Resolving diagnostic uncertainty in initially poorly localizable fevers: a prospective study

Area of Science:

• Infectious Diseases
• Clinical Medicine
• Diagnostic Tools

Background:

• Fever of unknown origin presents a diagnostic challenge in clinical practice.
• Accurate etiological diagnosis is essential for effective patient management and treatment.
• Understanding fever patterns can aid in differentiating infectious and non-infectious causes.

Purpose of the Study:

• To collect prospective data on fever patients to determine etiology and diagnostic methods.
• To identify factors that rapidly resolve diagnostic uncertainty in fever cases.
• To evaluate the utility of fever charting in diagnosing and managing non-localizable fevers.

Main Methods:

• Prospective observational study of patients with clinically non-localizable fever.
• Data collection included temperature response, clinical and laboratory findings, and treatment response.
• Patients were admitted to Manipal Teaching Hospital, Pokhara, Nepal.

Main Results:

• Enteric fever was the most common diagnosis (56.8%), followed by urinary tract infection (15.9%) and malaria (9%).
• Culture-positive results showed Salmonella typhi in 32% and S. paratyphi in 20% of cases.
• Treatment response varied, with ceftriaxone showing higher efficacy (44%) in enteric fever cases compared to first-line (16%) and second-line (20%) drugs.

Conclusions:

• Fever charting remains an invaluable clinical tool for differentiating Salmonella infections from other fevers in adult patients in Nepal.
• Judicious use of fever charting can effectively diagnose and treat initially non-localizable fevers.
• Antibiotic initiation should be delayed until fever patterns suggest enteric fever, and patience is advised before switching from first-line to second-line drugs, with quinolones as a potential first-line option.