https://meditropics.com/acute-undifferentiated-febrile-illness-in-emergency-department/

^*Moti Lal

^*Professor, Department of Medicine, LHMC, New Delhi

 

Acute fever, an elevation in core body temperature above the daily range (98.6ºF), is one of the most common presenting complaints to physicians in primary care and outpatient departments in India. It has a wide spectrum of differential diagnoses from infectious to noninfectious causes. Acute undifferentiated febrile illnesses (AUFI) are characterized by fever (>38.3°C or 101.0°F) for greater than 2 days and lasting up to 14 days without organ-specific symptoms at the onset. Fever is an important and one of the most common complaints of patients presenting to an emergency. The severity of AUFIs ranges from mild or self-limiting to life-threatening illness.

Some of the common causes of AUFIs include malaria, dengue, enteric fever, leptospirosis, and scrub typhus, which continue to contribute significantly to the febrile disease burden in India. Malaria and dengue are the most prevalent febrile illness-associated forms of fever in India. It has a wide spectrum of differential diagnosis from infectious to non‑infectious causes. These patients get over‑investigated and receive unnecessary antimicrobials. There are very few studies highlighting the importance of a standardized protocol of approach and treatment of these patients in the emergency department. The indiscriminate use of antimicrobials not only leads to an increased burden on health expenditure but also leads to a rise in drug resistance, drug interactions, and adverse drug reactions in these patients.

The differential diagnosis of AUFI is varied and confusing. Fevers such as malaria, scrub, and dengue lead to significant mortality and morbidity in these patients. However, the exhaustive clinical and diagnostic evaluation as well as rampant use of antibiotics increases the economic burden, especially on the healthcare system of developing countries.

The diagnostic work‑up and treatment of patients with AUFI depend upon the local prevalence of various diseases in the geographical area. The protocol thus should be guided by the prevalence of individual diseases such as malaria, dengue fever, scrub typhus, and enteric fever. This will improve the diagnostic evaluation and treatment of these patients.

A protocol‑based approach to AUFI can    limit the economic burden and mortality in these patients. AUFI is one of the most common presentations in tertiary care hospitals of various northern and southern parts of India during seasonal outbreaks. These patients have varied presentations. They present as complicated multisystem illnesses, especially in tertiary care hospitals. ARDS, aseptic meningitis, hematological complications, and hepatic and renal dysfunctions are common causes of referral of AUFI to the tertiary care hospital requiring immediate attention. The majority of the patients with short-duration fever will improve with symptomatic treatment and they don’t require investigation and antimicrobials. The stable patients can be screened by point-of-care tests at triage, managed by emergency as well as family physicians and community care workers who can pick up subtle signs of the febrile illness and make quicker diagnoses, thus aiding in preventing further comorbidities and mortalities.

There is an urgent need to devise a standardized protocol for the diagnosis and treatment of patients with acute undifferentiated febrile illness to avoid unnecessary investigations and antimicrobial use.