Clinical and etiological profile of children hospitalized with acute undifferentiated febrile illness in South-Eastern Rajasthan, India: a prospective observational study

Anjali Tiwari; Rajendra Prasad Nagar; Poorva Tiwari

doi:10.18203/2349-3291.ijcp20263817

Authors

Anjali Tiwari Department of Pediatrics, Shrimati Heera Kunwar Baa Mahila Hospital, Jhalawar Medical College, Jhalawar, Rajasthan, India
Rajendra Prasad Nagar Department of Pediatrics, Shrimati Heera Kunwar Baa Mahila Hospital, Jhalawar Medical College, Jhalawar, Rajasthan, India
Poorva Tiwari Department of Pediatrics, JK Lone Hospital, SMS Medical College, Jaipur, Rajasthan, India https://orcid.org/0009-0002-4538-8515

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263817

Keywords:

Acute undifferentiated febrile illness, Scrub typhus, Orientia tsutsugamushi, Children, Rajasthan, Diagnostic accuracy, India

Abstract

Background: Etiological data on acute undifferentiated febrile illness (AUFI) in India come mainly from adults in humid, high-endemicity regions; pediatric data from semi-arid north-west India are sparse. We determined the etiology, laboratory profile, outcomes and laboratory discriminators in hospitalized children in south-eastern Rajasthan.

Methods: Prospective observational study at a tertiary teaching hospital in Jhalawar, Rajasthan. Two hundred children aged 2 months–18 years with fever ≤7 days and no identifiable focus after baseline assessment underwent a standardized diagnostic panel. Proportions carry Wilson 95% confidence intervals (CIs). Sparse cell counts required Monte Carlo permutation testing (100 000 replicates) with Holm adjustment across 16 comparisons; threshold performance was assessed post hoc.

Results: No etiology was identified in 105 children (52.5%, 95% CI 45.6–59.3). Scrub typhus predominated (33, 16.5%, CI 12.0–22.3; 34.7% of resolved diagnoses), then urinary tract infection (25, 12.5%), dengue (22, 11.0%), malaria (10, 5.0%) and enteric fever (5, 2.5%). Enrollment peaked in August–October (88, 44.0%; p<0.001). All laboratory parameters except creatinine differed by diagnosis (adjusted p≤0.002), as did length of stay, complications and defervescence time. Thresholds were specific but insensitive: hemoglobin <80 g/l for scrub typhus (specificity 97.0%, sensitivity 45.5%, likelihood ratio 15.2), platelets <100×10⁹/l for dengue (86.0%, 68.2%, 4.9). Complications affected 39 children (19.5%), intensive care 25 (12.5%); none died.

Conclusions: Scrub typhus, not dengue or malaria, led identifiable causes and accounted for most transfusions. Empirical doxycycline warrants evaluation in post-monsoon fever. Routine thresholds modify suspicion but cannot replace specific testing; the unresolved half defines the gap molecular diagnostics must close.

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