IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 1 Ser.7 (January. 2020), PP 48-54 www.iosrjournals.org DOI: 10.9790/0853-1901074854 www.iosrjournals.org 48 | Page Clinical profile and etiological spectrum of patients present with Fever and altered sensorium Dr. Tarek Mahmood, Dr.Sanjoy Kumar Saha, Dr. Wahida Hasin, Dr. Akhi Roy Bipasha, Dr. Tamanna Tabassum Associate Professor Department of Medicine BashundaraAd-Din Medical College Hospital Dhaka, Bangladesh Professor of Medicine BashundaraAd-Din Medical College Hospital Associate professor BashundaraAd-Din Medical College Hospital Honorary Medical Officer, Dhaka Medical College Hospital Medical Officer, Comfort Hospital Corresponding Author: Dr. Tarek Mahmood Abstract: Background: Fever with altered mentation is a common problem in clinical practice and often poses a diagnostic challenge to the clinician. On that ground, the study was planned to assess theclinico-aetiological spectrum of patients present with fever and altered sensorium. Methods: A total 50 patients admitted to the department of Medicine, Mymensingh Medical College Hospital through the emergency department with complaints of fever along with altered sensorium were included in this study. The socio-demographic variables, clinical features and disease descriptions were recorded in detail. To evaluate aetiological spectrum detailed biochemical, microbiological and radiological investigations were done. Separate case record form was used during interview of the patients. Consenting was collected from the legal guardian of the patients. The study protocol was conformed with Declaration of Helsinki and was ethically permitted from the ERC of MMC.The results were analysed using SPSS 20 statistical software. Results: Mean age the patients were27.14 ±9.36 SD (years). Altered sensorium was more commonly found among the male (66%). Among 30 patients,32% (n=16) of the patients had pyogenic meningitis (meningo- encephalitis), 24% (n=12) had encephalitis, 20% (n=10) had cerebral malaria, 14% (n=7) were suffering from coma vigil and 10% (n=5) had tubercular meningitis. Fever pattern was persistent 76% (n=38) and was irregular in 24% (n=12) patients. Altered sensorium was sudden in 64% (n=32) patients and was gradual in 36% (n=18) patients. Conclusion: Pyogenic meningo-encephalitis and encephalitis was the two most common cause found in our setting present with variables clinical features. Keywords: Fever, Altered sensorium, Non traumatic comma, consciousness. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 01-01-2020 Date of Acceptance: 16-01-2020 --------------------------------------------------------------------------------------------------------------------------------------- I. Background Fever with altered sensorium is a problem commonly encountered by the physician in the emergency.Clinicians face challenges in the emergency to identify the clinical syndrome, establishing the etiology and its prompt treatment. Around 5% of the patients with an altered mental state present to the emergency department and 1% of the admissions is due to coma 1 . Fever, headache, altered mental status, and behavior changes encompass a broad differential diagnosis. Infections of CNS (may be a virus, bacteria or parasite) are the most common cause of nontraumatic coma. This includes meningitis, encephalitis, cerebral malaria, brain abscess, coma vigil or in combinations 1 . In some cases, sepsis may lead to altered mental state secondary to systemic complications like hypoglycemia, hypovolemia, hyperpyrexia, hepatic or renal failure. Focal neurological signs and seizures on clinical grounds are not enough, other investigations like CSF analysis and imaging are required to find out the etiology 2 . In Bhalla et al. revealed that patients presenting with fever and alteration in mentation common etiologies are meningitis, meningoencephalitis, sepsis-associated encephalopathy followed by cerebral malaria, leptospirosis, and brain abscess 3 . Similarly in Ruhi Khan reported that acute pyogenic meningitis followed by cerebral malaria, sepsis associated encephalopathy, acute meningoencephalitis, tubercular meningitis, enteric encephalopathy and fungal meningitis are the common cause of fever with alter sensorium 4 . Tubercular meningitis is more common among rural area and age group 20 to 39 years. Cerebrospinal fluid (CSF) findings include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose 5,6 . In case of pyogenic meningitis fever and an altered mental status were the most frequent findings followed by back rigidity, headache and convulsion. CSF parameters show WBC <500 cells/μL, high protein levels, glucose