622. Etiology of Acute Febrile Illness Among Hospitalized Adults and Children at a Public Tertiary-Care Center in Pune, India
Session: Poster Abstract Session: Oh One World: Infections from Near and Far
Thursday, October 27, 2016
Room: Poster Hall
  • ID Week Etiology of AFI Poster 26-10-16.pdf (6.1 MB)
  • Background: Fever is the most common symptom reported by Indians seeking medical care.  Despite the immense healthcare burden acute febrile illness (AFI) poses in India and beyond, systematic characterization of the etiology of AFI in India has been limited.

    Methods: Patients admitted to Sassoon General Hospital in Pune, India from July 2013 through December 2015 with fever were enrolled.  A dedicated study team obtained a standardized clinical history and samples for influenza rapid test, blood culture, malaria rapid test, chikungunya IgM, and dengue NS1 ELISA.  Treating clinicians ordered IgM tests for leptospirosis, dengue, hepatitis A, hepatitis E, and culture of blood, urine, cerebrospinal fluid (CSF), and sputum on select patients per routine clinical care, results of which were obtained from the medical record.  Contaminant organisms were discounted.  Meningitis was defined by headache or altered mental status, with >= 10 white blood cells (WBC)/µL in CSF, pneumonia by clinical suspicion confirmed by chest radiograph, and urinary tract infection by isolation of bacteria in urine plus dysuria or urine microscopy showing > 10 WBC/high power field.

    Results: Among 970 adults and 755 children under age 12, microbiologic testing within case definitions yielded a diagnosis in 528 (31%) patients.  An additional 193 (11%) patients met standardized case definitions, but did not have a positive culture.  Of the remaining patients, 658 (38%) were assigned a clinical diagnosis by their treating clinicians; no diagnosis was determined for 346 (20%) patients.  Vector-borne diseases were the most commonly identified causes of AFI in adults: dengue in 191 (20%), malaria in 72 (7%), leptospirosis in 18 (2%), and chikungunya in 16 (2%).  Pneumonia was the most common cause of AFI in children, occurring in 219 (29%) children (Fig 1 and 2).  Bacteremia was uncommon, found in 86 (5%) patients.  Central nervous system infections occurred in 59 (6%) adults and 65 (9%) children.

    Conclusion: Despite comprehensive testing, the etiology of AFI defies standardized diagnosis in one half of cases and remains a mystery in one fifth.  Determining the etiology of AFI is important to provide optimal patient care, and to guide allocation of resources to high-burden diseases.

    Matthew Robinson, MD1, Usha Balasubramanian, MSc2, Priyanka Raichur, MBBS2, Dileep Kadam, MD3, Sandhya Khadse, MD3, Ivan Marbaniang, MBBS, MPH2, Savita Kanade, MSc2, Jonathan Sachs, MD4, Anita Basavaraj, MD3, Renu Bharadwaj, MD3, Aarti Kinikar, MD3, Vandana Kulkarni, MSc2, Anju Kagal, MD3, Amita Gupta, MD, MHS1 and Vidya Mave, MD, MPH1,2, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)Byramjee-Jeejeebhoy Medical College Clinical Research Site, Pune, India, (3)Byramjee-Jeejeebhoy Medical College, Pune, India, (4)Tulane University School of Medicine, New Orleans, LA


    M. Robinson, None

    U. Balasubramanian, None

    P. Raichur, None

    D. Kadam, None

    S. Khadse, None

    I. Marbaniang, None

    S. Kanade, None

    J. Sachs, None

    A. Basavaraj, None

    R. Bharadwaj, None

    A. Kinikar, None

    V. Kulkarni, None

    A. Kagal, None

    A. Gupta, None

    V. Mave, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.