Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 18 , ISSUE 2 ( February, 2014 ) > List of Articles

GUIDELINES

Tropical fevers: Management guidelines

Rajesh Bhagchandani, Sunit Singhi, J. V. Peter, T. D. Chugh, George M. Varghese, N. Karthi, S. Kalantri, M. Munjal, Narendra Rungta

Keywords : Tropical fever, Dengue, Malaria, Typhoid, Leptospirosis, Scrub typhus, Sepsis, Influenza, Guidelines

Citation Information : Bhagchandani R, Singhi S, Peter JV, Chugh TD, Varghese GM, Karthi N, Kalantri S, Munjal M, Rungta N. Tropical fevers: Management guidelines. Indian J Crit Care Med 2014; 18 (2):62-69.

DOI: 10.4103/0972-5229.126074

License: CC BY-ND 3.0

Published Online: 01-11-2014

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Tropical fevers were defined as infections that are prevalent in, or are unique to tropical and subtropical regions. Some of these occur throughout the year and some especially in rainy and post-rainy season. Concerned about high prevalence and morbidity and mortality caused by these infections, and overlapping clinical presentations, difficulties in arriving at specific diagnoses and need for early empiric treatment, Indian Society of Critical Care Medicine (ISCCM) constituted an expert committee to develop a consensus statement and guidelines for management of these diseases in the emergency and critical care. The committee decided to focus on most common infections on the basis of available epidemiologic data from India and overall experience of the group. These included dengue hemorrhagic fever, rickettsial infections/scrub typhus, malaria (usually falciparum), typhoid, and leptospira bacterial sepsis and common viral infections like influenza. The committee recommends a ′syndromic approach′ to diagnosis and treatment of critical tropical infections and has identified five major clinical syndromes: undifferentiated fever, fever with rash / thrombocytopenia, fever with acute respiratory distress syndrome (ARDS), fever with encephalopathy and fever with multi organ dysfunction syndrome. Evidence based algorithms are presented to guide critical care specialists to choose reliable rapid diagnostic modalities and early empiric therapy based on clinical syndromes.


