Acute Undifferentiated Febrile Illness (AUFI) in adult hospitalized patients: An experience from a tertiary care hospital of western Uttar Pradesh region from North India
Abstract
Acute undifferentiated febrile illness (AUFI) is a common occurrence in low and middle income groups countries like India and constitutes heavy burden on healthcare industry especially from month of June to September. AUFI includes various diseases which are very difficult to differentiate. So this study was conducted on 504 AUFI cases to present an etiological profile of these AUFI cases. It was found that among these 504 AUFI cases, 6.54% were Malaria, 15% Typhoid, 14% Dengue, 3.17% Chickenguniya, 4.56% were mixed infections and 60.7% were undiagnosed.
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Introduction
Acute undifferentiated febrile illness (AUFI) is considered to be a febrile illness of < 3 weeks duration without any localized symptoms and specific signs.1 A number of diseases were included in this category. Most of these illnesses have nonspecific symptoms and signs and it is difficult to differentiate among them clinically. A huge gap is existing in understanding of specific clinical characteristics and diagnostic lab parameters to identify a specific illness. Even a very astute physician faces a big diagnostic challenge while managing these illnesses. Local pattern of febrile illness in a specific geographical area influences the differential diagnosis and laboratory workup for AUFI.
AUFI is a common occurrence in low and middle income groups countries like India and constitutes heavy burden on healthcare industry especially from month of June to September 12. During this season, these diseases form the main bulk of hospital admissions and OPD visits. 2,3,4
AUFI can be caused by bacterial, viral, rickettsial or protozoal organisms. Being situated in the tropical region, India is endemic for range of tropical infections like Dengue, Chikungunya, enteric fever, viral hepatitis, malaria, leptospirosis, Japanese encephalitis, meningitis, influenza etc. 5 Though data from western UP region is lacking.
Numerous laboratory investigations are done to diagnose aetiologies of AUFI, but despite of that some still may remain undiagnosed and are known as undiagnosed undifferentiated febrile illness (UUFI), though exact definition of UUFI is missing. This short term undiagnosed undifferentiated febrile illness (UUFI) closely resembles PUO. PUO in contrast to AUFI is a well-defined and widely studied problem.
Conclusion
It is important to know the various aetiologies responsible for AUFI. In present study, 60.7% of AUFI cases remain undiagnosed (UUFI) whereas 15% were diagnosed as typhoid, 14% as Dengue, 6.54% as Malaria, 3.1% as Chikungunia and 4.56% as mixed infection. It will not only help stakeholders for choosing preventive measures but will guide clinicians to make appropriate clinical judgement for diagnosing and treating these illnesses. UUFI formed the main category in this study, reflecting the need of broader diagnostic approach to identifying a broad range of infectious agents. A protocol based approach for diagnosing and managing AUFI will reduce the cost, burden on healthcare professional and help in selective use of antibiotics and antimalarials. Hence, need of protocol is well understood and it is to be established by each institute depending on their local prevalence and pattern of the illness.