Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 31;9(5):2232-2236.
doi: 10.4103/jfmpc.jfmpc_214_19. eCollection 2020 May.

Acute undifferentiated febrile illness: Protocol in emergency department

Vempalli N Subramanyam  1 , Nidhi Kaeley  1 , Manish Kumar  2 , Subodh K Pandey  1 , Bharat B Bhardwaj  1 , Konda S Reddy  3
Affiliations

Acute undifferentiated febrile illness: Protocol in emergency department

Vempalli N Subramanyam et al. J Family Med Prim Care. .

Abstract

Fever accounts for around 15% of emergency visits in elderly age group and around 5% in adults. The spectrum of etiologies ranges from non-infectious to infectious etiologies. There are very few studies done in the past highlighting the approach of patients with acute febrile illness without any localizing signs and symptoms.

Objectives: The aim of the study was to formulate a targeted approach for evaluation and treatment of patients with acute undifferentiated febrile illness without evidence of localizing symptoms and signs. The secondary objective was to study the etiology and final outcome of patients with acute undifferentiated febrile illness.

Materials and methods: A protocol was devised for patients aged more than 18 years, who presented in emergency department with complaints of fever without localizing symptoms or signs of sepsis over a period of 6 months from April 2018 to September 2018. Patient's data were collected retrospectively from the hospital record section.

Results: A total of 212 patients of undifferentiated acute febrile illness were enrolled in the study. Maximum number of patients [n = 69 (32.5%)], presented on second day of illness. All the patients presenting within 1 or 2 days of fever experienced defervescence. Out of these 69 patients, 35 (36.4%) were investigated of which in 29 (82.2%) investigations were not found to be useful; 75 (78.1%) patients with 1 or 2 days history of fever improved without investigations. Surprisingly, 54 patients (72%) with 1 or 2 days' history of acute febrile illness experienced defervescence without the need of antibiotics.

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

Keywords: Dengue; fever; malaria; scrub typhus.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Flow chart 1
Flow chart 1
Protocol for AUFI
See this image and copyright information in PMC

References

    1. Grandey KA. Fever [Internet] In: Sherman SC, Weber JM, Schindlbeck MA, Rahul GP, editors. Clinical Emergency Medicine. New York, NY: McGraw-Hill Education; 2014.
    1. Manock SR, Jacobsen KH, de Bravo NB, Russell KL, Negrete M, Olson JG, et al. Etiology of acute undifferentiated febrile illness in the Amazon basin of Ecuador. Am J Trop Med Hyg. 2009;81:146–51. - PubMed
    1. Gasem MH, Wagenaar JF, Goris MG, Adi MS, Isbandrio BB, Hartskeerl RA, et al. Murine typhus and leptospirosis as causes of acute undifferentiated fever, Indonesia. Emerg Infect Dis. 2009;15:975–7. - PMC - PubMed
    1. Joshi R, Colford JM, Jr, Reingold AL, Kalantri S. Nonmalarial acute undifferentiated fever in a rural hospital in central India: Diagnostic uncertainty and overtreatment with antimalarial agents. Am J Trop Med Hyg. 2008;78:393–9. - PubMed
    1. Phuong HL, de Vries PJ, Nagelkerke N, Giao PT, Hung le Q, Binh TQ, et al. Acute undifferentiated fever in Binh Thuan province, Vietnam: Imprecise clinical diagnosis and irrational pharmaco-therapy. Trop Med Int Health. 2006;11:869–79. - PubMed