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

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.

Detection of Zika virus in Anopheles stephensi Liston, 1901 (Diptera: Culicidae) in India - First report

Zika virus (ZIKV) a mosquito-borne, causing acute febrile illness associated with rash, arthralgia and conjunctivitis in the patient, was reported from Thiruvananthapuram, Kerala, as an outbreak with 83 cases. Entomological surveillance revealed the presence of aedine mosquitoes viz., Aedes aegypti (Linnaeus, 1762), Ae. albopictus (Skuse, 1894) and Ae. vittatus (Bigot, 1861) and nonaedine mosquitoes viz., Anopheles stephensi Liston,1901, Mansonia uniformis (Theobald, 1901), Culex tritaeniorhynchus Giles, 1901 and Cx. gelidus Theobald,1901. Aedes (Ae. aegypti, Ae. vittatus and Ae. Albopictus) mosquito larvae were high in the Zika affected areas. Moreover ZIKV was detected in An. stephensi mosquitoes collected from Parassala, Thiruvananthapuram (the native place of the first ZIKV confirmed case in the present outbreak in Kerala). Molecular diagnostics of Ae. Aegypti, Ae. vittatu and An. stephensi mosquitoes revealed that the species were loaded with ZIKV. Significantly this is the first ever report of ZIKV detecting in An. stephensi in the world. Aedes adults (male and female) and An. stephensi emerged from fourth instar larvae and pupae were found to have ZIKV, indicating transovarial transmission of the virus.

Challenges in Laboratory Diagnosis of Malaria in a Low-Resource Country at Tertiary Care in Eastern Nepal: A Comparative Study of Conventional vs. Molecular Methodologies

For ongoing malaria elimination programmes, available methods such as microscopy and rapid diagnostic tests (RDTs) cannot detect all malaria cases in acute febrile illness. These methods are entirely dependent on the course of infection, parasite load, and skilled technical resources. Our study objectives were to estimate the performance of light microscopy and a RDT as well as real-time PCR for the detection of the Plasmodium parasite. Altogether, 52 blood samples collected from patients with acute febrile illness were tested by microscopy, RDT, and real-time PCR. The results were compared in terms of sensitivity and specificity. Microscopy detected the malaria parasite in 5.8% of the blood samples whereas 13.5% were detected by the RDT and 27% by real-time PCR. Considering real-time PCR as the gold standard method, microscopy had a sensitivity of 21.4% and a specificity of 100%, and the RDT had a sensitivity of 28.6% and a specificity of 92.1%. Microscopy together with the RDT successfully detected malaria positive cases in blood samples of Ct value below 20, but both were unable to detect malaria cases between 26–40 Ct value ranges amplified by real-time PCR. Despite various diagnostic tools being available, microscopy still remains the method of choice for diagnosis, while the RDT is user-friendly when applied at the point of care. However, our preliminary results emphasize the need to implement the test with higher sensitivity and specificity in the context of a malaria elimination programme. Such programmes can be a crucial opportunity to understand the species prevalent in a low-endemic region. However, these results should be further verified with a large cohort study to document the submicroscopic infection.

West nile fever case in neurological practice

West Nile fever is a zoonotic arbovirus mosquito- and tick-borne infection, which occurs in humans in the form of an acute febrile illness with symptoms of general intoxication, in severe cases – with the central nervous system damage. West Nile virus belongs to the Flaviviridae family.After the start of Russians’ mass tourism to tropical and subtropical regions, number of cases of the disease in Russia has increased, especially in the south, where the virus is more viable. The infection mainly affects birds but also people and many mammals (bats, cats, dogs, skunks, squirrels, rabbits, etc.), which become infected after the bite of a mosquito of the genus Culex (Culex pipiens) carrying the disease, ixodid or argas mite. A clinical case of hemorrhagic stroke caused by West Nile fever is presented in the article.

A Study of D-Dimer Levels in Acute Febrile Non Covid Conditions in a Tertiary Care Hospital

Introduction: Acute undifferentiated febrile illness (AUFI) is caused by a multitude of diverse pathogens, with significant morbidity and mortality in the developing world. This study aims to highlight the gaps in our understanding of the various differential diagnosis of acute febrile illness and their prognostic outcomes. In this study, We used d-dimer levels to arrive at a differential diagnosis in acute febrile illness and also used it as a biomarker of disease severity and prognostic outcome. Materials and Methods: A prospective study was conducted at medicine department, Saveetha medical college and hospital, Thandalam, India for a period of 3 months from January 2020 - March 2020. Patients who presented to the medicine outpatient department with symptoms of acute febrile illness with non specific symptoms were registered after getting written consent in the study. The plasma concentration of D -dimer levels ,prothrombin time , APTT from which INR were measured. The duration of hospital stay of patients in study was recorded. The data collected was entered into an excel sheet and analysed using SPCC software. Results: A total of 50 patients with acute febrile illness were enrolled in the study. Out of which 37 patients (74./. of patients) were found to have elevated D dimer levels. These 37 patients with elevated D – dimer levels required longer duration of hospital stay, reflecting the need for more days for recovery.