PDF Share
  1. Diamon J. Guns, Germs and Steel: The Fates of Human Societies. New York: W.W Norton and Company; 1997.
  2. Patz JA, Graczyk TK, Geller N, Vittor AY. Effects of environmental change on emerging parasitic diseases. Int J Parasitol 2000;30:1395-405.
  3. 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.
  4. 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.
  5. John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet 2011;377:252-69.
  6. Myers RM, Carey DE. Concurrent isolation from patient of two arboviruses, Chikungunya and dengue type 2. Science 1967;157:1307-8.
  7. Bhalla A, Sharma N, Sharma A, Suri V. Concurrent infection with dengue and malaria. Indian J Med Sci 2006;60:330-1.
  8. Kaur H, John M. Mixed infection due to leptospira and dengue. Indian J Gastroenterol 2002;21:206.
  9. Committee to Advice on Tropical Medicine and Travel. Canadian recommendations for fever in the returning international travellers. CCDR2011;37:1-15.
  10. Frean J, Blumberg L. Tropical fevers part A. Viral, bacterial and fungal infections. Primer of Tropical Medicine. Ch. 5A. Brisbane:ACTM Publication; 2005. p. 1-18. Available from: HYPERLINK "http://www.tropmed.org/primer/chapter%2005a.pdf" http://www.tropmed.org/primer/chapter 05a.pdf. [Last accessed on 2013 Dec 23]
  11. Chaudhry D, Goyal S. Scrub typhus-resurgence of a forgotten killer. Indian J Anaesth 2013;57:135-6.
  12. Pandey D, Sharma B, Chauhan V, Mokta J, Verma BS, Thakur S. ARDS complicating scrub typhus in Sub-Himalayan region. J Assoc Physicians India 2006;54:812-3.
  13. Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: An unrecognized threat in South India-clinical profile and predictors of mortality. Trop Doct 2010;40:129-33.
  14. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD. Diagnosis of scrub typhus. Am J Trop Med Hyg 2010;82:368-70.
  15. Rajapakse S, Rodrigo C, Fernando SD. Drug treatment of scrub typhus. Trop Doct 2011;41:1-4.
  16. Fang Y, Huang Z, Tu C, Zhang L, Ye D, Zhu BP. Meta-analysis of drug treatment for scrub typhus in Asia. Intern Med 2012;51:2313-20.
  17. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, et al. Increasing trends of leptospirosis in northern India: A clinico-epidemiological study. PLoS Negl Trop Dis 2010;4:e579.
  18. Kalita JB, Rahman H. Leptospirosis among patients with pyrexia of unknown origin in a hospital in Guwahati, Assam. Indian J Public Health 2008;52:107-9.
  19. Chirathaworn C, Kaewopas Y, Poovorawan Y, Suwancharoen D. Comparison of a slide agglutination test, LeptoTek Dri-Dot, and IgM-ELISA with microscopic agglutination test for Leptospira antibody detection. Southeast Asian J Trop Med Public Health 2007;38:1111-4.
  20. Toyokawa T, Ohnishi M, Koizumi N. Diagnosis of acute leptospirosis. Expert Rev Anti Infect Ther 2011;9:111-21.
  21. Brett-Major DM, Coldren R. Antibiotics for leptospirosis. Cochrane Database Syst Rev 2012;2:CD008264.
  22. Charan J, Saxena D, Mulla S, Yadav P. Antibiotics for the treatment of leptospirosis: Systematic review and meta-analysis of controlled trials. Int J Prev Med 2013;4:501-10.
  23. Chakravarti A, Arora R, Luxemburger C. Fifty years of dengue in India. Trans R Soc Trop Med Hyg 2012;106:273-82.
  24. Handbook for Clinical Management of Dengue. WHO and Special Programme for Research and Training in Tropical Diseases (TDR) Report. Geneva: World Health Organization; 2012. Available from: http://apps.who.int/iris/bitstream/10665/76887/1/9789241504713_eng.pdf?ua=1 [Last accessed on 2013 Dec 23]..
  25. Singh MP, Majumdar M, Singh G, Goyal K, Preet K, Sarwal A, et al. NS1 antigen as an early diagnostic marker in dengue: Report from India. Diagn Microbiol Infect Dis 2010;68:50-4.
  26. Singhi S, Kissoon N, Bansal A. Dengue and dengue hemorrhagic fever: Management issues in an intensive care unit. J Pediatr (Rio J) 2007;83:S22-35.
  27. Hay SI, Gething PW, Snow RW. India′s invisible malaria burden. Lancet 2010;376:1716-7.
  28. Guidelines for the Treatment of Malaria. 2nd ed. Geneva: World Health Organization; 2010. Available from: http://www.whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf. [Last accessed on 2013 Dec 23].
  29. Maltha J, Gillet P, Jacobs J. Malaria rapid diagnostic tests in endemic settings. Clin Microbiol Infect 2013;19:399-407.
  30. Kanungo S, Dutta S, Sur D. Epidemiology of typhoid and paratyphoid fever in India. J Infect Dev Ctries 2008;2:454-60.
  31. Parry CM, Wijedoru L, Arjyal A, Baker S. The utility of diagnostic tests for enteric fever in endemic locations. Expert Rev Anti Infect Ther 2011;9:711-25.
  32. Trivedi NA, Shah PC. A meta-analysis comparing the safety and efficacy of azithromycin over the alternate drugs used for treatment of uncomplicated enteric fever. J Postgrad Med 2012;58:112-8.
  33. Joshi R, Kalantri SP, Reingold A, Colford JM Jr. Changing landscape of acute encephalitis syndrome in India: A systematic review. Natl Med J India 2012;25:212-20.
  34. Sarkari NB, Thacker AK, Barthwal SP, Mishra VK, Prapann S, Srivastava D, et al. Japanese encephalitis (JE). Part I: Clinical profile of 1,282 adult acute cases of four epidemics. J Neurol 2012;259:47-57.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.