A multi-centric observational study of 34 Intensive Care Units (ICUs) across India on 456 patients — critically ill adults and children with non-localised fever — has found that dengue was the reason for most ICU admissions (105.23%) across the country.
These admissions peaked after monsoon, from August to October. Dengue was followed by scrub typhus (83.18%), encephalitis (44.96%), malaria (37.8%) and bacterial sepsis (32.7%), noted the study.
Conducted between July 2013 and September 2014, the study was done by researchers from various hospitals, including Sir Ganga Ram Hospital in New Delhi, Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, Christian Medical College and Hospital (CMC) in Vellore. It was published in the December 2017 edition of the Indian Journal of Critical Care Medicine.
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Tropical fevers
Prakash Shastri, author and vice-chairman, Department of Critical Care Medicine, Sir Ganga Ram Hospital, said, “Tropical fevers are caused by a number of viruses, bacteria and Protozoa, and often get transmitted by insect bites.”
Some of the common tropical fevers from Asian countries include dengue, malaria, leptospirosis , influenza A, typhoid, scrub typhus, Japanese encephalitis and chikungunya.
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He added that the challenge lay in clinically diagnosing them at the time of presentation, as they often present as undifferentiated fever with overlapping signs and symptoms.
“Laboratory confirmation may not be available or reliable in the first few days,” noted the study.
The study went on caution that regardless, “it is important to treat these patients early as delay leads to increased complications and increased hospital stay, and expenditure”.
This nation-wide study was conducted to identify the prevalence, reasons and utilisation of ICU resources, and outcome of a patient with tropical fevers in Indian ICUs.
Prof Sunit Singhi, co-author and emeritus, paediatrics, PGIMER, Chandigarh, said, “Among patients admitted to the ICU with acute febrile illness and systemic manifestations, it was found that dengue and scrub typhus were the most common etiological diagnosis. Case fatality in our study was 18.4%.”
The study noted, “The outcome data highlights the importance of reaching the diagnosis as those without a specific diagnosis more often required organ supportive therapies and had poor outcome.”
In addition, tropical fevers also pose a significant burden on ICU health care resources. “Nearly , a fifth of all ICU resources were consumed by these illnesses,” the study stated.
Prof T.D. Chugh, emeritus, pathology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, said the study also showed that dengue, scrub typhus, encephalitis and malaria were common causes of tropical fevers presenting to Indian ICUs, with organ involvement, in post-monsoon season.
“Point of care testing for these tropical fevers can rule in or rule out these diagnosis at admission, and help in instituting specific therapy,” he said.