Kundu Suman, Mondal Purnima, Choudhury Kabita, Chakraborty Shruti, Banik Ankita, Pramanik Kaushik, Sinha Arijit, Bhattacharjee Swagata Ganguly, Dey Jayanta Bikash
Department of Microbiology, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Microbiology, Dr. B. C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, West Bengal, India.
J Family Med Prim Care. 2024 Oct;13(10):4231-4236. doi: 10.4103/jfmpc.jfmpc_322_24. Epub 2024 Oct 18.
Similar presenting manifestations in early phase and lack of awareness of aetiology of acute febrile illness (AFI) are major challenges in management of AFI.
This was a retrospective observational cross-sectional study conducted in the Department of Microbiology, NRS Medical College, from 1 July 2022 to 30 June 2023 in serologically diagnosed febrile patients attending the outpatient department or admitted. Clinical and epidemiological data and laboratory parameters were recorded in a pretested structured questionnaire study tool, and collected data were analysed on MS-Excel sheets with various charts and tables.
A total of 1711 serologically diagnosed febrile patients showed preponderance of dengue (38.3%), followed by leptospirosis (25%), scrub typhus (23.9%), malaria (12.6%), and enteric fever (1.92%). A majority of cases were male, less than 40 years of age, and from the rural population (73.2%), except in malaria (urban = 79.6%). The mean duration of fever was 9 days. Febrile cases were recorded maximum during the monsoon and postmonsoon periods (66.5%). The common manifestations are fever, headache (46.2%), pain abdomen (7.8%), nausea, and vomiting (9.4%). Thrombocytopenia with bleeding manifestation was higher in dengue (18%) cases. Mortality in dengue cases was recorded with multiorgan dysfunction syndrome (MODS). Scrub typhus cases showed seizure (8.3%) and altered sensorium (5%) due to fatal meningoencephalitis. Fatality in leptospirosis was mostly due to acute kidney injury (29.5%) and Weil's disease (4.4%).
Misdiagnosis or incorrect diagnosis and delay in initiation of appropriate treatment results in increased morbidity and mortality in AFI. Determination of epidemiological features and clinical manifestations of AFI along with timely correct diagnosis will benefit clinicians in proper treatment initiation, thereby reducing morbidity and mortality.
急性发热性疾病（AFI）早期相似的临床表现以及对病因缺乏认识是AFI管理中的主要挑战。
这是一项回顾性观察性横断面研究，于2022年7月1日至2023年6月30日在NRS医学院微生物科对门诊就诊或住院的血清学诊断发热患者进行。临床和流行病学数据以及实验室参数记录在预先测试的结构化问卷调查研究工具中，收集的数据在MS-Excel工作表上通过各种图表进行分析。
总共1711例血清学诊断的发热患者中，登革热占比最高（38.3%），其次是钩端螺旋体病（25%）、恙虫病（23.9%）、疟疾（12.6%）和伤寒（1.92%）。除疟疾外（城市地区占79.6%），大多数病例为男性，年龄小于40岁，来自农村人口（73.2%）。发热的平均持续时间为9天。发热病例在季风期和季风后期记录最多（66.5%）。常见表现为发热、头痛（46.2%）、腹痛（7.8%）、恶心和呕吐（9.4%）。登革热病例中血小板减少伴出血表现较高（18%）。登革热病例的死亡与多器官功能障碍综合征（MODS）有关。恙虫病病例因致命性脑膜脑炎出现癫痫发作（8.3%）和意识改变（5%）。钩端螺旋体病的死亡主要归因于急性肾损伤（29.5%）和韦尔氏病（4.4%）。
误诊或错误诊断以及延迟开始适当治疗会导致AFI的发病率和死亡率增加。确定AFI的流行病学特征和临床表现并及时正确诊断将有助于临床医生及时开始适当治疗，从而降低发病率和死亡率。
