Diagnostic tools used in the evaluation of acute febrile illness in South India: a scoping review

Divyalakshmi Bhaskaran, Sarabjit Singh Chadha, Sanjay Sarin, Rajashree Sen, Sonia Arafah, Sabine Dittrich, Divyalakshmi Bhaskaran, Sarabjit Singh Chadha, Sanjay Sarin, Rajashree Sen, Sonia Arafah, Sabine Dittrich

Abstract

Background: Acute febrile illness (AFI) is characterized by malaise, myalgia and a raised temperature that is a nonspecific manifestation of infectious diseases in the tropics. The lack of appropriate diagnostics for the evaluation of AFI leads to increased morbidity and mortality in resource-limited settings, specifically low-income countries like India. The review aimed to identify the number, type and quality of diagnostics used for AFI evaluation during passive case detection at health care centres in South India.

Methods: A scoping review of peer-reviewed English language original research articles published between 1946-July 2018 from four databases was undertaken to assess the type and number of diagnostics used in AFI evaluation in South India. Results were stratified according to types of pathogen-specific tests used in AFI management.

Results: The review included a total of 40 studies, all conducted in tertiary care centres (80% in private settings). The studies demonstrated the use of 5-22 tests per patient for the evaluation of AFI. Among 25 studies evaluating possible causes of AFI, 96% tested for malaria followed by 80% for dengue, 72% for scrub typhus, 68% for typhoid and 60% for leptospirosis identifying these as commonly suspected causes of AFI. 54% studies diagnosed malaria with smear microscopy while others diagnosed dengue, scrub typhus, typhoid and leptospirosis using antibody or antigen detection assays. 39% studies used the Weil-Felix test (WFT) for scrub typhus diagnosis and 82% studies used the Widal test for diagnosing typhoid.

Conclusions: The review demonstrated the use of five or more pathogen-specific tests in evaluating AFI as well as described the widespread use of suboptimal tests like the WFT and Widal in fever evaluation. It identified the need for the development of better-quality tests for aetiological diagnosis and improved standardised testing guidelines for AFI.

Keywords: Acute febrile illness; Dengue; Diagnostic tests; Diagnostics; Fever; Infectious diseases; Leptospirosis; Malaria; Scrub typhus; Tests; Typhoid.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Adapted from PRISMA study flow diagram [source: Mohr et al. [47]]
Fig. 2
Fig. 2
Distribution of studies in South India [Source: created from mapchart.net (https://mapchart.net/)]
Fig. 3
Fig. 3
(a) Percentage distribution of different types of studies in private and public sector health care settings (b) Distribution of studies evaluating individual causes/pathogens of AFI among different states of South India
Fig. 4
Fig. 4
Types of tests used for diagnosis of specific causes of AFI: (a) Malaria (b) Dengue (c1) Scrub typhus (c2) Types of diagnostic platforms for IgM detection in Scrub Typhus (d) Leptospirosis (e) Typhoid
Fig. 5
Fig. 5
Percentage distribution of studies using different test platforms for IgM, IgG and NS 1 detection
Fig. 6
Fig. 6
Distribution of dengue cases detected by NS1, IgM and IgG tests in 3 studies of different sample sizes (n)
Fig. 7
Fig. 7
Percentage of scrub typhus cases diagnosed at different thresholds of antibody detection on WFT in 3 studies [50, 63, 71]

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