Chapter-03 Fever Beyond Malaria in Indian Hospital Settings

BOOK TITLE: Concise Handbook of Infectious Diseases

1. Sahadulla MI
Publishing Year
Author Affiliations
1. Kerala Institute of Medical Sciences (KIMS) Healthcare Group, Thiruvananthapuram, Kerala, India, Kerala Institute of Medical Sciences (KIMS), Health Care Group, Thiruvananthapuram, Kerala, India
Chapter keywords
Enteric fever, Salmonella antigen, non-typhoidal Salmonella, malaria, scrub typhus, leptospirosis, brucellosis


This chapter discusses about the Indian hospital settings for fever beyond malaria. Infection with enteric fever serovars implies ingestion of a food or water vehicle contaminated by a chronic carrier or person with acute infection. Although fluoroquinolones are frequently used for empiric treatment of typhoid fever, a third generation is becoming the drug of choice because of increasing fluoroquinolone resistance. Salmonella enteritidis is the most common non-typhoidal subspecies because it is responsible for 65% of these infections, followed by S. typhimurium at 12%. Scrub typhus has emerged as an important cause of febrile illness. Diagnosis of scrub typhus should be largely based on a high index of suspicion and careful clinical, laboratory and epidemiological evaluation. Doxycycline is the most commonly used, while chloromycetin is an alternative. Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira, a common zoonotic infection worldwide, and spread through the urine of infected wild and domestic animals including dogs, cattle, pigs, horses and rodents. Human brucellosis in India is a deceptive infectious disease. This zoonotic disease is present in all livestock systems; this has raised concerns about transmission of this infection to the human population. Because monotherapy is associated with a high rate of relapse, combination therapy is recommended as standard treatment. Most combination regimens include oral doxycycline or trimethoprimsulfamethoxazole plus rifampin.

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