Acute Undifferentiated Febrile Illness: a Review of The Studies in Tropical Countries Reported During 2004 to 2015

Pongpisit Thumnu, Sumonmal Uttayamakul, Chariya Sangsajja


Acute febrile illness or acute undifferentiated fever has frequently been reported in
tropical countries. Such a disease is caused by several etiologies, principally from infection.
However, clinical manifestations are generally nonspecific, such as fever, myalgia, malaise,
resulting in difficulty to diagnose the actual cause of disease when relying upon patient history
and physical examination solely. Laboratory investigation has therefore been known to be
important for accurate diagnosis based on data from 14 studies in 5 tropical countries: Thailand,
Laos, Cambodia, Nepal and India for a period of 1-3 years ranging from 25-9,997 cases. These
studies mainly reported the causes of acute febrile illness from rickettsiosis, influenza, dengue
fever, leptospirosis, malaria and enteric fever, whereas the prevalence of these diseases was
different in each area. Nevertheless, the high proportion of undiagnosed cases (more than 50%)
was noted, since many studies focused only on the diagnosis of desired etiologic agents
according to the regional prevalence, as well as were confronted with the limitation of
laboratory equipment and methods. Hence, preparedness of laboratory tools and diagnostic
tests, as well as advances in molecular techniques would play a key role in the effective
diagnosis of patients suffering with acute febrile illness and the obtaining of comprehensive
epidemiological data.

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