The Outcome of Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal Vivek Kattel 1* , Yamuna Agrawal 2 , Naveen Kumar Pandey 3 , Semanta Dahal 4 , Basudha Khanal 5 1 Tropical and Infectious Disease Unit, BPKIHS, Dharan, Nepal; 2 Department of Pathology, BPKIHS, Dharan, Nepal; 3 Department of Cardiology, BPKIHS, Dharan, Nepal; 4 Department of Anesthesia, Institute of Medicine, Kathmandu, Nepal; 5 Department of Microbiology, BPKIHS, Dharan, Nepal ABSTRACT Introduction: Acute Febrile Illness (AFI) is a common clinical syndrome presenting at tropical health centers. The challenges in resource-limited set up are an undifferentiated clinical manifestation with wide differentials and inadequate laboratory diagnostic support. With this background, we conducted a study to look at the outcome of AFI spectrum presented at BP Koirala Institute of Health Sciences (BPKIHS), a referral medical school hospital in eastern Nepal. Objective: To determine the etiological diagnosis and hospital-based outcome of AFI. Methods: It was a prospective observational study of the AFI inpatient cases in the Department of Internal Medicine from 1 st January 2013 to 31 st December 2013. Considering a 15% prevalence of acute febrile in patients with a 95% confidence interval and 95% power of study a sample size of 196 was calculated. Assuming 25% as a sampling error 245 patients were enrolled. The patient was diagnosed and treated as per the hospital protocol developed by Tropical and Infectious Disease Unit. Case record form was used to record and tabulated in an excel sheet. Descriptive and analytic statistics were used. Results: The incidence of AFI was 12% (557) among the 4669 inpatient cases. Among 245 enrolled cases, 61% presented as localized fever. The most common clinical diagnosis was pneumonia (29%), urinary tract infection (18%), meningitis (11%) and tropical disease (14%) that includes malaria, dengue, rickettsia, and leptospirosis. The etiological diagnosis was established among 26% (64). Among AFI cases sepsis, acute renal injury and septic shock was present in 18%, 11%, and 6% respectively. The putative diagnosis could not be made in 18% (44) of the cases and they were treated empirically with dual antibiotics (injectable 3 rd generation cephalosporin with macrolides or fluoroquinolones or aminoglycosides). Favorable outcomes in term of clinical cure were seen in 76% (186) of the cases. Conclusion: Establishment of etiological diagnosis is logistically not feasible in developing the world. Contextual guidelines for undifferentiated fever may be a possible option for improving the outcome of undifferentiated fever in Nepal. Keywords: Acute febrile illness; Nepal; Outcomes; Undifferentiated fever INTRODUCTION Of all the manifestations of infections, fever is the most common and most constant presentation by the human host. Undifferentiated fever is one of the challenges for diagnostic workup to doctors. Sentinel hospital-based studies, performed over a defined period of time, have proven useful to gather J o u r n a l o f T r o p i c a l D i s e a s e s & P u b l i c H e a l t h ISSN: 2329-891X Journal of Tropical Diseases Research Article Corresponding author: Vivek Kattel, Tropical and Infectious Disease Unit, BPKIHS, Dharan, Nepal, E-mail: vivekkattel@bpkihs.edu Received date: July 11, 2019; Accepted date: July 27, 2019; Published date: August 06, 2019 Citation: Kattel V, Agrawal Y, Pandey NK, Dahal S, Khanal B (2019) Outcome OF Inpatient Acute Febrile Illness in A Referral Tropical Health Center in Nepal. J Trop Dis 7:328. Copyright: © 2019 Kattel V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. J Trop Dis, Vol.7 Iss.5 No:1000328 1