Rickettsial Infections among the Undifferentiated Febrile Patients Attending a Tertiary Care Teaching Hospital of Northern India: A Longitudinal Study
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. Materials and Methods: Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. Results: Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. Conclusion: Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness. Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.
Abstract
Background: Acute undifferentiated febrile illness (AUFI) is one of the most daunting challenges a physician faces in such settings. Among AUFI, rickettsial infections are most common and related infections (such as anaplasmosis, ehrlichiosis, and Q fever) which are caused by an unusual type of bacteria that can live only inside the cells of another organism. The present study was therefore planned with an objective to estimate the prevalence of rickettsial infection among patients of undifferentiated fever and to determine any association of socio-demographic characteristics with rickettsial disease. Materials and Methods: Patients presenting with febrile illness and admitted or attending out-patient department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar was approached and recruited in the study. Weil Felix Assay, enzyme-linked immunosorbent assay and indirect immunofluorescence assay were done to detect the anti-rickettsial antibodies. Serological evidence of a fourfold increase in IgG-specific antibody titer reactive with spotted fever group rickettsial antigen by indirect immunofluorescence antibody assays between paired serum specimens was considered a confirmatory diagnosis for the rickettsial disease. Results: Most of the patients were males 61.6%, and most 46.2% were in the age group of 20 -39 years. Most of the patients, 80.8% belonged to rural areas, and 48% belonged to the upper middle (II) class of the socio-economic class according to modified Kuppuswamy scale. Of the studied participants, a majority, 47.0%, were determined undiagnosed, while 15.4% studied participants were diagnosed to have a rickettsial disease. In patients positive for typhus group, 67.8% were IgM positive, 28.5% were IgG positive, and only 3% were positive for IgM and IgG. In patients positive for Scrub Typhus Group, 32.7% were positive for IgM, and 62.0% were positive for IgG, and only 5.0% were positive for both IgM and IgG. In patients positive for spotted fever group, 36.1% were positive for IgM, and 58.5% were positive for IgG, and only 5.5% were positive for both IgM and IgG. The prevalence of rickettsial disease was found to be 11.3%. Conclusion: Rickettsial diseases, typhoid and brucellosis, were the most prevalent diseased diagnosed among patients reporting to hospitals with undifferentiated febrile illness. Clinicians must consider rickettsial diseases as one of the differential diagnosis while treating patients with fever.
참고문헌 (34)
- Joshi R, "Nonmalarial acute undifferentiated fever in a rural hospital in central India: diagnostic uncertainty and overtreatment with antimalarial agents", Am J Trop Med Hyg, 78, pp.393~399 (2008)
- Chaturvedi HK, "Treatment-seeking for febrile illness in north-east India: an epidemiological study in the malaria endemic zone", Malar J, 8, pp.301~ (2009)
- Susilawati TN, "Acute undifferentiated fever in Asia: a review of the literature", Southeast Asian J Trop Med Public Health, 45, pp.719~726 (2014)
- Hechemy KE, "Rickettsiology and Rickettsial Diseases--Fifth International Conference. Foreword", Ann N Y Acad Sci, 1166, pp.vii~viii (2009)
- Batra HV, "Spotted fevers & typhus fever in Tamil Nadu", Indian J Med Res, 126, pp.101~103 (2007)
- Mahajan SK, "Scrub typhus in Himalayas", Emerg Infect Dis, 12, pp.1590~1592 (2006)
