{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:02:52Z","timestamp":1791756172214,"version":"4.3.4"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Infectious Diseases Training and Research Centre"},{"name":"Department of Medicine and Infectious Diseases"},{"DOI":"10.13039\/100008676","name":"CMC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008676","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Norwegian National Advisory Unit for Tropical Infectious Diseases"},{"DOI":"10.13039\/501100010586","name":"Haukeland University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010586","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute undifferentiated fever (AUF) ranges from self-limiting illness to life-threatening infections, such as sepsis, malaria, dengue, leptospirosis and rickettsioses. Similar clinical presentation challenges the clinical management. This study describes risk factors for death in patients hospitalized with AUF in India.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients aged \u22655 y admitted with fever for 2\u201314 d without localizing signs were included in a prospective observational study at seven hospitals in India during 2011\u20132012. Predictors identified by univariate analysis were analyzed by multivariate logistic regression for survival analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mortality was 2.4% (37\/1521) and 46.9% (15\/32) died within 2 d. History of heart disease (p=0.013), steroid use (p=0.011), altered consciousness (p&amp;lt;0.0001), bleeding (p&amp;lt;0.0001), oliguria (p=0.020) and breathlessness (p=0.015) were predictors of death, as were reduced Glasgow coma score (p=0.005), low urinary output (p=0.004), abnormal breathing (p=0.006), abdominal tenderness (p=0.023), leucocytosis (p&amp;lt;0.0001) and thrombocytopenia (p=0.001) at admission. Etiology was identified in 48.6% (18\/37) of fatal cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Bleeding, cerebral dysfunction, respiratory failure and oliguria at admission, suggestive of severe organ failure secondary to systemic infection, were predictors of death. Almost half of the patients who died, died shortly after admission, which, together with organ failure, suggests that delay in hospitalization and, consequently, delayed treatment, contribute to death from AUF.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trac091","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T20:48:39Z","timestamp":1663793319000},"page":"91-101","source":"Crossref","is-referenced-by-count":8,"title":["Clinical features and risk factors for death in acute undifferentiated fever: A prospective observational study in rural community hospitals in six states of India"],"prefix":"10.1093","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6401-1353","authenticated-orcid":false,"given":"Kristine","family":"M\u00f8rch","sequence":"first","affiliation":[{"name":"Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital , 5021, Bergen , Norway"},{"name":"Department of Clinical Science, University of Bergen , 5021, Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Manoharan","sequence":"additional","affiliation":[{"name":"Infectious Diseases Training and Research Centre, Department of Medicine , Christian Medical College, 632004, Vellore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Chandy","sequence":"additional","affiliation":[{"name":"Infectious Diseases Training and Research Centre, Department of Medicine , Christian Medical College, 632004, Vellore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashita","family":"Singh","sequence":"additional","affiliation":[{"name":"Baptist Christian Hospital , 784001, Tezpur, Assam , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cijoy","family":"Kuriakose","sequence":"additional","affiliation":[{"name":"Christian Fellowship Hospital , 624619, Oddanchatram, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvarna","family":"Patil","sequence":"additional","affiliation":[{"name":"B.K.L. Walawalkar Hospital , 415612, Ratnagiri, Maharashtra , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Henry","sequence":"additional","affiliation":[{"name":"Christian Hospital , Mungeli, 495001, Chhattisgarh , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Novin","family":"Chacko","sequence":"additional","affiliation":[{"name":"Duncan Hospital , Raxaul, 803101, Bihar , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Alvarez-Uria","sequence":"additional","affiliation":[{"name":"Rural Development Trust Hospital , 510051, Anantapur, Andhra Pradesh , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Nesaraj","sequence":"additional","affiliation":[{"name":"Bethesda Hospital , 635802, Ambur, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"Blomberg","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital , 5021, Bergen , Norway"},{"name":"Department of Clinical Science, University of Bergen , 5021, Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siby","family":"Kurian","sequence":"additional","affiliation":[{"name":"Infectious Diseases Training and Research Centre, Department of Medicine , Christian Medical College, 632004, Vellore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel Gill","family":"Haanshuus","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital , 5021, Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Vasanthan","family":"Antony","sequence":"additional","affiliation":[{"name":"Infectious Diseases Training and Research Centre, Department of Medicine , Christian Medical College, 632004, Vellore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0278-1616","authenticated-orcid":false,"given":"Nina","family":"Langeland","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital , 5021, Bergen , Norway"},{"name":"Department of Clinical Science, University of Bergen , 5021, Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip","family":"Mathai","sequence":"additional","affiliation":[{"name":"Infectious Diseases Training and Research Centre, Department of Medicine , Christian Medical College, 632004, Vellore , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"issue":"10176","key":"2023020109511027100_bib1","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/S0140-6736(19)30220-X","article-title":"Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies","volume":"393","author":"Fadel","year":"2019","journal-title":"Lancet"},{"issue":"4","key":"2023020109511027100_bib2","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4103\/0974-777X.192966","article-title":"Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: clinical spectrum and outcome","volume":"8","author":"Abhilash","year":"2016","journal-title":"J Glob Infect Dis"},{"issue":"1","key":"2023020109511027100_bib3","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1186\/s12879-017-2764-3","article-title":"Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy","volume":"17","author":"Morch","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"4","key":"2023020109511027100_bib4","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1258\/td.2010.100132","article-title":"Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India","volume":"40","author":"Chrispal","year":"2010","journal-title":"Trop Doct"},{"issue":"12","key":"2023020109511027100_bib5","first-page":"DC22","article-title":"Aetiologies of acute undifferentiated febrile illness in adult patients - an Experience from a tertiary care hospital in Northern India","volume":"9","author":"Mittal","year":"2015","journal-title":"J Clin Diagn Res"},{"issue":"5","key":"2023020109511027100_bib6","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/IPC.0b013e31817cfd66","article-title":"Mortality analysis of patients of acute febrile illness during monsoon in a tertiary care hospital of Mumbai","volume":"16","author":"Bajpai","year":"2008","journal-title":"Infect Dis Clin Pract"},{"issue":"5","key":"2023020109511027100_bib7","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.4269\/ajtmh.17-0571","article-title":"Vector-Borne disease is a common cause of hospitalized febrile illness in India","volume":"98","author":"Robinson","year":"2018","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"2023020109511027100_bib8","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/S1473-3099(12)70028-2","article-title":"Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia: a systematic review","volume":"12","author":"Deen","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"2023020109511027100_bib9","doi-asserted-by":"crossref","first-page":"e2605","DOI":"10.1371\/journal.pntd.0002605","article-title":"Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India","volume":"8","author":"Kumar","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"2023020109511027100_bib10","doi-asserted-by":"crossref","first-page":"e0008086","DOI":"10.1371\/journal.pntd.0008086","article-title":"Comparison of clinical presentation and out-comes of Chikungunya and Dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan","volume":"14","author":"Shahid","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"2023020109511027100_bib11","doi-asserted-by":"crossref","first-page":"e0006618","DOI":"10.1371\/journal.pntd.0006618","article-title":"Dengue infection in India: a systematic review and meta-analysis","volume":"12","author":"Ganeshkumar","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"2023020109511027100_bib12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1471-2334-7-43","article-title":"Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study","volume":"7","author":"Blomberg","year":"2007","journal-title":"BMC Infect Dis"},{"issue":"4","key":"2023020109511027100_bib13","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/cid\/ciy955","article-title":"The mortality burden of Multidrug-resistant pathogens in india: a retrospective, observational study","volume":"69","author":"Gandra","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2023020109511027100_bib14","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1186\/s12879-019-4589-8","article-title":"Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review","volume":"19","author":"Bhaskaran","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"7","key":"2023020109511027100_bib15","doi-asserted-by":"crossref","first-page":"e0158816","DOI":"10.1371\/journal.pone.0158816","article-title":"A high malaria prevalence identified by PCR among patients with acute undifferentiated fever in India","volume":"11","author":"Haanshuus","year":"2016","journal-title":"PLoS