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Dixit R, Manikandan S, Gopalan N, Mohanty BS, Behera SK. Temporal trends in diagnostic evolutions for rickettsial diseases including scrub typhus: a bibliometric study. Pathog Glob Health 2025; 119:75-86. [PMID: 40089993 DOI: 10.1080/20477724.2025.2475278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2025] Open
Abstract
The bibliometric analysis aimed to assess the bibliometric characteristics, current status and temporal trends in diagnostic evolutions related to infectious diseases caused by the genus Orientia and Rickettsia. Relevant studies were retrieved from Scopus using pre-determined standard keywords. The analysis was performed using the R package 'Bibliometrix' through the 'Biblioshiny' interface. A total of 239 studies were identified for Rickettsia diagnostics, while 168 studies focussed on scrub typhus diagnostics. The annual growth rate of publications in scrub typhus (1.82%) was found to be higher than that of diagnostic research in Rickettsia (1.44%). The Journal of Clinical Microbiology (IF: 5.8) was the most relevant source for Rickettsia research, whereas the American Journal of Tropical Medicine and Hygiene (IF: 3.7) led publications for scrub typhus. The most globally cited articles were authored by Biggs et al (2017) for Rickettsia and Blacksell et al. (2007) for scrub typhus. U.S.A. (n = 119) and India (n = 136) are the most productive nations, publishing in Rickettsia and scrub typhus diagnostics. Mahidol University (Thailand) and the University of Texas (U.S.A.) were the top-contributing institutions. Blacksell S.D. and Raoult D. were identified as the most prolific researchers in Rickettsia and scrub typhus diagnostics. This study provides insights into the impact, productivity, and collaborative patterns among authors, institutions, and other stakeholders in rickettsial disease diagnostics. It offers a historical overview of diagnostic developments and emphasizes the importance of continued innovation and international collaboration to ensure timely diagnosis and treatment of rickettsial diseases.
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Affiliation(s)
- Rashi Dixit
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, India
| | - Sandeep Manikandan
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, India
| | - Natarajan Gopalan
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, India
| | - Bhabani Shankar Mohanty
- Department of Statistics and Applied Mathematics, Central University of Tamil Nadu, Thiruvarur, India
| | - Sujit Kumar Behera
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, India
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Virk HS, Biemond JJ, Earny VA, Chowdhury S, Frölke RI, Khanna SM, Shanbhag V, Rao S, Acharya RV, Balakrishnan JM, Eshwara VK, Varma MD, van der Poll T, Wiersinga WJ, Mukhopadhyay C. Unraveling Sepsis Epidemiology in a Low- and Middle-Income Intensive Care Setting Reveals the Alarming Burden of Tropical Infections and Antimicrobial Resistance: A Prospective Observational Study (MARS-India). Clin Infect Dis 2025; 80:101-107. [PMID: 39352692 PMCID: PMC11797389 DOI: 10.1093/cid/ciae486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Our study addresses the sepsis research gap in lower- and middle-income countries, notably India. Here, we investigate community-acquired sepsis comprehensively and explore the impact of tropical microbiology on etiology and outcomes. METHODS MARS-India was a prospective observational study from December 2018 to September 2022 in a tertiary-care hospital in South India. Adult patients within 24 hours of intensive care unit (ICU) admission meeting the Sepsis-3 definition were enrolled, with 6 months of follow-up. RESULTS More than 4000 patients were screened on ICU admission, with 1000 unique patients meeting the inclusion criteria. Median age was 55 (interquartile range, 44-65) years, with a male preponderance (66%). Almost half the cohort resided in villages (46.5%) and 74.6% worked in the primary sector. Mortality in-hospital was 24.1%. Overall, about 54% had confirmed microbiological diagnosis and >18% had a viral cause of sepsis. Surprisingly, we identified leptospirosis (10.6%), scrub typhus (4.1%), dengue (3.7%), and Kyasanur forest disease (1.6%) as notable causes of sepsis. All of these infections showed seasonal variation around the monsoon. In community-acquired infections, we observed substantial resistance to third-generation cephalosporins and carbapenems. CONCLUSIONS In India, sepsis disproportionally affects a younger and lower-socioeconomic demographic, yielding high mortality. Tropical and viral sepsis carry a significant burden. Analyzing local data, we pinpoint priorities for public health and resources, offering valuable insights for global sepsis research. Clinical Trials Registration. NCT03727243.
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Affiliation(s)
- Harjeet S Virk
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Microbiology, Queen Alexandra Hospital, Portsmouth Hospitals University National Health Service Trust, Portsmouth, United Kingdom
| | - Jason J Biemond
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Venkat A Earny
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Soumi Chowdhury
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Roos I Frölke
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saachi M Khanna
- Mother and Baby Unit, Hellesdon Hospital (Norfolk and Suffolk NHS Foundation Trust), Norwich, United Kingdom
| | - Vishal Shanbhag
- Department of Critical Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Shwethapriya Rao
- Department of Critical Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Raviraj V Acharya
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Jayaraj M Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Vandana K Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Muralidhar D Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem J Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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Zhao P, Dong T, Lu H, Zhu R, Zhao S, Tao W, Li L, Liu C, Pu S, Mo L, Wang H. Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China. PLoS Negl Trop Dis 2025; 19:e0012829. [PMID: 39836661 PMCID: PMC11771934 DOI: 10.1371/journal.pntd.0012829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/27/2025] [Accepted: 01/08/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Despite its association with high mortality rates and negative fetal outcomes, large-scale epidemiological studies on scrub typhus (ST) during pregnancy remain scarce. METHODS We conducted a retrospective, multicenter study by collecting 260 pregnant women with ST in China across a 10-year time period to evaluate how clinical characteristics changed over this time and identify risk factors for poor fetal outcome. RESULTS In total, 78.5% (n = 204) presented with pathognomonic eschars or ulcers, and 75.4% (n = 196) had Weil-Felix test, in which 46.4% (n = 91) had a titer of ≥1:160 for OXK. A higher proportion of patients with pneumonia (18.7% vs. 9.5%, p = 0.033) and a longer length of hospitalization (7 vs. 6 days, p = 0.007) were seen in laboratory confirmed cases than clinically diagnosed cases. Compared to patients in the second trimester, a higher miscarriage rate (64.5% vs. 15.0%, p < 0.001) was observed in the first trimester, and a lower fetal death/stillbirth rate (1.0% vs 18.7%, p < 0.001) and a higher prematurity rate (21.0% vs. 9.3%, p = 0.019) were observed in the third trimester. The use of chloramphenicol (5.7% vs. 15.5%, p = 0.016) and fetal death/stillbirth rate (3.1% vs. 12.8%, p = 0.01) were decreased, but there was no significant improvement in fetal outcome in the second 5 years (35.1% vs. 39.7%, p = 0.466). Over 1/3 (n = 90) had a poor fetal outcome, including 40.0% (n = 36) miscarriage, 23.3% (n = 21) fetal death/stillbirth and 36.7% (n = 33) preterm birth. The use of macrolides reduced the risk of a poor fetal outcome, while lower gestational age (GA) at the time of infection, pneumonia, leucopoenia, thrombocytopenia, and use of chloramphenicol were associated with a poor fetal outcome in univariate logistic-regression analysis, but only lower GA at the time of infection and pneumonia were independent risk factors for a poor fetal outcome on multivariate logistic-regression analysis with an odds ratio of 6.6 (95% CI 2.4-17.8, p < 0.001) and 3.1 (95% CI 1.3-7.6, p = 0.011). CONCLUSIONS This is the largest number of cases of ST in pregnancy so far. Our findings indicate that this population have a high risk of poor fetal outcome, especially those with lower GA at the time of infection and those with pneumonia at the same time. Further studies are needed to investigate the correlation between antibiotics regimens for this population and fetal outcome.