- Chrispal A, "Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality", Trop Doct, 40, pp.129~133 (2010)
- Mahajan SK, "Relevance of Weil-Felix test in diagnosis of scrub typhus in India", J Assoc Physicians India, 54, pp.619~621 (2006)
- Batra HV, "Spotted fevers & typhus fever in Tamil Nadu", Indian J Med Res, 126, pp.101~103 (2007)
- Sheikh MS, "Modified Kuppuswamy scale updated for year 2018", Indian J Res, 7, pp.6~7 (2018)
- Abhilash KP, "Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: Clinical spectrum and outcome", J Glob Infect Dis, 8, pp.147~154 (2016)
- "Spotted fever rickettsiosis (including Rocky mountain spotted fever) (SFR, including RMSF) 2020 case definition"[URL]
- Koh GC, "Diagnosis of scrub typhus", Am J Trop Med Hyg, 82, pp.368~370 (2010)
- Putli Bai PS, "Laboratory diagnosis of rickettsial infections", Pediatr Infect Dis, 7, pp.85~87 (2015)
- Veligandla G, "Etiological spectrum of acute undifferentiated febrile illness (AUFI) in fever cases attending our tertiary care centre", Int J Curr Microbiol Appl Sci, 6, pp.954~962 (2017)
- Rathi N, "Rickettsial infections: Indian perspective", Indian Pediatr, 47, pp.157~164 (2010)
- Ittyachen AM, "Study of acute febrile illness: a 10-year descriptive study and a proposed algorithm from a tertiary care referral hospital in rural Kerala in Southern India", Trop Doct, 45, pp.114~117 (2015)
- Andrews MA, "Aetiology of acute febrile illness: a multicentre study from the province of Kerala in southern India", 48, pp.322~325 (2018)
- Thomas R, "Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications", J Infect Dev Ctries, 10, pp.657~661 (2016)
- Mattar S, "Undifferentiated tropical febrile illness in Cordoba, Colombia: Not everything is dengue", J Infect Public Health, 10, pp.507~512 (2017)
- Sahira H, "Seroprevalence of leptospirosis among febrile patients - A hospital based study", J Acad Ind Res, 3, pp.481~484 (2015)
- Nsutebu EF, "Prevalence of typhoid fever in febrile patients with symptoms clinically compatible with typhoid fever in Cameroon", Trop Med Int Health, 8, pp.575~578 (2003)
- Ramyil MS, "Comparative study on the use of widal test and stool culture in the laboratory diagnosis of Salmonella infection in adult and children in Jos Metropolis, Plateau State, Nigeria", Int J Sci Res, 2, pp.435~441 (2013)
- Bouley AJ, "Brucellosis among hospitalized febrile patients in northern Tanzania", Am J Trop Med Hyg, 87, pp.1105~1111 (2012)
- Moeini M, "The incidence of epstein-barr virus primary infection among suspected patients referred to namazi hospital of shiraz, iran", Jundishapur J Microbiol, 8, pp.e16109~ (2015)
- Oyeyemi OT, "Comparative assessment of microscopy and rapid diagnostic test (RDT) as malaria diagnostic tools", Res. J. Parasitol., 10, pp.120~126 (2015)
- Faruque LI, "Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh", BMC Infect Dis, 17, pp.141~ (2017)
- Hay SI, Graham AJ, Rogers DJ, "Guest editors' preface. Global mapping of infectious diseases: methods, examples and emerging applications", Adv Parasitol, 62, pp.ix~xi (2006)
- Peters TJ, "Pregnant women at work", pp.87~104 (1984), Palgrave
- Mahajan SK, "Relevance of Weil-Felix test in diagnosis of scrub typhus in India", J Assoc Physicians India, 54, pp.619~621 (2006)
- Mathai E, "Serological evidence for the continued presence of human rickettsioses in southern India", Ann Trop Med Parasitol, 95, pp.395~398 (2001)
- Nawab T, "A clinical study of rickettsial disease and its manifestations", Curr Pediatr Res, 19, pp.17~20 (2015)
- Bithu R, "Possibility of scrub typhus in fever of unknown origin (FUO) cases:an experience from Rajasthan", Indian J Med Microbiol, 32, pp.387~390 (2014)
- Laskar AR, "Scrub typhus: Re-emerging public health problem in India", J Commun Dis, 47, pp.19~25 (2015)