1475. Etiology and outcome of fever and respiratory distress in adult patients presenting to medical emergency in a tertiary care hospital in north India
Session: Poster Abstract Session: Respiratory Infections: Miscellaneous
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Id week 2018 poster Vikas Suri India.pdf (251.3 kB)
  • Background: To study the region specific etiology and outcome in adult patients with acute febrile illness and ARDS

    Methods: Prospective observational study done among 102 adult patients admitted to medical emergency, PGIMER, during study interval of 18 months( Jan 2016 to June 2017), with acute febrile illness (oral temperature more 101deg F for less than 14 days with no localising symptoms) and ARDS(acute onset respiratory distress within one week of fever or new/worsening respiratory symptoms with bilateral opacities on chest radiograph, symptoms not explained by cardiac failure or fluid overload with PaO2/FiO2 ratio less than 300 with PEEP or CPAP more than 5cm H2O).All patients were investigated for the etiology as per standard protocol for malaria, scrub typhus, Leptospira, enteric fever, dengue, H1N1 influenza. Patients were followed till discharge or 28thday whichever is longer

    Results: Among the 102 patients recruited in the study, 41.2% were males and 58.8% were females. Mean age of presentation was 38.06+/-17.26yrs. 46% of patients admitted during post monsoon season. 26.5% patients had succumbed to their illness. Cough(61.8%), hepatomegaly (50%), myalgia(50%), splenomegaly(30.3%), pedal edema(31.4%), pallor(39.4%), vomiting(26.7%) were most common findings apart from fever and dyspnoea. 9 of them had bleeding manifestations. The most common diagnosis was Scrub typhus(32.4%), followed by coinfections (13.7%), H1N1 influenza in 8.8% cases. 30.4% patients did not fall into any diagnostic criteria. Leptospira, dengue and Malaria were present in 4,4 and 2 cases respectively. A total of 50 patients were intubated and ventilated during their stay in the hospital. APACHE 2 score was observed to better predict mortality than SOFA score. Factors which predicted mortality were male sex, age more than 45yrs, invasive ventilation and low GCS

    Conclusion:

    Fever and ARDS has more incidence among young females and occurs significantly during post monsoon season. Scrub typhus constituted the majority of Fever with ARDS cases followed by H1N1. Coinfections were common cause of Fever with ARDS. Predictors of mortality were male gender, old age, long duration of invasive ventilation, higher serum procalcitonin levels and low GCS at admission. APACHE 2 score was a better predictor of mortality than SOFA score.

    Vikas Suri, MBBS MD(MED)1, Harshit R Rao, MBBS MD(MED)2, Ashish Bhalla, MBBS MD(MED)3,4, Inderpaul Singh, MBS MD DM(PUL MED)2, Manisha Biswal, MBBS MD(MICROBIOLOGY)5, Mini P Singh, MBBS MD(MICROBIOLOGY)6, Kapil Goyal, MBBS MD(MICROBIOLOGY)7 and Kamran Zaman, MBBS MD(MICROBIOLOGY)8, (1)Internal Medicine, PGIMER Chandigarh, CHANDIGARH, India, (2)Pulmonary Medicine, PGIMER CHANDIGARH, CHANDIGARH, India, (3)Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, (4)Internal Medicine, Postgaduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, (5)Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, (6)Virology, PGIMER CHANDIGARH, CHNADIGARH, India, (7)Microbiology(Virology), PGIMER CHANDIGARH, CHANDIGARH, India, (8)Medical Microbiology, PGIMER CHANDIGARH, CHANDIGARH, India

    Disclosures:

    V. Suri, None

    H. R. Rao, None

    A. Bhalla, None

    I. Singh, None

    M. Biswal, None

    M. P Singh, None

    K. Goyal, None

    K. Zaman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.