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Affiliation(s)
- Peilin Zhao
- Department of Neonatology, People’s Hospital of Jinping Miao and Yao Dai Autonomous County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Tieyong Dong
- Department of Neonatology, People’s Hospital of Lvchun County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Hongbin Lu
- Department of Infectious Disease, People’s Hospital of Jinping Miao and Yao Dai Autonomous County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Rui Zhu
- Department of Neonatology, People’s Hospital of Pingbian County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Shanshan Zhao
- Department of Neonatology, The First People’s Hospital of Honghe State, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Wuqian Tao
- Department of Neonatology, People’s Hospital of Hekou Yao Autonomous County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Li Li
- Department of Neonatology, People’s Hospital of Honghe County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Chunmei Liu
- Department of Neonatology, People’s Hospital of Yuanyang County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Shuwei Pu
- Department of Infectious Disease Control, Honghe Prefecture Center for Disease Control and Prevention, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Ling Mo
- Department of Obstetrics and Gynecology, People’s Hospital of Jinping Miao and Yao Dai Autonomous County, Honghe Hani and Yi Autonomous Prefecture, Yunnan Province, China
| | - Huanhuan Wang
- Department of Neonatology, National Children’s Medical Center/Children’s Hospital of Fudan University, National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Shanghai, China
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Perveen S, Srinivasan A, Prusty BSK, Jyotsna CV, Pabba S, Reddy R, Sheshala K, Ragavendra Asranna K. In-hospital new-onset seizures in patients admitted to the medical intensive care unit: An observational study and algorithmic approach. World J Crit Care Med 2024; 13:97399. [PMID: 39655304 PMCID: PMC11577533 DOI: 10.5492/wjccm.v13.i4.97399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/17/2024] [Accepted: 08/23/2024] [Indexed: 10/31/2024] Open
Abstract
BACKGROUND Seizures are one of the most common neurological complications encountered in the intensive care unit (ICU). They can occur in the background of exacerbation of a known neurological disease or secondary to non-neurological conditions such as sepsis and metabolic disturbances. However, there is a paucity of literature on the incidence and pattern of new-onset seizures in ICUs. AIM To study the incidence and patterns of new-onset seizures in patients admitted to the medical ICU. METHODS This was a prospective, multicenter, observational study performed in two tertiary care centers in Hyderabad, India over a period of 1 year. Patients upon ICU admission, who developed new-onset generalized tonic clonic seizures (GTCS), were enrolled. Those with a pre-existing seizure disorder, acute cerebrovascular accident, head injury, known structural brain lesions, or chronic liver disease were excluded as they have a higher likelihood of developing seizures. All enrolled patients were subjected to biochemical routines, radiological imaging of either computed tomography or magnetic resonance imaging, and other relevant laboratory tests as per clinical suspicion according to the protocol, and their data were recorded. Statistical analyses were conducted using descriptive statistics, χ 2 tests, and linear regression. RESULTS A total of 61 of 2522 patients developed GTCS. Among all etiologies of seizures, metabolic causes were most frequent (35%) followed by infective causes (27%) and others (new-onset structural, drug withdrawal, drug-induced, toxicology-related, and miscellaneous factors). Logistic regression analysis showed that increased sodium and calcium levels were associated with a lower likelihood of developing seizures. CONCLUSION This study identified the etiology of new-onset seizures developing in critically ill patients admitted to the ICU. These findings highlight the need for targeted monitoring of those at risk of developing seizures.
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Affiliation(s)
- Safina Perveen
- Critical Care Medicine, Amaravathi Institute of Medical Sciences, Guntur 522001, Andhra Pradesh, India
| | | | | | - Ch V Jyotsna
- Critical Care Medicine, Virinchi Hospital, Hyderabad 500034, Telangāna, India
| | - Shravani Pabba
- Critical Care Medicine, Virinchi Hospital, Hyderabad 500034, Telangāna, India
| | - Ramakrishna Reddy
- Critical Care Medicine, Virinchi Hospital, Hyderabad 500034, Telangāna, India
| | - Kaladhar Sheshala
- Critical Care Medicine, Yashoda Hospital, Malakpet, Hyderabad 500036, Telangāna, India
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Simon J, Perumal Kumaresan A, Chand U, Sriharsha T, Bose S. Tropical Co-infection in a Tertiary Care Center in South India: A Case Report. Cureus 2024; 16:e67487. [PMID: 39310443 PMCID: PMC11416202 DOI: 10.7759/cureus.67487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Tropical co-infections, characterized by overlapping clinical manifestations and the potential for diagnostic confusion, pose significant challenges in the management of febrile illnesses in endemic regions. This case report presents a 33-year-old male with a five-day history of fever, gastrointestinal symptoms, and dry cough, ultimately diagnosed with co-infections of dengue, leptospirosis, and Salmonella paratyphi A. This case underscores the challenges posed by the overlapping clinical features of endemic tropical diseases, emphasizing the necessity for comprehensive diagnostic strategies and tailored treatment protocols in managing febrile illnesses in endemic regions. Clinicians must also consider serological cross-reactivity when interpreting diagnostic tests, as it can complicate the identification of co-infections and impact treatment decisions, necessitating vigilance and an integrated approach in clinical practice.
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Affiliation(s)
- Jibin Simon
- Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Ananthakumar Perumal Kumaresan
- Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Utham Chand
- Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Tirumalasetty Sriharsha
- Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sharan Bose
- Internal Medicine, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Jayashree M, Parameswaran N, Nallasamy K, Chidambaram AC, Rajasegar R, Dhodapkar R, Chhabra M, Gupta N, Kaur H, Velayudhan A, Deol S, Lodha R, Vasanthapuram R, Verghese VP, Rose W. Approach to fever in children. Indian J Med Microbiol 2024; 50:100650. [PMID: 38897571 DOI: 10.1016/j.ijmmb.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Fever in children is one of the most common reasons for outpatient visits as well as in-patient evaluation, often causing anxiety among parents and caregivers. Fever can be a standalone feature or be associated with other localising symptoms and signs like rash, lymphadenopathy, or any other organ system involvement with or without a focus of infection. The etiologies of fever vary depending on the clinical setting and epidemiology. India being a tropical country, sees a distinct spectrum of tropical infections. Physicians need to stay updated on the prevalent diseases in their region and the unique factors that may influence the clinical presentations and course of fever in the cohort of children they manage. The challenge lies in balancing the benefit of early treatment for severe diseases versus the harms of unnecessary investigations and treatment for self-resolving illnesses. OBJECTIVES This review aims to provide a comprehensive overview of fever in children, covering its etiology, clinical features, and management strategies. This review offers an algorithmic approach to fever tailored to the Indian setting to guide physicians in identifying the disease based on clinical symptoms and signs, ordering essential laboratory investigations, and initiating appropriate management promptly. CONTENT The review categorises fever into various segments like fever with localising signs like rash, lymphadenopathy, fever due to infection localised to a particular organ system, and fever without a focus including fever of unknown origin. It delves into the diverse etiological factors contributing to fever in each of these categories, encompassing infectious and non-infectious origins. It gives pointers to identify the etiology from history, examination, and confirm them with judicious use of diagnostic investigations with emphasis on identifying the red flag signs that require immediate attention, especially in vulnerable groups like neonates and young infants.
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Affiliation(s)
- Muralidharan Jayashree
- Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Narayanan Parameswaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Aakash Chandran Chidambaram
- Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Raajashri Rajasegar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Rahul Dhodapkar
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Mala Chhabra
- Department of Microbiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital (RML), Delhi, India.
| | - Nivedita Gupta
- Division of Communicable Diseases, ICMR Headquarters, New Delhi, India.
| | - Harmanmeet Kaur
- Division of Communicable Diseases, ICMR Headquarters, New Delhi, India.
| | - Anoop Velayudhan
- Division of Communicable Diseases, ICMR Headquarters, New Delhi, India.
| | - Saumya Deol
- Division of Communicable Diseases, ICMR Headquarters, New Delhi, India.
| | - Rakesh Lodha
- Division of Pediatric Pulmonology& Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Ravi Vasanthapuram
- Department of Neurovirology, Registrar & Dean (Basic Sciences), NIMHANS Bengaluru, India.
| | | | - Winsley Rose
- Pediatric Infectious Diseases, Christian Medical College, Vellore, India.
