scholarly journals Healthcare Utilization Patterns for Acute Febrile Illness in Bangladesh, Nepal, and Pakistan: Results from the Surveillance for Enteric Fever in Asia Project

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S248-S256 ◽  
Author(s):  
Jason R Andrews ◽  
Krista Vaidya ◽  
Shampa Saha ◽  
Mohammad Tahir Yousafzai ◽  
Caitlin Hemlock ◽  
...  
Keyword(s):  
Disease Severity ◽  
Enteric Fever ◽  
Febrile Illness ◽  
Household Wealth ◽  
Acute Febrile Illness ◽  
Care Seeking ◽  
Mixed Effect ◽  
Healthcare Seeking ◽  
The Past ◽  
Catchment Areas

Abstract Background Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data. Methods We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with 1) fever for ≥3 consecutive days within the past 8 weeks; or 2) fever resulting in hospitalization within the past year. We also collected data about disease severity and household demographics and assets. We used mixed-effect multivariable logistic regression models to identify determinants of healthcare seeking at study hospitals and determinants of culture-confirmed enteric fever. Results We enrolled 31 841 households (53 926 children) in Bangladesh, 25 510 households (84 196 children and adults) in Nepal, and 21 310 households (108 031 children and adults) in Pakistan. Children <5 years were most likely to be taken to the study hospitals for febrile illness at all sites. Household wealth was positively correlated with healthcare seeking in 4 of 5 study sites, and at least one marker of disease severity was positively associated with healthcare seeking in 3 of 5 catchment areas. Wealth and disease severity were variably predictive of blood culture-confirmed enteric fever. Conclusions Age, household wealth, and disease severity are important determinants of healthcare seeking for acute febrile illness and enteric fever risk in these communities, and should be incorporated into estimation models for enteric fever incidence.

scholarly journals Diagnostic Value of Clinical Features to Distinguish Enteric Fever From Other Febrile Illnesses in Bangladesh, Nepal, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S257-S265 ◽  
Author(s):  
Kristen Aiemjoy ◽  
Dipesh Tamrakar ◽  
Shampa Saha ◽  
Shiva R Naga ◽  
Alexander T Yu ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Features ◽  
Diagnostic Performance ◽  
Enteric Fever ◽  
Random Effect ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Diagnostic Value ◽  
Case Definition ◽  
Mixed Effect

Abstract Background Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan. Methods Outpatients presenting with ≥3 consecutive days of reported fever and inpatients with clinically suspected enteric fever from all 6 SEAP study hospitals were eligible to participate. We evaluated the diagnostic performance of select clinical features against blood culture results among outpatients using mixed-effect regression models with a random effect for study site hospital. We also compared the clinical features of S. Typhi to S. Paratyphi A among both outpatients and inpatients. Results We enrolled 20 899 outpatients, of whom 2116 (10.1%) had positive blood cultures for S. Typhi and 297 (1.4%) had positive cultures for S. Paratyphi A. The sensitivity of absence of cough was the highest among all evaluated features, at 65.5% (95% confidence interval [CI], 55.0–74.7), followed by measured fever at presentation at 59.0% (95% CI, 51.6–65.9) and being unable to complete normal activities for 3 or more days at 51.0% (95% CI, 23.8–77.6). A combined case definition of 3 or more consecutive days of reported fever and 1 or more of the following (a) either the absence of cough, (b) fever at presentation, or (c) 3 or more consecutive days of being unable to conduct usual activity--yielded a sensitivity of 94.6% (95% CI, 93.4–95.5) and specificity of 13.6% (95% CI, 9.8–17.5). Conclusions Clinical features do not accurately distinguish blood culture–confirmed enteric fever from other febrile syndromes. Rapid, affordable, and accurate diagnostics are urgently needed, particularly in settings with limited or no blood culture capacity.

