Title: A study on short duration fever in a tertiary care centre in Kolkata, India
Abstract: Background: Aetiology of short duration fever varies according to the population characteristics, geographical area and season. Generation of region specific data is needed. Methods & Materials: From July 2011 to June 2012, 200 adults and adolescents >14 years of age presenting with fever (>99 degree F) of less than two weeks duration at School of Tropical Medicine, Kolkata were studied excluding patients with HIV infection, haematological malignancies and on immunosuppressive therapy. Detailed history and thorough clinical examination was done. Laboratory investigations were underttaken as appropriate for the clinical presentation using a syndromic approach. Patients were managed according to National Guidelines. Results: Aetiology was identified in 193 cases. Chikungunya was the commonest cause affecting 44% of study population (55%-female). Most patients were 31-40 years of age. Arthralgia and rash were found in 94.3% and 80.7%. Pattern of joint involvement was small-28%, large -11% and both-61%. Malaria occurred in 15.5% of subjects(67.7% male), no age preference was seen. 22 had P.vivax and 9 P.falciparum. Splenomegaly was commoner with P.vivax. One had complicated falciparum malaria. Dengue was found in 10% cases (60% male). Most patients were between 31-40 years of age. Rash, myalgia, arthralgia and diarrhoea were observed in 19, 17, 11 and 3.Findings included purpura in 4, epistaxis, hypotension, signs of plasma leakage each in 2 cases. 2 patients had Dengue and Chikungunya coinfection. UTI occurred in 12% cases (75%-females).Organisms were E.coli -75%, Klebsiella - 17% and enterococci - 8%. 37.5% of UTI were caused by ESBL producers. Respiratory tract infection occurred in 8.5% (53% male), organisms being S.pneumoniae-83%, K.pneumoniae-12%, H.influenzae-5%. In both UTI and RTI, incidence increased with age .Enteric fever was diagnosed in 5.5% cases (63% male). Leptospirosis was diagnosed in two male patients .7 cases remained undiagnosed despite meticulous search. Picture 1. Rash in ChikungunyaConclusion: The ongoing epidemics of Chikungunya and Dengue were reflected in the results. Malaria is still an important problem. Other common causes like UTI, RTI and enteric fever were observed. Females were affected more by Chikungunya and UTI while males suffered more from Malaria, Dengue and RTI. Occurrence of ESBL bacteria in community acquired UTI is a disturbing observation.