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Silva-Ramos CR, Gil-Mora J, Serna-Rivera CC, Martínez Díaz HC, Restrepo-López N, Agudelo-Flórez P, Arboleda M, Díaz FJ, Faccini-Martínez ÁA, Hidalgo M, Melby PC, Aguilar PV, Cabada MM, Tobón-Castaño A, Rodas JD, members of the GIDRN – Global Infectious Diseases Research Network. Etiological characterization of acute undifferentiated febrile illness in Apartadó and Villeta municipalities, Colombia, during COVID-19 pandemic. LE INFEZIONI IN MEDICINA 2023; 31:517-532. [PMID: 38075419 PMCID: PMC10705856 DOI: 10.53854/liim-3104-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/02/2023] [Indexed: 03/28/2024]
Abstract
Background Acute undifferentiated febrile illness (AUFI) is one of the leading causes of illness in tropical regions. Although malaria is the most important cause, other pathogens such as Dengue (DENV), Leptospira and recently, Coronavirus Disease 2019 (COVID-19) have gained importance. In Colombia, few studies aimed to identify the etiology of AUFI. Most of them performed in Apartadó and Villeta municipalities, identifying the active circulation of several pathogens. Thus, we conducted a cross-sectional study in these municipalities to characterize the etiologies of AUFI during COVID-19 pandemic. Methods An active surveillance was conducted between September and December 2021 in local hospitals of Apartadó and Villeta municipalities. Febrile patients were enrolled after voluntarily agreeing to participate in the study. Ten different etiologies were evaluated through direct, serological, molecular and rapid diagnostic methods. Results In Apartadó a confirmed etiology was found in 60% of subjects, DENV (25%) being the most frequent, followed by leptospirosis (16.7%), malaria (10%), COVID-19 (8.3%), spotted fever group (SFG) rickettsiosis (6.7%) and Chikungunya (1.7%). In Villeta, a specific etiology was confirmed in 55.4% of patients, of which SFG rickettsiosis (39.3%) was the most frequent, followed by leptospirosis (21.4%), DENV (3.6%) and malaria (1.8%). No cases due to Mayaro, Yellow Fever, Oropouche and Venezuelan Equine Encephalitis viruses were detected. Conclusion We confirm the relevance of dengue fever, leptospirosis, SFG rickettsiosis, COVID-19 and malaria as causes of AUFI in the municipality of Apartadó, and highlight the great importance of SFG rickettsiosis as the main cause of AUFI in the municipality of Villeta.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juliana Gil-Mora
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Cristian C. Serna-Rivera
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
| | - Heidy-C. Martínez Díaz
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Nicaela Restrepo-López
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
| | - Piedad Agudelo-Flórez
- Grupo de Investigación en Ciencias Básicas, Escuela de Graduados, Universidad CES, Medellín, Colombia
| | - Margarita Arboleda
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Francisco J. Díaz
- Grupo de Inmunovirología, Universidad de Antioquia, Medellin,Colombia
| | - Álvaro A. Faccini-Martínez
- Servicio de Infectología, Hospital Militar Central, Bogotá, Colombia
- Servicios y Asesorías en Infectología - SAI, Bogotá, Colombia
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotà, Colombia
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Peter C. Melby
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
| | - Patricia V. Aguilar
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Miguel M. Cabada
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Juan David Rodas
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
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Dev A, Kumar A, Kumar S, Gunjan G, Singh S, Arun N. Clinical and Etiological Profile of Acute Undifferentiated Fever With Thrombocytopenia in an Emergency Department. Cureus 2023; 15:e44719. [PMID: 37809143 PMCID: PMC10552881 DOI: 10.7759/cureus.44719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Acute undifferentiated fever with thrombocytopenia is a common and challenging clinical presentation encountered in the emergency departments of tertiary care centers, particularly in tropical regions, often requiring prompt evaluation and management. The study aimed to explore the clinical and etiological profile of acute undifferentiated fever with thrombocytopenia in the Emergency Department of Indira Gandhi Institute of Medical Sciences, Patna. It investigates factors associated with patient outcomes and compares platelet transfusion requirements among different etiological groups. METHODS In this cross-sectional observational study, 350 patients with acute undifferentiated fever with thrombocytopenia were analyzed for one year from October '21 to September '22. Pre-existing chronic infectious diseases, liver cirrhosis, and autoimmune conditions were excluded. RESULTS Thrombocytopenia was observed in all patients, with 65% having platelet counts below 50,000/µL. Associations were found between the degree of thrombocytopenia and organ dysfunction, shock, and third space loss. Logistic regression analysis identified thrombocytopenia, organ dysfunction, and platelet transfusion requirement as significant predictors of the overall outcome. Etiological group comparisons revealed higher platelet transfusion requirements in the bacterial group. CONCLUSION Prompt recognition and management of thrombocytopenia in acute undifferentiated fever are vital. Thrombocytopenia, along with organ dysfunction and shock, significantly influence patient outcomes. Tailored interventions based on etiological factors are crucial. Further research should focus on specific viral aetiologies in acute undifferentiated fever with thrombocytopenia.
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Affiliation(s)
- Anand Dev
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Abhay Kumar
- Internal Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Santosh Kumar
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Gagan Gunjan
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Siddharth Singh
- Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Nitali Arun
- Infectious Diseases, Radha Devi Jageshwari Memorial Medical College, Muzaffarpur, IND
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Olaniyi O, Ayotunde O, Christabel T, Idowu O. Delayed diagnosis of bacterial cervical lymphadenitis in the tropics: a case report. J Med Case Rep 2023; 17:41. [PMID: 36755272 PMCID: PMC9909935 DOI: 10.1186/s13256-023-03773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. There are multiple etiologies in the setting of a diseased lymph node, including conditions of infection, autoimmune diseases, and neoplasia. Lymphadenitis is a term that refers to lymphadenopathies that are due to inflammatory processes and can represent an acute bacterial infection resulting from streptococcal pharyngitis or a prior viral upper respiratory infection. Cervical lymphadenopathy refers to nodal swelling in the neck region. While cervical lymphadenitis is a common clinical finding in the setting of a transient response to a benign local or generalized infection, it may evade detection sometimes and thus account for a percentage of misdiagnosis or delayed diagnosis in the tropics. This case report is aimed at increasing the awareness about the presentation of bacterial cervical lymphadenitis and how it can sometimes mimic the presentation that is typical and regularly found with plasmodiasis. It contributes to improved awareness and high index of suspicion in clinic when dealing with patients in the tropics. CASE PRESENTATION We present a case of delayed diagnosis of bacterial cervical lymphadenitis that initially presented with typical features of malaria from Plasmodium falciparum. A 26-year-old Nigerian woman presented to the outpatient department following complaints of a recurring fever of a month's duration and bilateral neck swelling of about 2 weeks prior to presentation. CONCLUSION In the setting of a busy clinic, details are easily missed and salient features in the presentation of a patient that are needed for accurate diagnosis and management could go unrecognized. Hence, this case report highlights the importance of proper examination particularly of lymph nodes and use of different diagnostic modalities for the exact diagnosis of disease.
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Affiliation(s)
- Oladosu Olaniyi
- Outpatient Department, Roding Medical Center, Lagos, Nigeria.
| | | | - Thomas Christabel
- grid.411278.90000 0004 0481 2583Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Divyashree K, Singh H, Suri V, Bhalla A. Empirical intravenous aciclovir therapy in a suspected case of acute encephalitis. Trop Doct 2023; 53:321-324. [PMID: 36694451 DOI: 10.1177/00494755231152654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Herpes simplex encephalitis is the most common cause of sporadic viral encephalitis worldwide but presents as a diagnostic challenge at many settings due to its non-specific symptoms, which can be easily mistaken for systemic infection or metabolic encephalopathy. It has diverse range of presentations from fever, altered sensorium, nausea, vomiting, meningismus to seizures, neurological deficits and coma in advanced stages. It is associated with significant morbidity and mortality if treatment is delayed or inadequate. We here discuss a case of Herpes simplex virus (HSV) encephalitis which rapidly progressed to result in irreversible neurological insult due to delayed diagnosis and treatment.