scholarly journals Antibiotic Use Prior to Hospital Presentation Among Individuals With Suspected Enteric Fever in Nepal, Bangladesh, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S285-S292
Author(s):  
Krista Vaidya ◽  
Kristen Aiemjoy ◽  
Farah N Qamar ◽  
Samir K Saha ◽  
Dipesh Tamrakar ◽  
...  
Keyword(s):  
Blood Culture ◽  
Disease Severity ◽  
Enteric Fever ◽  
Clinical Care ◽  
Prevalence Ratio ◽  
Antibiotic Use ◽  
Urine Samples ◽  
Mixed Effect ◽  
Culture Positivity ◽  
Blood Culture Positivity

Abstract Background Antibiotic use prior to seeking care at a hospital may reduce the sensitivity of blood culture for enteric fever, with implications for both clinical care and surveillance. The Surveillance for Enteric Fever in Asia Project (SEAP) is a prospective study of enteric fever incidence in Nepal, Bangladesh, and Pakistan. Nested within SEAP, we evaluated the accuracy of self-reported antibiotic use and investigated the association between antibiotic use and blood culture positivity. Methods Between November 2016 and April 2019, we collected urine samples among a subset of SEAP participants to test for antibiotic use prior to the hospital visit using an antibacterial activity assay. All participants were asked about recent antibiotic use and had a blood culture performed. We used mixed-effect logit models to evaluate the effect of antimicrobial use on blood culture positivity, adjusted for markers of disease severity. Results We enrolled 2939 patients with suspected enteric fever. Antibiotics were detected in 39% (1145/2939) of urine samples. The correlation between measured and reported antibiotic use was modest (κ = 0.72). After adjusting for disease severity, patients with antibiotics in their urine were slightly more likely to be blood culture positive for enteric fever; however, the effect was not statistically significant (prevalence ratio, 1.22 [95% confidence interval, .99–1.50]). Conclusions The reliability of self-reported prior antibiotic use was modest among individuals presenting with fever to tertiary hospitals. While antibiotics are likely to reduce the sensitivity of blood culture, our findings indicate that there is still considerable value in performing blood culture for individuals reporting antibiotic use.

scholarly journals COMPARATIVE ASSESSMENT OF ICT,WIDAL WITH BLOOD CULTURE FOR THE DIAGNOSIS OF TYPHOID FEVER AMONG PUO CASES IN A TERTIARY CARE: A HOSPITAL BASED STUDY OF NORTH EAST.

2020 ◽  
pp. 19-20
Author(s):  
Banti Das ◽  
Niladri Sekhar Das
Keyword(s):  
Blood Culture ◽  
Disease Burden ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Comparative Assessment ◽  
Acute Febrile Illness ◽  
North East ◽  
Laboratory Confirmation ◽  
Tropical Areas

Background: Disease burden of acute febrile illness due to infectious etiologies is under reported in various parts of India including North east due to lack of laboratory confirmation. Undifferentiated febrile illnesses common in tropical areas of Asia and enteric fever is one of them Aims: This study was conducted to determine the best investigative procedures for the diagnosis of enteric fever . Setting and Design: This was a hospital based study among 205 patients including paediatric patients admitted with acute febrile illness were evaluated by ICT, Widal and Blood culture Materials and Methods: ICT , Widal and blood culture were performed according to manufactuter instruction Results: When ICT was compared to blood culture concordence rate was found to be 92% where as discrepacancy was just 8% and sensitivity and specificity was found to be 100 % and 90.24%.

Retropharyngeal Cellulitis: A Manifestation of Kawasaki Disease in Children

1993 ◽  
Vol 109 (6) ◽  
pp. 1030-1033 ◽  
Author(s):  
T. Oma Hester ◽  
J. Peter Harris ◽  
Jean F. Kenny ◽  
Marcus S. Albernaz
Keyword(s):  
Kawasaki Disease ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
The United States ◽  
Acute Febrile Illness ◽  
Mucocutaneous Lymph Node Syndrome ◽  
The Past ◽  
Soft Tissue Swelling ◽  
Initial Description ◽  
Lymph Node Syndrome

