mL) for B19V, HCMV and HHV-6, respectively. HHV-7 was not detected in RD or AFI patients.ConclusionThese results suggest the importance of including B19V and herpesviruses in the differential laboratory diagnoses for patients with RD and AFI, not only for epidemiological purposes but also for the proper management of the patient.

Genotypic Characterization of Orientia tsutsugamushi Isolated From Acute Encephalitis Syndrome and Acute Febrile Illness Cases in the Gorakhpur Area, Uttar Pradesh, India.

Scrub typhus infections caused by Orientiatsutsugamushi (OT), continue to remain underdiagnosed globally, due to the lack of distinctive symptoms. The elusive nature of the Acute Encephalitis Syndrome (AES) outbreak in Gorakhpur, Uttar Pradesh that claimed numerous pediatric lives was the driving force of this study which involved serological diagnosis (IgM–ELISA), isolation of OT in cell culture, confirmation by PCR, and characterization by Sanger sequencing. In total, 12 out of 36 patients were seropositive, of which 4 were positive by PCR. Upon enrichment in cell culture, additional 3 patients (including two seronegative) were detected positive by PCR. In total, three of these 7 patients were found to be infected with two strains of OT. Taken together, this study for the first time reports the occurrence of dual infections in addition to three circulating OT genotypes (Gilliam, Kato, and Karp-like) and highlights the significance of enriching OT in cell culture systems for efficient molecular detection.

Potential impact of SARS COV-2 infection on the performance of serological assays used to diagnose arboviral diseases

BackgroundThe COVID-19 pandemic caused by SARS-CoV-2 was first described in December 2019, in China. In addition, there has also been an increase in arboviral infections in recent years. As both infections have similar symptoms, misdiagnosis may occur if both outbreaks occur at the same time. ObjectiveOur objective was to assess the potential impact of SARS-CoV-2 infection on diagnostic assays used for arboviral diseases. Materials and methodsWe conducted this study by testing samples obtained during the precovid phase (before November 2019) and during the covid period (after February 2020). Samples were further grouped as those with acute febrile illness (AFI) and those without. All samples were tested for anti SARS-CoV-2 Ab, Chikungunya and Dengue specific IgM antibodies to evaluate potential serological cross-reactions between COVID-19 and Arbovirus specific antibodies. ResultsOne sample from the 62 cases of AFI during the pre-covid phase showed seropositivity for SARS-CoV-2 antibodies. Also, in asymptomatic individuals, arboviral seropositivity was significantly higher in the COVID period samples (22%) compared to pre-COVID samples (3%). ConclusionDue to similar clinical symptoms and cross reactions in both infections, relying solely on serological testing for arboviral diagnosis may be less sensitive; other clinical and laboratory parameters may be required.

COINFECTION OF DENGUE AND CHIKUNGUNYA VIRUSES: A PREVALENCE STUDY IN A TERTIARY HOSPITAL AT HYDERABAD, INDIA.

Background & objectives: Dengue and Chikungunya fever are the endemic arboviral infections appearing to be increasing in all parts of India. This study aims to determine the prevalence of Dengue and Chikungunya co-infection among acute febrile illness cases. A prospective observational study was conducted including patients with an acute febrile illnessMethods: whose blood samples were collected and subjected to tests like IgM & IgG ELISA for dengue virus and IgM Capture ELISA for Chikungunya virus. Among the 90 samples that were subjected to both Dengue and Chikungunya virus tests for coinfections, 18 samples testedResults: positive for both Dengue and Chikungunya tests conrming coinfections. Chikungunya virus can be confusedInterpretation and conclusion: with diseases such as Dengue based on the similarity of the symptoms and sharing of vectors. Thus the differential diagnosis of these infections is essential for clinical management and epidemiological study in the tropics.

NOMAD: metagenomic characterisation of the viral pathogen composition in outbreaks of non-malaria acute febrile illness cases

The clinical importance of non-malaria febrile acute illness (NM-AFI) in patients with a negative parasitological test has become apparent, with the progressive reduction in malaria transmission in endemic regions. Bacterial pathogens, for example Streptococcus pneumoniae and Haemophilus influenzae, which contribute disproportionally to febrile illness, are now preventable by vaccines. However, there are no vaccines, and little is known about viral NM-AFI prevalence, proliferation, virulence, and transmission chains between hosts. Although the predominant viral causes of NM-AFI are established, it is unclear if there are other NM-AFI associated emerging infectious viral pathogens that previously remained undetectable by conventional diagnostic strategies, for example severe acute respiratory syndrome coronavirus 2 (SARS-CoV-​2). Presumptive broad-spectrum antibiotic prescriptions to aparasitaemic patients not only drive drug resistance, but also lead to poor treatment outcomes. We hypothesized that insights on NM-AFI etiology, and consequently case management, could be improved by exploiting viral sequence diversity to identify viral pathogens present within metagenomics samples. We exploited simulated and existing infectious disease (Ebola, hepatitis C, chikungunya, and mosquito-borne arboviruses) metagenomic datasets to determine the composition of viral pathogens present, by implementing profile Hidden Markov Models derived from Swiss-Prot viral reference sequences for accurate pathogen detection and classification. Our analysis identified a combination of sequences from multiple viral etiological agents within the same disease sample. This approach provides a granular perspective of multiple viral etiological agents present within a single intra-host disease episode. It highlights prevalent viral strains that can subsequently be routinely detected using directed diagnostic tests to improve disease surveillance in endemic regions.

Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.

The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.

Scrub Typhus and its co-infection with Leptospirosis at a tertiary care hospital in Uttar Pradesh.

The diagnosis of Scrub Typhus is now improving with the availability of an array of serological tests at the majority of diagnostic centres and of molecular tests at advanced laboratories. Our study focuses on evaluating the spectrum of Scrub Typhus and its coinfection with Leptospirosis in patients presenting with acute febrile illness. A total of 1743 blood samples were collected from both In and Out Patient Department (OPD) patients and analyzed for anti Orientia tsutsugamushi and anti-Leptospira IgM antibodies. Our study showed the presence of Scrub Typhus IgM antibodies in 20.7% of all the cases of acute febrile illness. We also found an interesting correlation of Scrub Typhus with Leptospirosis owing to the presence of co-infection in 8.4% of Scrub Typhus cases paving a way for future research in this regard.

A Clinical Study of the Association of Thrombocytopenia with Acute Febrile Illness

Abstract Background: Thrombocytopenia accompanying acute febrile illnesses is a matter of concern because lack of prompt treatment could result in significant mortality. We in this study tried to evaluate the clinical profile of cases with acute fever and thrombocytopenia and determine the cause of fever with thrombocytopenia and the outcome of treatment of such patients in our hospital. Methods: A total of n=50 successive cases of acute febrile illness with thrombocytopenia following inclusion and exclusion criteria were included in this study. Clinical signs such as rashes, signs of dehydration, petechiae, jaundice, lymphadenopathy, hepatomegaly, splenomegaly, anemia, abdominal tenderness, altered sensorium, were noted. Investigations included CBP, ESR, LFT, RFT, serum electrolytes, Chest X-ray, USG abdomen were done. Other investigations included Dengue serology, Malaria, Widal, IgM for leptospirosis, sputum for AFB. Results: Out of n=50 patients with acute fever with thrombocytopenia, all of them had a definitive diagnosis with malaria (40%) as the commonest cause, followed by enteric fever (24%), viral fever (14%), septicemia (6%), dengue (14%), and leptospirosis (2%). 50% of the patients had platelet count in the range of 50, 000 – 1,00, 000 and 30% had platelet counts above 100000-150000. 8% of cases had platelet counts below 25000 and 12% had platelet counts between 25000-50000 at the time of admission. 10% mortality was observed. Conclusion: infections as the commonest cause of thrombocytopenia. Malaria, dengue enteric fever, leptospirosis, and other viral infections formed the major diseases in this group of population. The diagnosis of malaria was the common cause because of seasonal and regional variations. A definitive increase in platelet count was noted after the underlying cause was treated. Severe cases of septicemia with associated co-morbidities resulted in mortality.

Seroprevalence and Clinicoepidemiological Profile of Leptospirosis in Acute Febrile Illness Cases at a Medical College in Amritsar, Punjab, India

Introduction: Leptospirosis is an anthropozoonotic disease; it occurs worldwide but is most common in tropical and subtropical countries. It is usually underreported due to a lack of awareness, atypical presentations and lack of diagnostic facilities, especially in a resource-limited setting like India. Knowing the local prevalence of such infections is of utmost importance for appropriate control and management. Aim: To estimate the seroprevalence of leptospirosis among suspected Acute Febrile Illness (AFI) cases and to assess the clinicoepidemiological profile of leptospirosis cases presented at Government Medical College, Amritsar, Punjab, India. Materials and Methods: This hospital-based cross-sectional study was conducted at Government Medical College, Amritsar, Punjab, India. A total of 360 clinically suspected AFI cases were enrolled in the study. The demographic and clinical profile of the cases was taken on a semistructured predesigned proforma. Blood sample was collected from the patients, and an Immunoglobulin M (IgM) Enzyme-linked Immunosorbent Assay (ELISA) was done for diagnosis. Data analysis was done using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistical package for windows. Results: Out of 360 AFI cases suspected of leptospirosis, 62 (17.2%) were positive for leptospirosis IgM ELISA. The majority of AFI cases and leptospirosis cases belonged to the 21-40 years age group followed by the 41-60 years age group. Seroprevalence was found to be higher in males (20.8%) as compared to females (12.7%). Maximum seroprevalence (20.1%) was seen during the monsoon season followed by the autumn, summer and winter season. The association between risk exposure to risk factors and leptospirosis seroprevalence was found to be statistically significant (p=0.034). Fever, myalgia, headache, nausea/vomiting, icterus and hepatomegaly were common clinical features observed in leptospirosis cases. Conclusion: Leptospirosis has rapidly emerged to become the major cause of AFI in many parts of India. High seroprevalence of leptospirosis was reported among undifferentiated AFI cases in the present study. A programmatic approach towards the prevention, control and management of these emerging diseases in Punjab is highly recommended.