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Affiliation(s)
- Krishna Divyashree
- Department of Internal Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Department of Internal Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Sharma R, Gurtoo A, Prakash A, Jose R, Bansal P. Leptospiral myocarditis and pancreatitis. Trop Doct 2023; 53:329-331. [PMID: 36597661 DOI: 10.1177/00494755221148227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
While Leptospira are known to cause multi-system dysfunction, cardiac involvement is uncommon. We present a case febrile myocarditis diagnosed to have leptospirosis. The patient also had pancreatitis, jaundice and renal failure but recovered well with timely management.
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Affiliation(s)
- Rohan Sharma
- Department of Medicine, 28856Lady Hardinge Medical College, New Delhi, India
| | - Anil Gurtoo
- Department of Medicine, 28856Lady Hardinge Medical College, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, 28856Lady Hardinge Medical College, New Delhi, India
| | - Rosmy Jose
- Department of Medicine, 421037Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Priya Bansal
- Department of Medicine, 28856Lady Hardinge Medical College, New Delhi, India
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12
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Kapoor M, Kumar N, Panda PK. The symptomatology of fever: A step towards qualitative definition of fever. J Family Med Prim Care 2022; 11:5990-6000. [DOI: https:/doi.org/10.4103/jfmpc.jfmpc_360_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 05/15/2025] Open
Abstract
ABSTRACT
Background:
The old definitions of fever are based on cross-sectional surveys of the population without analyzing the associated symptomatology as fever is a sign, not symptom. Therefore, a longitudinal follow-up study is the need of hour to analyze associated symptoms with fever.
Methods:
In a longitudinal study over one year, 196 participants recorded three temperature readings daily, one after waking up, one between 12 and 3 PM, one before sleeping, and filled the symptomatology questionnaire in a thermometry diary.
Results:
Per protocol analysis was done for febrile participants (n = 144). Fatigue (50.3%), warmth (47.3%), headache/head heaviness (47.0%), feeling malaise/general weakness (46.7%), loss of appetite (46.5%), muscle cramps/muscle aches (45.6%), chills/shivering (44.6%), increased sweating (43.0%), nausea (42.5%), irritability (38.9%), increased breathing rate (37.1%), and restlessness/anxiety/palpitations (36.5%) were the symptoms maximally seen during the febrile phase. A higher number of associated symptoms are associated with higher temperature readings. Dehydration suggested the numerically highest temperature values (100.86 ± 1.70°F) but seen in few febrile patients.
Conclusions:
Incorporation of symptom analysis in febrile patients is the need of the hour. Fatigue and warmth are found to be the most prevalent symptoms during febrile phase. Associated symptoms can help in predicting the intensity of fever also.
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Affiliation(s)
- Mayank Kapoor
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nitin Kumar
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan K. Panda
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Kapoor M, Kumar N, Panda PK. The symptomatology of fever: A step towards qualitative definition of fever. J Family Med Prim Care 2022; 11:5990-6000. [PMID: 36618218 PMCID: PMC9810860 DOI: 10.4103/jfmpc.jfmpc_360_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The old definitions of fever are based on cross-sectional surveys of the population without analyzing the associated symptomatology as fever is a sign, not symptom. Therefore, a longitudinal follow-up study is the need of hour to analyze associated symptoms with fever. METHODS In a longitudinal study over one year, 196 participants recorded three temperature readings daily, one after waking up, one between 12 and 3 PM, one before sleeping, and filled the symptomatology questionnaire in a thermometry diary. RESULTS Per protocol analysis was done for febrile participants (n = 144). Fatigue (50.3%), warmth (47.3%), headache/head heaviness (47.0%), feeling malaise/general weakness (46.7%), loss of appetite (46.5%), muscle cramps/muscle aches (45.6%), chills/shivering (44.6%), increased sweating (43.0%), nausea (42.5%), irritability (38.9%), increased breathing rate (37.1%), and restlessness/anxiety/palpitations (36.5%) were the symptoms maximally seen during the febrile phase. A higher number of associated symptoms are associated with higher temperature readings. Dehydration suggested the numerically highest temperature values (100.86 ± 1.70°F) but seen in few febrile patients. CONCLUSIONS Incorporation of symptom analysis in febrile patients is the need of the hour. Fatigue and warmth are found to be the most prevalent symptoms during febrile phase. Associated symptoms can help in predicting the intensity of fever also.
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Affiliation(s)
- Mayank Kapoor
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nitin Kumar
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan K. Panda
- Department of Internal Medicine (Infectious Disease Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Shenoy S, Rajan AK, Rashid M, Chandran VP, Poojari PG, Kunhikatta V, Acharya D, Nair S, Varma M, Thunga G. Artificial intelligence in differentiating tropical infections: A step ahead. PLoS Negl Trop Dis 2022; 16:e0010455. [PMID: 35771774 PMCID: PMC9246149 DOI: 10.1371/journal.pntd.0010455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background and objective Differentiating tropical infections are difficult due to its homogenous nature of clinical and laboratorial presentations among them. Sophisticated differential tests and prediction tools are better ways to tackle this issue. Here, we aimed to develop a clinician assisted decision making tool to differentiate the common tropical infections. Methodology A cross sectional study through 9 item self-administered questionnaire were performed to understand the need of developing a decision making tool and its parameters. The most significant differential parameters among the identified infections were measured through a retrospective study and decision tree was developed. Based on the parameters identified, a multinomial logistic regression model and a machine learning model were developed which could better differentiate the infection. Results A total of 40 physicians involved in the management of tropical infections were included for need analysis. Dengue, malaria, leptospirosis and scrub typhus were the common tropical infections in our settings. Sodium, total bilirubin, albumin, lymphocytes and platelets were the laboratory parameters; and abdominal pain, arthralgia, myalgia and urine output were the clinical presentation identified as better predictors. In multinomial logistic regression analysis with dengue as a reference revealed a predictability of 60.7%, 62.5% and 66% for dengue, malaria and leptospirosis, respectively, whereas, scrub typhus showed only 38% of predictability. The multi classification machine learning model observed to have an overall predictability of 55–60%, whereas a binary classification machine learning algorithms showed an average of 79–84% for one vs other and 69–88% for one vs one disease category. Conclusion This is a first of its kind study where both statistical and machine learning approaches were explored simultaneously for differentiating tropical infections. Machine learning techniques in healthcare sectors will aid in early detection and better patient care. Distinguishing tropical infections is difficult due to its homogeneous nature from clinical and laboratory presentations among them. This is a first of its kind study where both statistical and machine learning approaches were explored simultaneously for differentiating tropical infections. Dengue, malaria, leptospirosis and scrub typhus were the common tropical infections in our settings as per the need analysis. Better predictors in terms of laboratory parameters and clinical presentations were identified from retrospective analysis and used for the regression and machine learning models. The parameters such as accuracy, true positive rate/sensitivity/recall, false positive rate, precision/positive predictive value, F-measure and ROC area for both the training and validation sets (10-fold cross validation) for all modelling approaches and diseases (One vs One and One vs others) were calculated. All the models observed to have an acceptable range of model performance in differentiating tropical infections. Albumin can be considered as the main parameter in differentiating these tropical infections. These models should be implemented in daily clinical routine practice via mobile or desktop assisted applications or tools.
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Affiliation(s)
- Shreelaxmi Shenoy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Asha K. Rajan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Vijayanarayana Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Dinesh Acharya
- Department of Computer Science & Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
- * E-mail:
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15
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Abstract
How to cite this article: Pannu AK, Bhalla A. Secondary Hemophagocytic Lymphohistiocytosis: Think of the Devil Lurking! Indian J Crit Care Med 2022;26(5):545-546.
