A Study of the Clinical Profile and Pattern of Acute Febrile Illness in a Teaching Hospital in Central Mumbai

Aims and Objectives: Fever remains the commonest cause of OPD and indoor admissions, in underdeveloped and developing countries including India. The present study was undertaken to study the fever profile, compare the aetiologies, outcome and change in pattern.

Material and Methods: A prospective observational study was carried out on adults (>12 years), with acute undifferentiated febrile illness (temperature >38°C), within 14 days of fever, admitted between Jan and Dec 2014, in a teaching hospital in central Mumbai. 472 adult febrile cases were included and analysed as per study criteria. Clinical examination was done and laboratory data was studied and compared. Empirical polytherapy with antimalarials, symptomatic treatment for dengue and antibiotics as per clinical suspicion in high risk cases was resorted on a priority basis.

Results: Dengue {116 cases (24.6%)} and Malaria {95 cases (20.1%)} formed the largest group. 52 (11.1%) cases of enteric fever and 56 (11.8%) pneumonia cases were notable. 34 (7.3%) UTI cases formed a significant group (10-pyelonephritis, 8 diabetic nephropathy, 4-urolithiasis, 8-secondary to benign prostatic hypertrophy and 4 had urosepsis). This group comprised of most of the geriatric population. 2 cases of leptospirosis and 5 of hepatitis E were diagnosed. Undiagnosed cases attributed and consistent with viral infections, formed a significant group 66 (13.9 %). Overlap cases comprising co-infections and mixed infections were 46 (9.7%). The largest group (60.6%) comprised of middle aged males (31-40 years). As expected the largest number of cases (66.6 %) were recorded during the pre-monsoon and monsoon season. Bacterial and viral pathogens topped the chart (30.1% and 25.6% respectively) with the parasitic group a close second (20.6%). Overlap and undiagnosed cases formed a significant group (23.6%) (Fig-3). ICU admissions and mortality in the parasitic group was relatively high.

Conclusion and Discussion : Dengue formed the largest group, the surge attributed to the recent indiscriminate and incomplete construction leading to increased Aedes breeding sites. Malarial fever along with respiratory and urinary infections formed a sizable group, though malaria cases were fewer, as a result of focussed malaria control. Overlap cases, co-infection and mixed infections were a significant group meriting further study. Persistent enteric and hepatitis E infections highlight the need for continued efforts at health education and sanitation. Undiagnosed febrile cases, most consistent with viral fever, underscore the need for effective diagnostic tools for detailed testing.