One"},{"issue":"3","key":"2023020109511027100_bib16","doi-asserted-by":"crossref","first-page":"234","DOI":"10.3855\/jidc.8067","article-title":"Serovar prevalence of Leptospira in semirural India and the development of an IgM-based indirect ELISA","volume":"11","author":"Chandy","year":"2017","journal-title":"J Infect Dev Ctries"},{"issue":"23","key":"2023020109511027100_bib17","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1703058","article-title":"Time to treatment and mortality during mandated emergency care for sepsis","volume":"376","author":"Seymour","year":"2017","journal-title":"N Engl J Med"},{"issue":"3","key":"2023020109511027100_bib18","first-page":"226","article-title":"Spectrum of malaria complications in an intensive care unit","volume":"51","author":"Sahu","year":"2010","journal-title":"Singapore Med J"},{"key":"2023020109511027100_bib19","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijid.2014.02.009","article-title":"Clinical profile and improving mortality trend of scrub typhus in South India","author":"Varghese","year":"2014","journal-title":"Int J Infect Dis"},{"issue":"6","key":"2023020109511027100_bib20","doi-asserted-by":"crossref","first-page":"973","DOI":"10.4269\/ajtmh.2008.78.973","article-title":"Risk factors associated with life-threatening rickettsial infections","volume":"78","author":"Lee","year":"2008","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"2023020109511027100_bib21","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1093\/trstmh\/tru144","article-title":"Predictors of mortality in leptospirosis: an observational study from two hospitals in Kolkata, eastern India","volume":"108","author":"Goswami","year":"2014","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"1","key":"2023020109511027100_bib22","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3329\/jhpn.v30i1.11274","article-title":"Profile of neonatal septicaemia at a district-level sick newborn care unit","volume":"30","author":"Viswanathan","year":"2012","journal-title":"J Health Popul Nutr"},{"issue":"3","key":"2023020109511027100_bib23","doi-asserted-by":"crossref","first-page":"359","DOI":"10.4103\/0255-0857.188350","article-title":"Multidrug resistance mediated by co-carriage of extended-spectrum beta-lactamases, AmpC and New Delhi metallo-beta-lactamase-1 genes among carbapenem-resistant Enterobacteriaceae at five Indian medical centres","volume":"34","author":"Manoharan","year":"2016","journal-title":"Indian J Med Microbiol"},{"issue":"2","key":"2023020109511027100_bib24","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s101560100011","article-title":"Clinical observation and treatment of leptospirosis","volume":"7","author":"Kobayashi","year":"2001","journal-title":"J Infect Chemother"},{"issue":"4","key":"2023020109511027100_bib25","first-page":"16","article-title":"Mortality in Malaria: intensive care (MIMIC)","volume":"66","author":"Trivedi","year":"2018","journal-title":"J Assoc Physicians India"},{"issue":"2","key":"2023020109511027100_bib26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4269\/ajtmh.18-0005","article-title":"Malaria severity in Mangaluru city in the southwestern coastal region of India","volume":"100","author":"Dayanand","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"2023020109511027100_bib27","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00436-019-06540-2","article-title":"Clinical features and haematological parameters among malaria patients in Mangaluru city area in the southwestern coastal region of India","volume":"119","author":"Punnath","year":"2020","journal-title":"Parasitol Res"},{"issue":"5","key":"2023020109511027100_bib28","doi-asserted-by":"crossref","first-page":"981","DOI":"10.4269\/ajtmh.2010.09-0633","article-title":"Clinical features of children hospitalized with malaria\u2013a study from Bikaner, northwest India","volume":"83","author":"Kochar","year":"2010","journal-title":"Am J Trop Med Hyg"},{"key":"2023020109511027100_bib29","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciaa1490","article-title":"The search for effective empiric therapy for acute undifferentiated febrile illness","volume":"73","author":"Varghese","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"10","key":"2023020109511027100_bib30","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/cid\/cix1059","article-title":"Antibiotic utilization and the role of suspected and diagnosed Mosquito-borne illness among adults and children with acute febrile illness in Pune, India","volume":"66","author":"Robinson","year":"2018","journal-title":"Clin Infect Dis"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/advance-article-pdf\/doi\/10.1093\/trstmh\/trac091\/45956384\/trac091.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/2\/91\/49016952\/trac091.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/2\/91\/49016952\/trac091.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T21:17:09Z","timestamp":1675286229000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/117\/2\/91\/6708397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,20]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,9,20]]},"published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trac091","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2]]},"published":{"date-parts":[[2022,9,20]]}}}