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Affiliation(s)
- Ashok K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Samprathi M, Narayanappa S, Sridhar M, Ramachandra P, Vemgal P. Multisystem Inflammatory Syndrome in Children: A Mimicker of Severe Dengue. Indian J Pediatr 2021; 88:486-487. [PMID: 33095394 PMCID: PMC7581688 DOI: 10.1007/s12098-020-03550-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Madhusudan Samprathi
- Pediatric Intensive Care Unit, Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India.
| | - Shivtej Narayanappa
- Pediatric Intensive Care Unit, Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India
| | - M Sridhar
- Pediatric Intensive Care Unit, Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India
| | - Prakash Ramachandra
- Pediatric Cardiology Unit, Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India
| | - Prakash Vemgal
- Department of Pediatrics, Rainbow Children's Hospital, Bannerghatta Road, Bangalore, India
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Williams V, Menon N, Bhatia P, Biswal M, Sreedharanunni S, Jayashree M, Nallasamy K. Hyperferritinemia in children hospitalized with scrub typhus. Trop Med Health 2021; 49:15. [PMID: 33597024 PMCID: PMC7890859 DOI: 10.1186/s41182-021-00304-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hyperferritinemia is increasingly associated with mortality in sepsis. Studies estimating the prevalence of hyperferritinemia in pediatric scrub typhus are limited. METHODS This was a secondary analysis of a prospective observational study (FERRIS) from a tertiary care teaching hospital in North India where 72 children with confirmed scrub typhus, 4 (5.5%) PCR positive, 55 (76.4%)-IgM ELISA positive, and 13 (18.1%)-both PCR and ELISA positive, were analyzed. Serum ferritin was measured in 62 children to identify the prevalence of hyperferritinemia and determine its association with mortality. RESULTS Hyperferritinemia (> 500 μg/L) was seen in 72.6% [n = 45] children; 26 (41.9%) were mild (500-2000 μg/L), 13 (21%) were moderate (2000-10,000 μg/L), and 6 (9.7%) were severe (> 10,000 μg/L). Early presentation to hospital (≤ 7 days of febrile illness) had more survivors than late presentation (> 7 days). Non-survivors had significantly higher PRISM III, PELOD-2, hyperlactatemia, hypoalbuminemia, organ dysfunction, need for mechanical ventilation, and need of RRT. Ferritin had poor sensitivity and specificity in predicting survival with AUC of 0.56. Organ dysfunction and risk scores as PRISM III, PELOD 2, and VIS at admission were better predictors with AUC (95% CI) of 0.72 (0.56, 0.89), 0.77 (0.63, 0.92), and 0.90 (0.78, 1.0) respectively. CONCLUSIONS Hyperferritinemia is common in scrub typhus but it did not predict survival. Organ dysfunction and risk scores were better predictors of mortality than ferritin.
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Emergency and Intensive care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Nisha Menon
- Division of Pediatric Emergency and Intensive care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Prateek Bhatia
- Division of Pediatric Hematology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India.
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Karnad DR, Amin P. An Approach to a Patient with Tropical Infection in the Intensive Care Unit. Indian J Crit Care Med 2021; 25:S118-S121. [PMID: 34345123 PMCID: PMC8327794 DOI: 10.5005/jp-journals-10071-23867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Karnad DR, Amin P. An Approach to a Patient with Tropical Infection in the Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S118–S121.
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Affiliation(s)
- Dilip R Karnad
- Department of Critical Care, Jupiter Hospital, Thane, Maharashtra, India
| | - Pravin Amin
- Department of Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Abstract
Scrub typhus and other rickettsial infections contribute to 25 - 50% of acute undifferentiated febrile illnesses in endemic regions. Delayed recognition and therapy increase the morbidity and mortality. The constellation of fever with eschar or rash and multisystem involvement should facilitate the diagnosis and initiation of appropriate therapy. The pathological hallmark of rickettsial infections is endothelial infection and inflammation causing vasculitis. Endothelial inflammation results in microvascular dysfunction and increased vascular permeability. Immune and endothelial activation may worsen microvascular dysfunction, predisposing to multi-organ failure. Serology is the mainstay of diagnosis, although false negatives occur early in the disease. Point-of-care rapid diagnostic tests and molecular techniques, such as quantitative polymerase chain reaction (qPCR), can hasten diagnostic processes. Intravenous doxycycline with a loading dose is the most widely used antibiotic in critically ill patients, with azithromycin as a suitable alternative. Early appropriate treatment and organ support can decrease the duration of illness and be life-saving. How to cite this article: Gunasekaran K, Bal D, Varghese GM, et al. Scrub Typhus and Other Rickettsial Infections. Indian J Crit Care Med 2021;25(Suppl 2):S138-S143.
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Affiliation(s)
- Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepti Bal
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Singhal T. "Rationalization of Empiric Antibiotic Therapy" - A Move Towards Preventing Emergence of Resistant Infections. Indian J Pediatr 2020; 87:945-950. [PMID: 31912460 DOI: 10.1007/s12098-019-03144-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance is a key factor leading to emerging/ re-emerging infections. Rational antimicrobial therapy or antimicrobial stewardship is one of the important interventions to prevent emergence of resistance. Choosing correct empiric therapy is crucial not only to prevent antimicrobial resistance but also to achieve good treatment outcomes. Antimicrobial therapy can be broadly classified as empiric, definitive/ targeted and preventive. It is in choice of empiric therapy that the largest margin of error exists. Paradoxically, empiric therapy is the most commonly employed therapy since microbiologic results are either not available at initiation of treatment or cannot be sent due to logistic reasons or are negative. In the Indian setting, where penetration of microbiologic diagnostic methods in small cities, towns and rural areas is still fairly low, therapy is largely empiric. Choice of empiric therapy is governed by various factors including likely pathogens, antimicrobial resistance, degree of sickness, site of infection and host co-morbidities. These principles can be applied to any clinical syndrome whether it is fever without focus, infections of the respiratory tract, gastrointestinal tract, abdomen, central nervous system, bone and joint, skin and soft tissue, urinary tract as well as neonatal sepsis and healthcare associated infections. Adherence to published guidelines for syndromic management such as that by the Indian Academy of Pediatrics and Indian Council of Medical Research is strongly recommended. One can tailor these guidelines and suggestions made in this article to an individual setting.
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Affiliation(s)
- Tanu Singhal
- Department of Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
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Abstract
OBJECTIVE The aim of this study was to perform a needs assessment of pediatric (PEM) and general emergency medicine (EM) provider knowledge, comfort, and current practice patterns in the evaluation of pediatric tropical infectious diseases. METHODS An online survey was developed based on educational priorities identified by an expert panel via modified Delphi methodology. The survey included assessment of providers' typical evaluation, diagnosis, and treatment of tropical diseases and was distributed to PEM and EM providers in 2 large professional organizations. RESULTS A total of 333 physicians (285 PEM, 32 EM, 8 combined PEM/EM, and 8 general pediatricians in emergency department) participated. Fifty-five percent of vignettes were answered correctly. Those who trained outside the United States or Canada (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0) and PEM-trained providers (OR, 2.6; 95% CI, 1.2-5.9) were more likely to answer questions correctly. Providers answered more questions correctly about dengue (76%) and tuberculosis (77%) than typhoid (53%) and malaria (39%) (OR, 3.8; 95% CI, 3.0-4.9). Diagnostic evaluation for tropical diseases was variable with greater than 75% agreement for only 2 tests: blood smears in febrile patients from Africa (86%) and bacterial stool cultures in patients with bloody stools from Africa, Asia, or Latin America (94%). Providers had low (62%) or medium (35%) comfort level with pediatric tropical diseases, and 93% were interested in accessing emergency department-specific resources. CONCLUSIONS Pediatric EM and EM providers' knowledge and evaluation for pediatric tropical diseases are variable. Providers recognized their knowledge gaps and expressed interest in gaining access to resources and guidelines to standardize and improve evaluation and treatment of these diseases.
