Journal of the Association of Physicians of India
JAPI
Editor : Dr. Siddharth N. Shah
February 2019 • VOL. 67
Abstracts : Free Papers – Platform Presentation (APICON-2019) - Tropical Medicine
Retrospective Study of Clinical Profile of Acute Febrile Illness in a Tertiary Care Hospital
Background: Acute febrile illness is a common cause of
patients seeking health care settings posing a diagnostic and
therapeutic challenge to the health care workers. The aim of
the study was to study the aetiology, clinical and laboratory
profile of patients with acute febrile illness admitted to our
hospital which caters to the population of Navi Mumbai.
Material and Methods: A retrospective data analysis
was carried out by collecting the details of patients above
the age of 13 years admitted with fever of less than 8 days
with or without complications during the period from
January to December 2017 at tertiary care hospital. Relevant
investigations for the diagnosis of illness and organ
dysfunction were collected and analysed for each patient.
Result: Out of 648 patients analysed, male 431 (66.21
%) and age group of below 40 years comprised the larger
proportion of cases with total 395(61.56 %). The diagnosis
was available in 515 (79.48%) cases. The causes of fever
in our study were; dengue 372 (57.41 %), malaria 109
(16.82%), hepatitis 30 (4.63%), leptospirosis 4 (0.62%).
Undifferentiated fever contributed to 133(20.53%) cases.
The most common symptoms reported amongst the patients
included generalised body ache (75.12%), headache (45%),
abdominal pain (23%), loose motions (18%), vomiting
(8%). Clinical signs recorded and significantly associated
were icterus (36.88 %) and tachypnoea (19.44%). A most
common complication of dengue was a shock (70.16%)
followed by haematological (61.56%) and hepatic (29%)
derangements. Overall mortality was 0.4% with 2 cases
in dengue group and 1 case in malaria group. The largest
number of cases (68.36%) were recorded in monsoon and
post-monsoon season.
Conclusion: This study reveals that dengue, malaria,
hepatitis were common causes of acute febrile illness
requiring admission in hospital affecting largely middleaged
population.
Clinical profile and treatment outcome in scrub typhus patients in central India
Background: Scrub typhus is an acute febrile illness
caused by Orientia tsutsugamushi. It is known from various
parts of India. However, reports from central India region
are sparse. Hence, present research was undertaken to study
the clinical profile and treatment outcome of scrub typhus
cases admitted in tertiary care center of central India.
Method: In this study, total 140 patients with an acute
febrile illness diagnosed as scrub typhus by positive IgM
antibodies against O. tsutsugamushi were enrolled, over a
period of 2 months (August to October 2018). All relevant
data were recorded and analyzed.
Results: Among 140 cases, 52.14% patients reported
from urban area and 47.85% patients from rural area.
The mean age of patients was 43.75±16.82 years, ranged
from 12-83 years with female (81 females) predominance.
Fever (100%), cough (38.57%) breathlessness (27.85%),
altered sensorium (9.28%) and headache (7.85%) were
the predominant clinical features. Eschar was seen in
33 patients (23.57 %). Renal (73; 52.14%) and hepatic
dysfunction (68; 48.57%) was the commonest followed by
respiratory dysfunction (59; 42.14%). All patients were
treated with oral or injectable doxycycline. Seventeen
patients needed mechanical ventilation and 5 patients
required dialysis. Total 24 (17.14%) patients died during
the study period.
Conclusion: Scrub typhus has become a leading
infectious disease in central India and an important cause
of infectious fever. An increasing awareness of this disease
coupled with prompt management will go a long way in
reducing both morbidity and mortality from this disease.
Prognostic Value of NLR in Snake Bite Patients
Introduction and Objectives: India is a snake-bite
endemic area. India is estimated to have the highest
snakebite mortality in the world. WHO estimates place
the number of bites to be 83,000 per annum with 11,000
deaths. Most of the cases are reported from rural areas
where adequate facilities are lacking. Snakebites can result
in serious complications like neurotoxicity, haem toxicity
and late complications like AKI, cellulitis, Myocarditis.
The parameters for the prognosis of snakebites are very
valuable. The neutrophil/lymphocyte ratio (NLR) provides
valuable information for the determination of the diagnosis
and prognosis of various diseases. In this study, we aimed
to investigate the relationship between NLR with the
development of complications and duration of hospital
stay in snakebite cases.
Materials and Methods: In this study, 124 patients
admitted in tertiary care hospital from Jun 2017- Sept
2018 were retrospectively reviewed. The control group
comprised of 124 age-and gender-matched healthy subjects.
