Study of acute febrile illness with low platelet count

 

 

Abstract              Aim: To Evaluate different cause, Clinical profile and complication of Acute febrile illness with low platelet count. Material and Method: Total 200 Patient age>12 year admitted with acute onset of fever (AM temperature>37.2 C and PM temperature >37.7C) and found to have thrombocytopenia (platelet count<150000) are included in the study. Result: Out of 200 patients 121 were males and 79 were females. Duration of hospitalization was between 3 to 7 days. Out of 200 patients, most of patients were of malaria (134 patients), followed by dengue fever (40 patients), enteric fever (16 patients), unexplained viral fever (10 patients). So malaria is commonest cause of fever with thrombocytopenia in my study. In malaria, P. vivax (118 patients) was commonest followed by falciparum (14 patients) and mixed malaria (2 patients). Conclusion: infection is most common cause of fever with thrombocytopenia. Clinical manifestation of thrombocytopenia was present in only 3 cases and only 3 patient required platelet transfusion while most of patients (197 patients) required only disease specific treatment and platelet transfusion was not given in those patients. So platelet transfusion is rarely needed in patients of fever with thrombocytopenia

Key Word: Dengue Fever, Enteric fever, Malaria, Petechiae, Thrombocytopenia.

 

INTRODUCTION

Modern research of fever had its beginning in 1948 when Dr. Paul beeson determined that fever is caused by product of inflammatory cell. IL-1 has been shown to have major role in thermoregulation of fever. Normal body temperature displays a diurnal variation with lower value in early morning and higher in the afternoon. Normal ranges are between 35.8 C(96.5F) and 37.2C(99F). Fever is defined as elevation of body temperature above the normal circadian range as result of the change in the thermoregulatory centre located in the anterior hypothalamus. It is important to be aware of common febrile condition leading to thrombocytopenia and have systemic approach to evaluation and management of these patients. As acute febrile illness with low platelet count is common and physician face large number of patient in his routine practice. As platelet play important role in homeostasis, thrombocytopenia is commonly associated with the risk of bleeding. Mild to moderate thrombocytopenia mostly doesn’t cause bleeding. Although skin and mucous membrane bleeding is the most common in thrombocytopenia, major bleeding (ICH) may occur with severe thrombocytopenia. Thrombocytopenia is defined as subnormal number of platelet (<1,50,000/µl) in circulatory blood. Normal platelet count is 1,50,000 to 4,50,000/µL. There are so many cause of thrombocytopenia but when patient’s presentation is fever with thrombocytopenia, possibilities of infectious etiologies are high in our set up. In our geographic distribution infectious causes like malaria (both P.vivax and P. falciparum),enteric fever, dengue fever are commonly associated with thrombocytopenia with mild to moderate degree. Most of these patients require only disease specific treatment, only those patients who are at risk of bleeding or already having bleeding manifestation due to thrombocytopenia require platelet transfusion.

 

OBJECTIVE

• To evaluate different causes of acute febrile illness with thrombocytopenia which are common in our geographic distribution
• To determine which diseases are common in our set up
• To evaluate clinical profile of fever with thrombocytopenia
• To assess clinical complications associated with fever with thrombocytopenia.

 

MATERIAL AND METHODS

A study was done on the patients, who were admitted to General hospital during period of January 2018 to December 2018. Study was done on 200 patients who were presented with acute onset of fever and having low platelet count.

Criteria for selection of the patients

Inclusion criteria:

• The patient of both sexes and > 12 year
• Patient admitted with acute onset of fever (AM temperature>37.2 C and PM temperature >37.7C) and found to have thrombocytopenia (platelet count<150000) are included in the study.

Exclusion criteria:

• Patients <12 yrs are excluded
• Patients having fever but no thrombocytopenia are excluded
• Patients having thrombocytopenia but no fever are exclude
• Inherited cause, autoimmune, drug induced cause of thrombocytopenia, thrombocytopenic purpura, hematological cause like leukemia and myelodysplastic syndrome, HELLP syndrome, DIC of non infective etiology are excluded
• Chronic cause like HIV and cirrhosis of liver are excluded.

Detailed clinical history was taken in each patient. Detailed physical examination including systemic examination was carried out in all patients. Routine investigation along with CBC was carried out in all patients. The special investigation like S. widal, serological test, G6PD was carried out as and when required. All patients were treated with disease specific treatment and platelet transfusion was given as per indication. Platelet count was repeated on discharge in indicated patients.

 

RESULT AND DISCUSSION

Total number of 200 patients admitted over my study period in our hospital were studied. No particular age group was considered, but study was conducted in age above 12 year. Out of 200 patients 121 were males and 79 were females.Duration of hospitalization was between 3 to 7 days. Out of 200 patients, most of patients were of malaria (134 patients), followed by dengue fever (40 patients), enteric fever (16 patients), unexplained viral fever (10 patients). So malaria is commonest cause of fever with thrombocytopenia in my study. In malaria, P. vivax (118 patients) was commonest followed by falciparum (14 patients) and mixed malaria (2 patients). Most common range of platelet at time of admission was 81-100 thousands in 54 cases, followed by 61-80 thousands in 42 cases, 101 -120 thousand in 31 cases, 41-60 thousands in 26 cases, 32-40 thousands in 20 cases, 1-20 thousands in 15 cases, 121-140 thousands in 12 cases. Clinical manifestation of thrombocytopenia was there in only 3 patients and only 3 patients required PRC while all other patients required only disease specific treatment. Out of 3 patients, 1 patient had petichae and 2 patients had hematuria. Out of 200 patients, 198 had good recovery and only 2 of them expired. In 198 cases, who had good recovery, 118 cases were subjected for repeat platelet count at discharge or at follow up and platelet count were near normal. In 2 mortality, 1 was due to P. vivax, and 1 was due to P. falciparum.

SUMMARY AND CONCLUSION

• Male to Female ratio being 6:4. These factors any way were not considered in our study.
• The duration of hospitalization was 3-7 days.
• Among the diagnosed cases, malaria formed the largest group with 67%, Dengue 20%, enteric fever 8% and unexplained viral fever 5%. So infection is most common cause of fever with thrombocytopenia.
• Among malaria, P.vivax formed the largest group with 88.06% followed by P.falciparum and mixed malaria with 10.45%, 1.49% respectively. So P.vivax is most common cause of fever with thrombocytopenia in my study.
• Common range of platelet at the time of admission was 81000-100000 in 54 cases, followed by 61-80 thousands in 42cases, 101-120 thousands in 31 case, 41-60 thousands in 26 cases, 21-40 thousands in 20 cases, 1-20 thousands in 15 cases, 121-140 thousands in 12 cases.
• Clinical manifestation of thrombocytopenia was present in only 3 cases and only 3 patient required platelet transfusion while most of patients (197 patients) required only disease specific treatment and platelet transfusion was not given in those patients. So platelet transfusion is rarely needed in patients of fever with thrombocytopenia.
• In general 198 patients had good recovery and only 2 had mortality. So mortality is very rare in fever with thrombocytopenia.
• In 2 mortality cases, one was due to P.falciparum and one was due to P.vivax. DHF and DSS cases in my study being in small number, Exact figures of mortality can not be calculated.
• Mortality of P.falciparum with low platelet count is 7.14% (1 out of 14 case) and P.vivax with low platelet count is 0.84% (1 out of 118 cases).
• During discharge or at follow up Most of patients were having near normal platelet count.

 

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