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Ghimire RH, Ghimire A, Dhungana S, Bista B, Shreewastav RK. Clinical Profile and Outcome of Adult Patients with Scrub Typhus in a Tertiary Care Centre of Eastern Nepal. JNMA J Nepal Med Assoc 2020; 58:165-169. [PMID: 32347822 PMCID: PMC7580313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Scrub typhus is an under-diagnosed and undertreated zoonotic human infection. There are no data related to profile of adult patients in Nepal. We conducted this study to report socio-demographic, clinical profile and complications of scrub typhus in our scenario. METHODS This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital, eastern Nepal. The sample enrollment process was consecutively who were admitted under medical ward and intensive care unit. Diagnosis was established serologically with positive test of IgM antibodies against scrub typhus using immuno-chromatography. Operational definitions for organ system dysfunction were based upon simple available clinic laboratory profiles and imaging. Collected data were entered in Microsoft Excel 2007 and converted it into Statistical Package for Social Science 11.5 Version for statistical analysis. RESULTS A total of 47 patients were analyzed during this study. Diagnosis of scrub typhus was more common 17 (36.17%) in age group of (40-60 years) with female predominance 32 (68.08%). Most patients (70.15%) were of above 40 years. Fever 47 (100%), asthenia 40 (85.10%), generalized body-ache 41 (87.23%), anorexia 46 (97.87%) and headache 39 (82.97%) were present in most of our patients at sometime during their illness. Respiratory dysfunction was the commonest 37 (78.72%) system dysfunction followed by renal 30 (63.82%) and hepatic 20 (42.55%) impairment. Fortunately no deaths occurred. CONCLUSIONS Scrub typhus occurred more commonly in elderly female patients. Early empirical treatment may prevent mortality. Large studies involving whole country is needed to see real scenario of disease in this setting.
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Affiliation(s)
- Ram Hari Ghimire
- Department of Pulmonary, Critical Care and Sleep Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Ashima Ghimire
- Department of Pulmonary, Critical Care and Sleep Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Sunil Dhungana
- Department of Pulmonary, Critical Care and Sleep Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Bides Bista
- Department of Pulmonary, Critical Care and Sleep Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
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Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, Williams V, Kumar A. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020; 24:445-450. [PMID: 32863638 PMCID: PMC7435082 DOI: 10.5005/jp-journals-10071-23445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6–11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation (n = 27, 17%), vasoactive drugs therapy for hemodynamic support (n = 43, 27%), osmotherapy to treat raised intracranial pressure (n = 27, 17%), and renal replacement therapy (n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance Our results would help clinicians identify severe cases and prioritize resources. How to cite this article Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, et al. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020;24(6):445–450.
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Affiliation(s)
- Karthi Nallasamy
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalu Gupta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamran Zaman
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijai Williams
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhay Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chaudhry D, Tyagi D, Jakka S. Severe Tropical Infections. ICU PROTOCOLS 2020. [PMCID: PMC7139445 DOI: 10.1007/978-981-15-0898-1_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 26-year-old female patient presented with high-grade fever for 10 days followed by pedal edema and decreased urine output for 4 days. She developed shortness of breath for last 2 days which was associated with dry cough. There was no history of paroxysmal nocturnal dyspnea and orthopnea. History of epistaxis was present for 1 day. No history of travel to another place was present. On examination, she was conscious, well oriented. Her pulse rate was 124/min, blood pressure was 90/60 mmHg and SpO2was 86% on room air. Eschar was present under the left breast. On auscultation, bilateral crepitations were present. Cardiovascular examination revealed no abnormality. Blood Investigations revealed hemoglobin—9.0 mg/dl, platelet count—70,000/mm3, blood urea—108 mg/dl, serum creatinine—1.6 mg/dl, blood sugar—91 mg/dl, SGOT/PT—440/235. X-ray chest was suggestive of bilateral diffuse alveolar shadows. Arterial blood gas analysis revealed pH—7.38, pO2—58 mmHg, pCO2—44 mmHg, HCO3—15 mmol/L, SaO2—86%.
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Williams V, Menon N, Bhatia P, Biswal M, Sreedharanunni S, Rawat A, Jayashree M, Nallasamy K. Serum Ferritin Predicts Neither Organ Dysfunction Nor Mortality in Pediatric Sepsis Due to Tropical Infections. Front Pediatr 2020; 8:607673. [PMID: 33344390 PMCID: PMC7747694 DOI: 10.3389/fped.2020.607673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: To evaluate serial ferritin levels measured in the initial 72 h of admission as a biomarker for new and progressive multi organ dysfunction syndrome (NPMODS) and mortality (unfavorable outcomes) in critically ill children with sepsis due to tropical infections. Material and Methods: In this prospective observational study from a tertiary care teaching hospital in India, children 3 month to 12 years with a diagnosis of acute febrile illness and any two features suggesting tropical infections [cytopenia (platelet count <1,00,000/cu.mm, total leucocyte count <4,000/cu.mm), hepatomegaly and/or splenomegaly, lymphadenopathy, systemic signs (rash, edema), respiratory distress, and encephalopathy not accounted by localized infection] were eligible for inclusion. Children with known or suspected disorder of iron metabolism were excluded. Primary outcome was to determine the association of serial ferritin levels with mortality and NPMODS. Secondary outcomes included estimation of the prevalence of hyperferritinemia and comparison of risk prediction scores with serial ferritin measurement in predicting unfavorable outcomes. Measurements and Main Results: In the 202 children enrolled, diagnosis could be established in 133 (65.8%) children. Scrub typhus and dengue were the most common infections. Median (IQR) ferritin measured at admission (n = 183) and on day 3 (n = 120) of hospital stay were 798 (378, 3,205) μg/L and 429 (213,680) μg/L, respectively. Majority (n = 180, 89.1%) had MODS at admission defined as per International pediatric sepsis consensus conference. NPMODS occurred in 47 (23.3%) children of whom 37 (18.3%) died. Children with three or less organ dysfunctions had lower mortality. Neither admission ferritin values nor the percentage change over 72 h was different between children with favorable and unfavorable outcomes. Pediatric Risk of Mortality (PRISM-III) and daily Pediatric Logistic Organ Dysfunction score (dPELOD2 score) were significantly different in those with unfavorable outcomes. Admission ferritin levels and percentage change in 72 h had poor discriminatory power for mortality with AUC of 0.53 (0.53, 0.67) and 0.50 (0.50, 0.64), respectively. dPELOD2 had the best discriminatory power for mortality with AUC of 0.89 (0.89, 0.95). Conclusions: Serial ferritin estimation predicted neither organ dysfunction nor mortality in pediatric sepsis with tropical infections. dPELOD-2 and PRISM-III predicted unfavorable outcomes better than ferritin. The current diagnostic criteria for MODS overestimated organ dysfunctions in tropical infections and hence may need modification with further validation in this epidemiological cohort.
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nisha Menon
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Prateek Bhatia
- Division of Pediatric Hematology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Rawat
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Bhaskaran D, Chadha SS, Sarin S, Sen R, Arafah S, Dittrich S. Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review. BMC Infect Dis 2019; 19:970. [PMID: 31722678 PMCID: PMC6854686 DOI: 10.1186/s12879-019-4589-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India. METHODS A scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management. RESULTS The review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated the use of 5-22 tests per patient for the evaluation of AFI. Among 25 studies evaluating possible causes of AFI, 96% tested for malaria followed by 80% for dengue, 72% for scrub typhus, 68% for typhoid and 60% for leptospirosis identifying these as commonly suspected causes of AFI. 54% studies diagnosed malaria with smear microscopy while others diagnosed dengue, scrub typhus, typhoid and leptospirosis using antibody or antigen detection assays. 39% studies used the Weil-Felix test (WFT) for scrub typhus diagnosis and 82% studies used the Widal test for diagnosing typhoid. CONCLUSIONS The review demonstrated the use of five or more pathogen-specific tests in evaluating AFI as well as described the widespread use of suboptimal tests like the WFT and Widal in fever evaluation. It identified the need for the development of better-quality tests for aetiological diagnosis and improved standardised testing guidelines for AFI.
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Affiliation(s)
- Divyalakshmi Bhaskaran
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics (FIND), New Delhi, India
| | - Rajashree Sen
- Foundation for Innovative New Diagnostics (FIND), New Delhi, India
| | - Sonia Arafah
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Singhi P. Central Nervous System Infections in Children: An Ongoing Challenge! Indian J Pediatr 2019; 86:49-51. [PMID: 30132192 DOI: 10.1007/s12098-018-2745-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Pratibha Singhi
- Director Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurgaon, Haryana, India.