These patients were examined using their previous
laboratory results, analysis of complications that developed
during the hospitalization.
Results: Out of 124 patients 38 patients are bitten by
poisonous snakes with patients showing hemotoxic or
neurotoxic symptoms. 12 patients developed AKI during
the stay in hospital and 4 patients developed cellulitis.
When NLR on admission were compared between
poisonous and non-poisonous snake bites, a statistically
significant difference was found (p < 0.001). when
among non-poisonous snake bite cases who developed
complications were compared with patients having
snakebite but no complication, the initial NLR was found to
be higher and statistically significant (p = 0.032). Correlation
between NLR and hospital stay, patient with higher NLR
value have longer hospital stay.
Conclusions: Admission NLCR predicts severity and
can be used as prognostic marker for snake bite cases.
Prophylactic Platelet Transfusion: An Unfortunate Misconception in Dengue with Thrombocytopenia
Introduction & objectives: Dengue fever is one of
the most rapidly spreading mosquito-borne diseases
that has become a major public health problem in India.
Thrombocytopenia is a defining finding in Dengue
fever and it is often mistreated. It is a common practice
to transfuse platelets prophylactically in patients with Dengue fever with severe thrombocytopenia (<20,000/
mm3) irrespective of bleeding manifestations. This study
is undertaken to check the effectiveness of prophylactic
platelet transfusion in patients with Dengue fever with
severe thrombocytopenia.
Materials & Methods: We conducted a retrospective
cohort study on patients with serologically proven Dengue
fever with platelet count <20,000/mm3 admitted to Bapuji
Hospital from January to December 2017. The comparison
between transfused vs non-transfused groups were done
based on signs and symptoms at lowest platelet count,
duration of hospital stay, platelet increment the next day
and the number of days to reach platelet count of 50,000/
mm3.
Results: Of 104 patients, 69 (66.3%) received platelet
transfusion and among them, 24 (34.8%) had bleeding
manifestations clinically. Patients who received platelets
took a median of 2 days longer to reach platelet count of
50,000/mm3 compared to those who didn’t (4 days vs 2
days, p= 0.00001). Patients in non-transfused group showed
significantly higher increment in platelet count on the next
day compared to transfused group (74.3% >10,000/mm3 rise,
91.2% >5,000/mm3 rise vs 46.4% >10,000/mm3 rise, 59.4%
>5,000/mm3 rise, p=0.003). The duration in the hospital stay
was higher in transfused group (median 6 days vs 5 days
in non-transfused group, p=0.016).
Conclusion: In Dengue with platelet count <20,000/
mm3, prophylactic platelet transfusion is not advised in
the absence of clinically significant bleeding as it hinders
the recovery of platelet count and increases the duration of
hospital stay and cost of treatment along with the potential
risks of transfusion.
Rising Tide of Expanded dengue syndrome- where do we stand ? Our Experience
Introduction: Classic dengue fever presentation has
expanded its horizon by involving various organ systems
recently & is named as expanded dengue syndrome by
WHO 2012. This changing presentation & rising burden
across the globe may lead to delayed diagnosis & under
reporting of this syndrome.
Aim of study: To analyse the mode of presentation,
the clinical course & outcome of patients with expanded
dengue syndrome.
Material & Methods: 520 cases of expanded dengue
syndrome as per WHO definition criteria 2012 were studied
with their informed consent. Detailed history, thorough
clinical examination & relevant investigations were done in
all cases. Their age & sex distribution, signs and symptoms,
haematological parameters, clinical course of the illness
& outcome were analysed in detail. Standard treatment
guidelines were followed in all cases.
Observation: 301 patients were male & 219 were
female with male to female ratio of 2:1. Their age varied
from 12 years to 76 years with the average age of 47.5
years. 92 % of cases presented with various gastro hepatic
manifestations,5.5% neurological, three with acute kidney
injury & eight patients had co-infection with malaria. The
commonest gastro hepatic manifestation was transaminitis
(57.5%) followed by acalculous cholecystitis (21%) & acute
pancreatitis (13.9%). Two patients had features of sub- acute
intestinal obstruction. Twenty nine patients presented
with neurological manifestations (15- acute encephalitis,
5- meningitis, intracranial bleed-5, infarct-1, 2-hypokalemic
paralysis & 1 acute transverse myelitis). 40.6% of patients
presenting with gastro hepatic manifestations had platelet
count < 20,000/cu mm vs 9.8% patients with other system
involvement which is statistically significant (p value,
0.0001)
Conclusion: Expanded dengue syndrome may be
unrecognised & under reported. Atypical presentation
should prompt us to investigate for dengue especially
during ongoing epidemics.
