Rickettsial Infection in Patients with Acute Febrile Illness at a Tertiary Care Hospital in Bengaluru, India - Serological, Demographic and Clinical Profile

Background and Objectives: Rickettsial infections are under recognised cause of acute febrile illness (AFI) in India. The reason being low index of suspicion, the absence of specific signs/ symptoms and lack of access to confirmatory laboratory tests. These diseases have a high mortality, which can be averted if diagnosed and treated early. Weil- Felix test is the cheapest and widely used test for diagnosis in India. The present study was undertaken with the objective of evaluating the patients with AFI, for rickettsial infection using Weil- Felix test and study their demographic and clinical profile.

Materials and Methods: One hundred Patients with AFI, from June 2015 to December 2016 were evaluated for Rickettsial infection. Detailed history, signs, symptoms were recorded. The serum samples were analysed by Weil-Felix test.

Results: Of the 100 patients, 69 showed a titre of 1:80/>. The disease was more common in children and in the cooler months. Rash, headache, vomiting, pain abdomen and altered sensorium were common symptoms. Most common signs were hepatomegaly/ splenomegaly (51%), rash (40%), CNS involvement (26%). All 69 patients diagnosed with Rickettsial infection, were started on Doxycycline, however 07% of patients succumbed.

Interpretation and Conclusions: Rickettsial infection should be considered in the differential diagnosis of AFI, especially when associated with rash, gastrointestinal symptoms, seasonality etc. Weil Felix test is useful for initial diagnosis and timely treatment of Rickettsial infection. Delay in diagnosis and treatment can lead to increased mortality.