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Bhargava A, Ralph R, Chatterjee B, Bottieau E. Assessment and initial management of acute undifferentiated fever in tropical and subtropical regions. BMJ 2018; 363:k4766. [PMID: 30498133 DOI: 10.1136/bmj.k4766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of Medicine, McGill University, Montreal, Canada
| | - Ravikar Ralph
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Biswaroop Chatterjee
- Department of Microbiology, IQ City Medical College, Durgapur, West Bengal, India
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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A Bacterial Profile of Scrub typhus Infections in North Karnataka and their Isolation by Serological and Molecular Method. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Karnad DR, Richards GA, Silva GS, Amin P. Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. J Crit Care 2018; 46:119-126. [PMID: 29625787 DOI: 10.1016/j.jcrc.2018.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 12/23/2022]
Abstract
Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.
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Affiliation(s)
| | - Guy A Richards
- Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo and Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Batra P, Thakur N, Mahajan P, Patel R, Rai N, Trivedi N, Fassl B, Shah B, Saha A, Lozon M, Oteng RA, Shah D, Galwankar S. An evidence-based approach to evaluation and management of the febrile child in Indian emergency department. Int J Crit Illn Inj Sci 2018; 8:63-72. [PMID: 29963408 PMCID: PMC6018255 DOI: 10.4103/ijciis.ijciis_3_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fever is the most common complaint for a child to visit hospital. Under the aegis of INDO-US Emergency and Trauma Collaborative, Pediatric Emergency Medicine chapter of Academic College of Emergency Experts in India developed evidence-based consensus for evaluation and management of febrile child in emergency department. An extensive literature search and further online communication of the group led to the development of a detailed approach for the evaluation and management of individual conditions associated with fever. To develop an approach to individual conditions presenting with fever, that is, best suited to the epidemiology prevalent in India. The algorithmic approach given by the group describes in details the evaluation and management of specialized and individual conditions like fever and immunocompromised state, fever with localizing signs that include fever with seizures, cough, ear discharge, loose stools, rash and dysuria; fever without localization with epidemiological evidence supporting diagnosis such as malaria, enteric fever and dengue; and fever without any localization and no epidemiological evidence supporting the diagnosis.
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Affiliation(s)
- Prerna Batra
- Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India,Address for correspondence: Prof. Prerna Batra, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India. E-mail:
| | - Neha Thakur
- Department of Pediatrics, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prashant Mahajan
- Department of Emergency Medicine, Chief Section of Pediatric Emergency Medicine, CS Motts Children's Hospital, University of Michigan, Salt Lake City, UT, USA
| | - Reena Patel
- Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, UT, USA
| | - Narendra Rai
- Department of Pediatrics, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitin Trivedi
- Department of Pediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Bernhard Fassl
- Department of Epidemiology and Biostatistics, Division of Inpatient Medicine, University of Utah, Salt Lake City, UT, USA
| | - Binita Shah
- Department of Emergency Medicine and Pediatrics, SUNY Downstate Medical Center, Director Emeritus, Pediatric Emergency Medicine, Kings County Hospital Center, Brooklyn, NY, USA
| | - Abhijeet Saha
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Marie Lozon
- Department of Emergency Medicine, University of Michigan, Salt Lake City, UT, USA
| | - Rockefeller A. Oteng
- Department of Emergency Medicine, University of Michigan, Salt Lake City, UT, USA,Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
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Keshtkar-Jahromi M, Martins KAO, Cardile AP, Reisler RB, Christopher GW, Bavari S. Treatment-focused Ebola trials, supportive care and future of filovirus care. Expert Rev Anti Infect Ther 2017; 16:67-76. [PMID: 29210303 DOI: 10.1080/14787210.2018.1413937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION During the 2014-2016 Ebolavirus (EBOV) outbreak, several candidate therapeutics were used in EBOV-infected patients in clinical trials and under expanded access for emergency use. This review will focus briefly on medications used during the outbreak. We will discuss current therapeutic candidates and their status and will then turn to a related and essential topic: supportive care and the standard of care for filovirus infected patients. Potential benefits and pitfalls of combination therapies for filoviruses will be discussed. Areas covered: Clinical trials of therapeutics targeting EBOV; clinical usage of therapeutics during recent EBOV outbreak; potential need for combination therapy; role of supportive care in treatment of Ebola virus disease (EVD). Expert commentary: In the absence of another large scale EBOV outbreak, the path to therapeutic product licensure in the United States of America (USA) would need to be via the FDA Animal Rule. However, human data may be needed to supplement animal data. The future of filovirus therapeutics may therefore benefit by establishing the ability to implement clinical trials in an outbreak setting in a timely fashion. Supportive care guidelines for filovirus infection should be defined and established as standard of care for treatment of EVD.
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Affiliation(s)
- Maryam Keshtkar-Jahromi
- a Division of Infectious Diseases, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Karen A O Martins
- b Division of Medicine , United States Army Medical Research Institute of Infectious Diseases , Frederick , MD , USA
| | - Anthony P Cardile
- b Division of Medicine , United States Army Medical Research Institute of Infectious Diseases , Frederick , MD , USA
| | - Ronald B Reisler
- b Division of Medicine , United States Army Medical Research Institute of Infectious Diseases , Frederick , MD , USA
| | - George W Christopher
- c Project Management Office, Medical Countermeasure systems , Fort Belvoir , VA , USA
| | - Sina Bavari
- b Division of Medicine , United States Army Medical Research Institute of Infectious Diseases , Frederick , MD , USA
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Silva GS, Richards GA, Baker T, Amin PR. Encephalitis and myelitis in tropical countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017; 42:355-359. [PMID: 29157660 DOI: 10.1016/j.jcrc.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
Tropical diseases are those that occur primarily or solely in the tropics, and as such include infectious diseases that are particularly prevalent in hot, humid conditions. The incidence of encephalitis in tropical countries is reported to be as high as 6.34/100,000/year. The term encephalitis implies inflammation of the brain and includes the presence of encephalopathy with two and more of the following features: fever, seizures and/or focal neurological findings; a cerebrospinal fluid pleocytosis; electroencephalographic findings or abnormal neuroimaging suggestive of encephalitis. Transverse myelitis (TM) is an inflammation of the spinal cord which has a wide variety of clinical presentations depending on the degree (severity of myelin and neuronal injury) and site of spinal cord involvement. In the present article we discuss the various forms of tropical, viral encephalitides and myelitis and the diagnosis and management.
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Affiliation(s)
- Gisele Sampaio Silva
- Departament of Neurology and Neurosurgery, Universidade Federal de São Paulo and Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Guy A Richards
- Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Tim Baker
- Department of Anaesthesia & Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi; Global Health - Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Pravin R Amin
- Head of Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Undifferentiated tropical febrile illness in Cordoba, Colombia: Not everything is dengue. J Infect Public Health 2017; 10:507-512. [DOI: 10.1016/j.jiph.2016.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/09/2016] [Accepted: 09/10/2016] [Indexed: 11/21/2022] Open
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Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India. Indian Pediatr 2017; 54:652-660. [PMID: 28607213 DOI: 10.1007/s13312-017-1129-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
JUSTIFICATION India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. PROCESS We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. OBJECTIVE To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. RECOMMENDATIONS We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.