Kawasaki disease (KD) or mucocutaneous lymph node syndrome is an acute febrile illness with prominent vasculitic features. The cause is unknown and the disease is seen most commonly in young children. After Its initial description in Japan,1 the disease was thought to be rare in the United States, but recognition has dramatically increased over the past decade. Common symptoms of the disease for which the otolaryngologist may be initially consulted include inflammation of the lips and oral cavity and acute cervical lymphadenopathy. We present a case of Kawasaki disease initially complicated by retropharyngeal soft tissue swelling. Similar reports are rare in the pediatric literature; however, no such reports appear in the otolaryngology literature.

scholarly journals Spatial Heterogeneity of Enteric Fever in 2 Diverse Communities in Nepal

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S205-S213
Author(s):  
Dipesh Tamrakar ◽  
Krista Vaidya ◽  
Alexander T Yu ◽  
Kristen Aiemjoy ◽  
Shiva Ram Naga ◽  
...  
Keyword(s):  
Rural Communities ◽  
Spatial Heterogeneity ◽  
Urban Areas ◽  
Enteric Fever ◽  
Febrile Illness ◽  
Household Survey ◽  
Salmonella Typhi ◽  
Population Based ◽  
Care Seeking ◽  
Urban Catchment

Abstract Background Typhoid fever is endemic in the urban Kathmandu Valley of Nepal; however, there have been no population-based studies of typhoid outside of this community in the past 3 decades. Whether typhoid immunization should be prioritized in periurban and rural communities has been unclear. Methods We performed population-based surveillance for enteric fever in 1 urban catchment (Kathmandu) and 1 periurban and rural catchment (Kavrepalanchok) as part of the Surveillance for Enteric Fever in Asia Project (SEAP). We recruited individuals presenting to outpatient and emergency departments at 2 study hospitals with suspected enteric fever and performed blood cultures. Additionally, we conducted a household survey in each catchment area to characterize care seeking for febrile illness. We evaluated spatial heterogeneity in febrile illness, care seeking, and enteric fever incidence. Results Between September 2016 and September 2019, we enrolled 5736 participants with suspected enteric fever at 2 study hospitals. Among these, 304 (5.3%) were culture positive for Salmonella Typhi (249 [81.9%]) or Paratyphi A (55 [18.1%]). Adjusted typhoid incidence in Kathmandu was 484 per 100 000 person-years and in Kavrepalanchok was 615 per 100 000 person-years. While all geographic areas for which estimates could be made had incidence >200 per 100 000 person-years, we observed spatial heterogeneity with up to 10-fold variation in incidence between communities. Conclusions In urban, periurban, and rural communities in and around Kathmandu, we measured a high but heterogenous incidence of typhoid. These findings provide some support for the introduction of conjugate vaccines in Nepal, including outside urban areas, alongside other measures to prevent enteric fever.

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

2022 ◽  
Vol 9 (3) ◽  
pp. 12-15
Author(s):  
Gangum Venkatreddy ◽  
Shireesha Gugloth
Keyword(s):  
Platelet Count ◽  
Enteric Fever ◽  
Viral Infections ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Platelet Counts ◽  
Chest X Ray ◽  
The Common ◽  
Time Of Admission

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.

scholarly journals A study on clinical profile of acute undifferentiated febrile illness in a tertiary care hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 404
Author(s):  
Mariraj I. ◽  
Mohammed Adil ◽  
Ramkumar M. ◽  
Jagadeesan M. ◽  
Prasanna Karthik S. ◽  
...  
Keyword(s):  
Enteric Fever ◽  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Malarial Parasite ◽  
Care Hospital ◽  
Acute Febrile Illness ◽  
Function Test

Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e045826
Author(s):  
Arjun Chandna ◽  
Endashaw M Aderie ◽  
Riris Ahmad ◽  
Eggi Arguni ◽  
Elizabeth A Ashley ◽  
...  
Keyword(s):  
Observational Study ◽  
Prediction Model ◽  
Prospective Observational Study ◽  
Model Building ◽  
Venous Blood ◽  
Febrile Illness ◽  
Nasopharyngeal Swab ◽  
Acute Febrile Illness ◽  
Clinical Prediction ◽  
Open Access Journals

IntroductionIn rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care.Methods and analysisThis prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies.Ethics and disseminationThe study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings.Trial registration numberNCT04285021.

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