Salagre Kaustubh Dilip, Sahay Ravindra Nath, Pazare Amar R, Dubey Abhishek, Marathe Kunal K
Assistant Professor.
Professor.
J Assoc Physicians India. 2017 Sep;65(9):37-42.
The objective of this study was to describe clinico-laboratory profile and outcome of complicated acute febrile illnesses among inpatients in a tertiary care hospital during monsoon.
This was an observational, prospective study conducted in a tertiary care hospital in Mumbai, India. Between July 2016 to October 2016, adult patients admitted to the hospital with complicated acute febrile illness were included. Demographic, clinical and laboratory data were collected and analyzed for each patient. Associations were sought between death and organ specific complications.
Out of 276 patients enrolled male gender 187(67.8%) and age group of below 35 years comprised the larger proportion of the cases with total 115(63.2%) dengue,37(80.4%) leptospirosis, 25(69.4%) malaria cases. The most common symptoms reported amongst the enrolled patients included generalized body ache (85.9%), headache (77.4%), vomiting (73.4%), abdominal pain (50%), high coloured urine (34.2%), and breathlessness (32.1%), loose motion (25.1%) and altered Sensorium (8.8%). Clinical signs seen and significantly associated were pedal edema 14.5% (P=0.001), icterus 20.7%(P=0.0001) and tachypnoea 19.4%(P =0.001). Most common complication of dengue was shock (70.9%) followed by hepatic (66.5%) and haematological (65%) derangements, that of malaria was CNS involvement (29.4%), and for leptospirosis it was renal failure (45.9%) followed by respiratory distress (22.3%). Overall mortality in Dengue was 7(3.8%), malaria 2(5.6%), leptospirosis 15(32.6%), Hepatitis E 2(50%).
The similarity in clinical presentation and diversity of etiological agents demonstrates the complexity of diagnosis and treatment of acute febrile illness. This study of clinico-laboratory profile of complicated febrile monsoon illnesses will be helpful to reduce mortality associated with monsoon illnesses by early referral and prompt treatment. Dengue and leptospirosis remain the commonest etiologies and major killer due to respiratory and renal involvements.
本研究的目的是描述一家三级医疗机构住院患者在季风季节复杂急性发热性疾病的临床实验室特征及转归。
这是一项在印度孟买一家三级医疗机构进行的观察性前瞻性研究。纳入2016年7月至2016年10月期间因复杂急性发热性疾病入院的成年患者。收集并分析每位患者的人口统计学、临床和实验室数据。探寻死亡与器官特异性并发症之间的关联。
在276例入组患者中，男性187例（67.8%），年龄在35岁以下的患者占较大比例，其中登革热115例（63.2%）、钩端螺旋体病37例（80.4%）、疟疾25例（69.4%）。入组患者中报告的最常见症状包括全身疼痛（85.9%）、头痛（77.4%）、呕吐（73.4%）、腹痛（50%）、深色尿（34.2%）、呼吸急促（32.1%）、腹泻（25.1%）和意识改变（8.8%）。观察到且有显著关联的临床体征为足背水肿14.5%（P = 0.001）、黄疸20.7%（P = 0.0001）和呼吸急促19.4%（P = 0.001）。登革热最常见的并发症是休克（70.9%），其次是肝脏（66.5%）和血液学（65%）紊乱；疟疾的并发症是中枢神经系统受累（29.4%）；钩端螺旋体病的并发症是肾衰竭（45.9%），其次是呼吸窘迫（22.3%）。登革热的总体死亡率为7例（3.8%），疟疾为2例（5.6%），钩端螺旋体病为15例（32.6%），戊型肝炎为2例（50%）。
临床表现的相似性和病原体的多样性表明急性发热性疾病诊断和治疗的复杂性。这项关于复杂发热性季风疾病临床实验室特征的研究将有助于通过早期转诊和及时治疗降低与季风疾病相关的死亡率。登革热和钩端螺旋体病仍然是最常见的病因，并且由于呼吸和肾脏受累是主要致死原因。