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Chen H, Ning Z, Qiu Y, Liao Y, Chang H, Ai Y, Wei Y, Deng Y, Shen Y. Elevated levels of von Willebrand factor and high mobility group box 1 (HMGB1) are associated with disease severity and clinical outcome of scrub typhus. Int J Infect Dis 2017; 61:114-120. [PMID: 28652214 DOI: 10.1016/j.ijid.2017.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study aimed to investigate whether von Willebrand factor (vWF) and high mobility group box 1 (HMGB1) are associated with the severity and clinical outcome of scrub typhus and to seek novel biomarkers for surveillance and prediction of the prognosis of this infection. METHODS Serum concentrations of vWF and HMGB1 were measured twice by ELISA for scrub typhus patients (n=103), once prior to doxycycline therapy and then on day 7 of doxycycline therapy; concentrations were measured once for healthy controls (n=32). RESULTS Among the total 103 patients enrolled, 38 had disease complicated by multiple organ dysfunction syndrome (MODS). Serum concentrations of vWF and HMGB1 were significantly higher in all the patients than in the healthy controls, both prior to doxycycline treatment and on day 7 of doxycycline treatment (p<0.01). Furthermore, serum levels of vWF, HMGB1, and creatinine (SCr) in the patients with MODS increased distinctly, while the platelet (PLT) count diminished markedly compared to the levels in patients without MODS (p<0.01). The concentration of vWF was positively correlated with that of HMGB1 (r=0.764, p<0.001) and SCr (r=0.528, p<0.001), but negatively correlated with the PLT count (r=-0.632, p<0.001). Both HMGB1 and vWF were significantly associated with mortality in scrub typhus (area under the curve (AUC)=0.864, p=0.001, and AUC=0.862, p=0.001, respectively). CONCLUSIONS Elevated levels of vWF and HMGB1 are associated with the severity and clinical outcome of scrub typhus. These represent possible new biomarkers for use in the assessment and prognostic prediction of this infection.
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Affiliation(s)
- Hongliu Chen
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Zong Ning
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Qiu
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanli Liao
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Haihua Chang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanyuan Ai
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yinghua Wei
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yiming Deng
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Shen
- General Practice School of Guangxi Medical University, Nanning, Guangxi Province, 530021, China.
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Pannu AK, Adarsh MB, Sharma N. Not all febrile critical illness with rash is infective: Drug reaction may be a mimic. Indian J Crit Care Med 2017; 21:229-231. [PMID: 28515609 PMCID: PMC5416792 DOI: 10.4103/ijccm.ijccm_397_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We report a case of ciprofloxacin-related drug rash with eosinophilia and systemic symptoms (DRESS) which was initially diagnosed and managed on the line of tropical fever. Later, a diagnosis of definite case of DRESS was made according to the RegiSCAR scoring system and the patient was managed with the removal of ciprofloxacin along with steroids. DRESS is a great masquerader. The diagnosis should be highly suspected in the presence of fever, skin rash, liver involvement, and hypereosinophilia.
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Affiliation(s)
- Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M B Adarsh
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singhi S, Rungta N, Nallasamy K, Bhalla A, Peter JV, Chaudhary D, Mishra R, Shastri P, Bhagchandani R, Chugh TD. Tropical Fevers in Indian Intensive Care Units: A Prospective Multicenter Study. Indian J Crit Care Med 2017; 21:811-818. [PMID: 29307960 PMCID: PMC5752788 DOI: 10.4103/ijccm.ijccm_324_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Infections in tropics often present as undifferentiated fevers with organ failures. We conducted this nationwide study to identify the prevalence, profile, resource utilization, and outcome of tropical fevers in Indian Intensive Care Units (ICUs). Materials and Methods This was a multicenter prospective observational study done in 34 ICUs across India (July 2013-September 2014). Critically ill adults and children with nonlocalizing fever >48 h and onset < 14 days with any of the following: thrombocytopenia/rash, respiratory distress, renal failure, encephalopathy, jaundice, or multiorgan failure were enrolled consecutively. Results Of 456 cases enrolled, 173 were children <12 years. More than half of the participants (58.7%) presented in postmonsoon months (August-October). Thrombocytopenia/rash was the most common presentation (60%) followed by respiratory distress (46%), encephalopathy (28.5%), renal failure (23.5%), jaundice (20%), and multiorgan failure (19%). An etiology could be established in 365 (80.5%) cases. Dengue (n = 105.23%) was the most common followed by scrub typhus (n = 83.18%), encephalitis/meningitis (n = 44.9.6%), malaria (n = 37.8%), and bacterial sepsis (n = 32.7%). Nearly, half (35% invasive; 12% noninvasive) received mechanical ventilation, a quarter (23.4%) required vasoactive therapy in first 24 h and 9% received renal replacement therapy. Median (interquartile range) ICU and hospital length of stay were 4 (3-7) and 7 (5-11.3) days. At 28 days, 76.2% survived without disability, 4.4% had some disability, and 18.4% died. Mortality was higher (27% vs. 15%) in patients with undiagnosed etiology (P < 0.01). On multivariate analysis, multiorgan dysfunction syndrome at admission (odds ratio [95% confidence interval]-2.8 [1.8-6.6]), day 1 Sequential Organ Failure Assessment score (1.2 [1.0-1.3]), and the need for invasive ventilation (8.3 [3.4-20]) were the only independent predictors of unfavorable outcome. Conclusions Dengue, scrub typhus, encephalitis, and malaria are the major tropical fevers in Indian ICUs. The data support a syndromic approach, point of care tests, and empiric antimicrobial therapy recommended by Indian Society of Critical Care Medicine in 2014.
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Affiliation(s)
- Sunit Singhi
- Professor Emeritus Pediatrics, PGIMER, Chandigarh, Haryana, India
| | - Narendra Rungta
- Critical Care Medicine, Jeevanrekha Critical Care and Trauma Hospital, Jaipur, Rajasthan, India
| | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, Haryana, India
| | - J V Peter
- Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhruva Chaudhary
- Department of Pulmonology and Critical Care, PGIMS, Haryana, India
| | - Rajesh Mishra
- Critical Care Medicine, Sanjivani Super Speciality Hospital, Ahmedabad, Gujarat, India
| | - Prakash Shastri
- Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | - T D Chugh
- Professor Emeritus Pathology, PGIMS, Rohtak, Haryana, India
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Approach to clinical syndrome of jaundice and encephalopathy in tropics. J Clin Exp Hepatol 2015; 5:S116-30. [PMID: 26041951 PMCID: PMC4442860 DOI: 10.1016/j.jceh.2014.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/14/2014] [Indexed: 12/12/2022] Open
Abstract
A large number of patients present with jaundice and encephalopathy in tropical country like India and acute liver failure is the usual cause. Clinical presentation like ALF is also a complication of many tropical infections, and these conditions may mimic ALF but may have subtle differences from ALF. Moreover, what hepatologists see as acute liver failure in tropics is different from what is commonly described in Western Textbooks. Paracetamol overdose, which is possibly the commonest cause of ALF in UK and USA, is hardly ever seen in India. Most common etiology here is viral hepatitis (hepatitis E > hepatitis B> hepatitis A). Apart from ALF, one may also come across subacute hepatic failure (SAHF) as well as acute-on-chronic liver failure (ACLF) due to viral hepatitis. Interestingly, a host of other conditions can mimic ALF because clinical presentation in these conditions can be dominated by jaundice and encephalopathy. Malarial hepatopathy is possibly the best-known condition out of these and is not an uncommon manifestation of severe malaria. A similar presentation can also be seen in other common infections in tropics such as dengue fever, typhoid fever, leptospirosis, scrub typhus, amoebic liver abscesses, tuberculosis and other bacterial and fungal infections with or without human immunodeficiency virus (HIV) related disease. In many of these conditions, liver failure may not be underlying pathophysiology. Some pregnancy related liver diseases could also present with jaundice and encephalopathy. This review summarizes the commonly seen presentations in tropical country like India, where jaundice and encephalopathy dominate the clinical picture.
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Raina S. Syndrome based treatment guidelines for critical tropical infections. Indian J Crit Care Med 2014; 18:761. [PMID: 25425846 PMCID: PMC4238096 DOI: 10.4103/0972-5229.144026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sujeet Raina
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
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Err H, Wiwanitkit V. "Syndromic approach" to diagnosis and treatment of critical tropical infections. Indian J Crit Care Med 2014; 18:479. [PMID: 25097366 PMCID: PMC4118519 DOI: 10.4103/0972-5229.136082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hai Err
- Sanitation 1 Medical Academic Center, Bangkok, Thailand
| | - Viroj Wiwanitkit
- Hainan Medical University, China ; Faculty of Medicine, University of Nis, Serbia ; Joseph Ayobabalola University, Nigeria
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