Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 12 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Tropical fevers in Indian intensive care units: A prospective multicenter study

Prakash Shastri, Rajesh Bhagchandani, Sunit Singhi, Karthi Nallasamy, J. V. Peter, T. D. Chugh, for Indian Society of Critical Care Medicine Research Group

Keywords : Dengue, encephalitis, India, Intensive Care Unit, malaria, scrub typhus, tropical infections

Citation Information : Shastri P, Bhagchandani R, Singhi S, Nallasamy K, Peter JV, Chugh TD, FI. Tropical fevers in Indian intensive care units: A prospective multicenter study. Indian J Crit Care Med 2017; 21 (12):811-818.

DOI: 10.4103/ijccm.IJCCM_324_17

License: CC BY-ND 3.0

Published Online: 00-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


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.


PDF Share
  1. The Indian Society of Critical Care Medicine Tropical Fever Group, Singhi S, Chaudhary D, Varghese GM, Bhalla A, Karthi N, et al. Tropical fevers: Management guidelines. Indian J Crit Care Med 2014;18:62-9.
  2. Suttinont C, Losuwanaluk K, Niwatayakul K, Hoontrakul S, Intaranongpai W, Silpasakorn S, et al. Causes of acute, undifferentiated, febrile illness in rural Thailand: Results of a prospective observational study. Ann Trop Med Parasitol 2006;100:363-70.
  3. Punjabi NH, Taylor WR, Murphy GS, Purwaningsih S, Picarima H, Sisson J, et al. Etiology of acute, non-malaria, febrile illnesses in Jayapura, Northeastern Papua, Indonesia. Am J Trop Med Hyg 2012;86:46-51.
  4. Phuong HL, de Vries PJ, Nga TT, Giao PT, Hung le Q, Binh TQ, et al. Dengue as a cause of acute undifferentiated fever in Vietnam. BMC Infect Dis 2006;6:123.
  5. Simmerman JM, Uyeki TM. The burden of influenza in east and South-East Asia: A review of the English language literature. Influenza Other Respir Viruses 2008;2:81-92.
  6. Jung HC, Chon SB, Oh WS, Lee DH, Lee HJ. Etiologies of acute undifferentiated fever and clinical prediction of scrub typhus in a non-tropical endemic area. Am J Trop Med Hyg 2015;92:256-61.
  7. Susilawati TN, McBride WJ. Acute undifferentiated fever in Asia: A review of the literature. Southeast Asian J Trop Med Public Health 2014;45:719-26.
  8. Patz JA, Graczyk TK, Geller N, Vittor AY. Effects of environmental change on emerging parasitic diseases. Int J Parasitol 2000;30:1395-405.
  9. Abrahamsen SK, Haugen CN, Rupali P, Mathai D, Langeland N, Eide GE, et al. Fever in the tropics: Aetiology and case-fatality – A prospective observational study in a tertiary care hospital in South India. BMC Infect Dis 2013;13:355.
  10. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: The disease spectrum and diagnostic predictors – An experience from a tertiary care hospital in South India. Trop Doct 2010;40:230-4.
  11. John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet 2011;377:252-69.
  12. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
  13. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/Society of critical care medicine. Chest 1992;101:1644-55.
  14. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  15. Ellis RD, Fukuda MM, McDaniel P, Welch K, Nisalak A, Murray CK, et al. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg 2006;74:108-13.
  16. Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 2004;87:464-72.
  17. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, et al. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Trop Med Hyg 2004;70:670-5.
  18. Sripanidkulchai R, Lumbiganon P. Etiology of obscure fever in children at a university hospital in Northeast Thailand. Southeast Asian J Trop Med Public Health 2005;36:1243-6.
  19. Mittal G, Ahmad S, Agarwal RK, Dhar M, Mittal M, Sharma S, et al. Aetiologies of acute undifferentiated febrile illness in adult patients – An experience from a tertiary care hospital in Northern India. J Clin Diagn Res 2015;9:DC22-4.
  20. Watt G, Jongsakul K, Chouriyagune C, Paris R. Differentiating dengue virus infection from scrub typhus in Thai adults with fever. Am J Trop Med Hyg 2003;68:536-8.
  21. Kar A, Dhanaraj M, Dedeepiya D, Harikrishna K. Acute encephalitis syndrome following scrub typhus infection. Indian J Crit Care Med 2014;18:453-5.
  22. Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India – A retrospective study. PLoS One 2013;8:e66595.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.