INSIGHTS INTO A FEVER OUTBREAK AT A RURAL TERTIARY CARE CENTRE- A DESCRIPTIVE STUDY

Dr. Rajendran Subramaniam, MD. and *Dr. Swarnalatha, MD.

ABSTRACT

Importance: Dengue outbreaks occur in an unprecedented manner and cause a huge burden on health resources. Mortality is high among vulnerable population. Aim: To investigate the cause and clinical manifestations of a sudden upsurge of fever patients admitted to Govt Villupuram Medical college. Design: This is a prospective observational study of acute fever patients who got from September to November 2017. Setting and Participants: The study was conducted at Government Villupuram Medical College and Hospital, Southern India. All patients with more than 16 years of age, hospitalized with fever of < 7 days duration [oral temperature of 101*F at least once during admission. Results: A total of 240 patients were included in the study. The male to female ratio was approximately 2:1[male 65%[n=156], female 35%(n=84)]. The distribution of acute fever was Dengue 153, Enteric fever 9, Malaria 2, Scrub Typhus 2, other fevers [liver abscess, pneumonia,etc] 4 and undiagnosed 70[Figure 3].Symptom analysis into the illness into the illness revealed that only 3 were significantly associated with confirmed Dengue. These were giddiness 168(p<0.001), bleeding manifestations 133(p<0.001) and pruritis 57(p<0.01).The dominant physical examination findings which had a predictive value for Dengue were orthostatic hypotension 187(p<0.01), clinical shock 199(p<0.001) and bleeding manifestations 133(p<0.001). However Tourniquet test was positive only in 73(30.4%) of patients. Cumulatively their positive predictive value was >90%.The important laboratory findings associated with Dengue were thrombocytopenia, leucopenia and raised hematocrit[p<0.01]. Conclusion: In the recent Dengue outbreak in Villupuram District many insights were drawn as regards the predictive capacity of clinical signs and symptoms for dengue. The information gained could be used in the early diagnosis and triage of patients in resource poor settings.

Keywords: Dengue outbreak, Clinical features, Acute fever.