Relationship of outcomes between different etiologies and severity groups of patients presenting with acute febrile illness with transaminitis

Abstract

Background: Acute febrile illness (AFI) is defined as a fever lasting less than 14 days with no evidence of organ-specific symptoms or signs of infection. Our aim was to determine the most common etiology of AFI with transaminitis and to find the relationship between clinical and laboratory investigation profile, as well as outcomes of illness.

Methods: This is a hospital based prospective study conducted in Chitwan Medical College and Teaching Hospital (CMC-TH) from 17 April 2021 to 18 October 2021. All patients >15 years of age admitted with acute febrile illness and elevated transaminases under Pulmonary and Critical Care Medicine (PCCM) Unit of CMCTH were enrolled consecutively.

Results: The mean age of the patients (n=103) was 45.1 ± 16.8 years. There were almost equal proportion of males and females. The most common presenting symptom (besides fever) was headache, followed by myalgia, with a median duration of 5 days. Scrub typhus was the commonest diagnosis (60, 58.3%). A diagnosis of Acute Undifferentiated Febrile Illness (AUFI) was given in (39, 37.9%) patients. The three transaminitis severity groups (mild, moderate and severe) were not significantly different by age, gender and comorbidity status. Acute kidney injury and multi-organ dysfunction syndrome (MODS) were significantly associated with severe transaminitis (P<0.05). The mortality rate was also higher in the severe transaminitis group.

Conclusions: Scrub typhus has emerged as the most common cause of Acute Febrile Illness with transaminitis requiring hospital admission in this part of the country. Scrub typhus should be suspected in all patients who report with AFI with transaminitis in endemic areas.