3.5 Lakh patients suffered from fever of unknown origin in 2.5 years in Bengaluru: Study

BENGALURU: A study to ascertain why people visited government and private hospitals in Bengaluru has thrown up a baffling revelation: Around 3.5 lakh people who knocked on the doors of these establishments in the past two-and-a-half years were suffering from fever of unknown origin (FUO).

FUO is a condition where a person’s down with fever (101° F) for over 2-3 weeks and investigations fail to determine its cause. While there were 1,57,881 FUO cases in 2017, the number stood at 1,42,890 in 2018 and 50,062 till May 2019.

According to the ongoing study conducted by the the BBMP’s Public Health Information and Epidemiological Cell (PHIEC), FUO has emerged as the most common reason for hospital visits by Bengalureans under the ‘communicable diseases’ category.

The data was collated from 450 private and government hospitals in the city, including independent labs and diagnostic centres, BBMP’s 85 primary health centres and 30 maternity hospitals. The exercise was taken up under the National Urban Health Mission to enable policymakers to design preventive strategies.

However, hardly any efforts are being made to analyse FUO. Senior doctors working with PHIEC admitted the team hasn’t done much to decipher the FUO data. “We are focusing more on preventing common communicable diseases like typhoid, cholera, dengue and gastroenteritis. If tests for typhoid, dengue, malaria and Hepatitis are negative, hospitals report them as FUO cases,” said BBMP officials.

The data has come as a shocker for the medical community. Those with self-limiting fever hardly come back for follow-up visits and can’t be categorised as FUO patients, said Dr Ambanna Gowda, consultant, internal medicine specialist, Fortis Hospitals.

“On the first day of fever, we don’t advise a battery of tests. If the patient doesn’t return, it can’t be called FUO. If the same person visits another hospital, we wouldn’t know. The data may not be completely accurate,” said Dr Gowda. He recalled the case of 10-year-old boy from Odisha who’s being treated for FUO. Formation of lymph nodes in the chest has now emerged as the cause. FUO is usually a symptom of tuberculosis, malignancy or abscess (puss formation in body tissue), which are diagnosed only after several tests, he pointed out.

However, the BBMP ruled out duplication in data furnished by city hospitals. “A patient’s name and address can’t appear more than once in BBMP’s PHIEC data pool if he or she goes to another hospital with the same complaint. The address is captured using GIS-based reporting and hence, there’s no room for repeat entries,” civic officials explained.

Loopholes in data reporting?

According to Dr SM Prasad, vice president, Indian Academy of Paediatrics, Bengaluru chapter, to consider a case as that of FUO, a patient’s fever must be watched and documented for at least seven days. “If it persists for the duration and tests don’t reveal any cause, only then can it be called FUO. There could be loopholes in reporting of data. FUO could be an uncommon manifestation of a common illness, like fever seen in a child with skin allergy or puss formation. It could also be a common manifestation of an uncommon illness like meningitis (inflammation of brain, spinal cord),” he opined. The expert ruled out the possibility of lakhs of such cases being seen regularly in OPDs.

Doctors also said since the BBMP data doesn’t reflect the duration of FUO, it’s not sufficient to draw any conclusions. “Usually in fever cases that are self-limiting viral infections, we don’t look for the cause. If a child has fever but is stable, no investigation is done if it subsides. There’s a possibility of such cases being reported as those of FUO. The data doesn’t make much sense,” said Dr SG Kasi, a paediatrician.

DISEASE

Cases in 2017

2018

2019 (Till date)

Fever of unknown origin

1,57,881

1,42,890

50,062

Acute respiratory infection/influenza-like illness

1,09,805

1,26,743

44,321

Acute diarrhoeal diseases

95,257

85,391

33,811

Typhoid

98,546

35,820

11,205

Source: BBMP PHIEC