Aetiology and Clinical Profile of Infectious Causes of Febrile Jaundice at a Tertiary Care Hospital in Eastern Odisha- An Observational Prospective Study

Abstract

Introduction: Fever with jaundice is one of the most common presentations seen in both outdoor and indoor patients. This manifestation is seen in many individuals infected with hepatotropic viruses (A to E), bacteria, protozoa, fungi, and non hepatotropic viruses. In viral hepatitis due to hepatotropic viruses the patient presents with a short febrile prodrome followed by jaundice, and is often self-limiting without any treatment whereas in patients other than viral hepatitis the patients present with ongoing fever and jaundice and need specific treatment. Aim: To evaluate clinical profile of patients presenting with febrile jaundice and finding the infections agent responsible for fever with jaundice baring viral hepatitis (A to E). Materials and Methods: This observational prospective study included 107 patients admitted in the Kalinga Institute of Medical Sciences, from September 2019 to August 2021, who were found to have febrile jaundice after initial evaluation, based on liver function tests and hepatotropic viral markers {hepatitis B surface antigen (HBsAg), Immunoglobulin M antibody against hepatitis C virus (Anti-HCV IgM), Immunoglobulin M antibody against hepatitis A virus (Anti-HAV IgM), Immunoglobulin M antibody against hepatitis E virus (Anti-HEV IgM)}. Routine laboratory parameters, chest radiograph, and electrocardiogram were performed in all cases. Appropriate investigations like specific serological, radiological investigations and cultures were performed to identify the causal pathogen. Statistical analysis of categorical variables was conducted by Statistical Package for Social Sciences (SPSS) 26.0 version. Results: Out of 107 patients, (23.3%) patients were found to have scrub typhus. Dengue was found in 23 (21.4%) patients (three had dengue associated with scrub typhus). Coronavirus Disease 2019 (COVID-19) was found in 11 patients (10.2%) of study population. Malaria, tuberculosis, S. typhi, K. pneumonia, E. coli, B. cepacia, E. feacalis were isolated in other individuals. Among these, 41.12% patients had associated transaminitis, whereas, 16 had elevated aspartate transaminase/alanine transaminase (>3 times of ULN). Overall, 18.4% patients had hepatomegaly, and 6.5% were found to have splenomegaly. Eight patients had septic shock, and associated Multiple Organ Dysfunction Syndrome (MODS) was seen in six patients. No definitive aetiology was found in 25 patients. Conclusion: The study identified a variety of organisms in sera from the patients presenting with febrile jaundice. The most common clinical feature was anorexia followed by headache. The common aetiology for febrile jaundice was viral infections {barring viral hepatitis (A to E)} followed by bacterial Infections.

Keywords

• coronavirus disease 2019
• dengue
• multiple organ dysfunction syndrome
• scrub typhus
• septic shock