The impact of pulse oximetry on diagnosis, management and outcomes of acute febrile illness in low-income and middle-income countries: a systematic review

BackgroundAcute fever is a common presenting symptom in low/middle-income countries (LMICs) and is strongly associated with sepsis. Hypoxaemia predicts disease severity in such patients but is poorly detected by clinical examination. Therefore, including pulse oximetry in the assessment of acutely febrile patients may improve clinical outcomes in LMIC settings.MethodsWe systematically reviewed studies of any design comparing one group where pulse oximetry was used and at least one group where it was not. The target population was patients of any age presenting with acute febrile illness or associated syndromes in LMICs. Studies were obtained from searching PubMed, EMBASE, CABI Global Health, Global Index Medicus, CINAHL, Cochrane CENTRAL, Web of Science and DARE. Further studies were identified through searches of non-governmental organisation websites, snowballing and input from a Technical Advisory Panel. Outcomes of interest were diagnosis, management and patient outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 tool for Cluster Randomised Trials and Risk of Bias in Non-randomized Studies of Interventions tools, as appropriate.ResultsTen of 4898 studies were eligible for inclusion. Their small number and heterogeneity prevented formal meta-analysis. All studies were in children, eight only recruited patients with pneumonia, and nine were conducted in Africa or Australasia. Six were at serious risk of bias. There was moderately strong evidence for the utility of pulse oximetry in diagnosing pneumonia and identifying severe disease requiring hospital referral. Pulse oximetry used as part of a quality-assured facility-wide package of interventions may reduce pneumonia mortality, but studies assessing this endpoint were at serious risk of bias.ConclusionsVery few studies addressed this important question. In LMICs, pulse oximetry may assist clinicians in diagnosing and managing paediatric pneumonia, but for the greatest impact on patient outcomes should be implemented as part of a health systems approach. The evidence for these conclusions is not widely generalisable and is of poor quality.

The Burden of Acute Febrile Illness Attributable to Dengue Virus Infection in Sri Lanka: A Single-Center 2-Year Prospective Cohort Study (2016–2019)

We performed a 2-year prospective cohort study to determine the incidence of dengue in Angoda, Colombo district, Sri Lanka (NCT02570152). The primary objective was to determine the incidence of acute febrile illness (AFI) because of laboratory confirmed dengue (LCD). Secondary objectives were to determine AFI incidence due to non-LCD, describe AFI symptoms, and estimate AFI incidence because of LCD by dengue virus (DENV)-type and age group. Participants from households with at least one minor and one adult (≤50 years) were enrolled and followed with scheduled weekly visits and, in case of AFI, unscheduled visits. Blood was collected for DENV detection at AFI visits, and symptoms recorded during the 7-day period following AFI onset. A total of 2,004 participants were enrolled (971 children, and 1,033 adults). A total of 55 LCD episodes were detected (overall incidence of 14.2 per 1,000 person-years). Incidence was the highest among children < 5 years (21.3 per 1,000 person-years) and 5–11 years (22.7 per 1,000 person-years), compared with adults ≥ 18 years (9.2 per 1,000 person-years). LCD was mostly (83.6%) caused by DENV-2 (N = 46), followed by DENV-1 (N = 6) and DENV-3 (N = 3). Common symptoms of LCD were headache, fatigue, myalgia, loss of appetite, and arthralgia. Incidence of AFI because of non-LCD was 47.3 per 1,000 person-years. In conclusion, this study reports the LCD incidence for a DENV-2 dominated epidemic that is comparable to the incidence of suspected dengue reported passively for 2017, one of the worst outbreaks in recent history.

A novel nairovirus associated with acute febrile illness in Hokkaido, Japan

The increasing burden of tick-borne orthonairovirus infections, such as Crimean-Congo hemorrhagic fever, is becoming a global concern for public health. In the present study, we identify a novel orthonairovirus, designated Yezo virus (YEZV), from two patients showing acute febrile illness with thrombocytopenia and leukopenia after tick bite in Hokkaido, Japan, in 2019 and 2020, respectively. YEZV is phylogenetically grouped with Sulina virus detected in Ixodes ricinus ticks in Romania. YEZV infection has been confirmed in seven patients from 2014–2020, four of whom were co-infected with Borrelia spp. Antibodies to YEZV are found in wild deer and raccoons, and YEZV RNAs have been detected in ticks from Hokkaido. In this work, we demonstrate that YEZV is highly likely to be the causative pathogen of febrile illness, representing the first report of an endemic infection associated with an orthonairovirus potentially transmitted by ticks in Japan.

Detection of NS1 antigen, IgM and IgG antibodies using a commercial Dengue rapid test kit for the diagnosis of dengue infection in patients with acute febrile illness

Dengue is an endemic arboviral illness. With the increasing incidence of dengue infection, an early diagnostic confirmation of dengue infection in patients facilitates timely clinical intervention, etiological investigation, and disease control. Objective of this study was to evaluate a commercially available serological test kit - Dengue Day 1 Test. This is for the detection of dengue NS1 antigen, differential detection of IgM and IgG antibodies on a single acute serum sample. Atotal of 100 patients with acute febrile illness were included in this study. Serum samples were analysed for Dengue NS1 Ag, IgM & IgG Antibodies using a commercially available Dengue Day 1 Test, rapid solid phase immuno-chromatographic test.As many as 23 (23%) samples were NS1 positive and 17 (17%) samples were positive for IgM antibodies. Based on the combination of dengue NS1 antigen and IgM antibody test, total of 34 patients (34%) were positive for dengue virus infection.Results of the study suggested that a combination of dengue NS1 antigen and IgM antibody tests would increase the rate of detection of dengue illness. This combination would increase the efficacy and aid in early diagnosis of dengue infection.