Clinical profile and role of serology in pediatric acute febrile illness: Experience from a tertiary care hospital in South India

Problem addressed: Acute febrile illness (AFI) is a diagnostic challenge for the laboratory and clinicians. Serological diagnosis plays a major role in diagnosis of AFI. The data regarding pediatric AFI is limited. The present study was conducted to evaluate the clinical spectrum of acute febrile illness (AFI) in pediatric patients, along with the role of various diagnostic modalities. Method: It was a retrospective observational study. The clinical and laboratory data for the pediatric AFI cases were collected and analyzed for percentage of etiologies and role of serological assays. Results: Out of 214 cases studied, 57.9% were males, and 42.1% were females. Majority children were <10 years. Fever alone was seen in 36% of cases. The other common presentations were upper respiratory tract illness and gastroenteritis. Mean duration of fever was six days. Leukocytosis was seen in 36.4% of cases. Increased AST and ALT was noted in 48.7% and 39.5% of cases. Serological tests gave a positive result in 14.9% of cases. Most common disease diagnosed was Dengue (10/94 samples tested). Percentage positivity for different immunoassays was 31.8% for Hepatitis A- ELISA, 9% for Hepatitis E ELISA, 2.9% for Scrub typhus ELISA, 5% for Leptospirosis ELISA, 10.6% for Dengue ELISA. Febrile agglutination tests for Brucellosis, Typhoid and Rickettsial diseases showed positivity of 3.9%, 1.7% and 7.1% respectively. Clinical recovery was documented in 96.5% of cases with no significant association with serological positivity. Conclusion: Serology is important in diagnostic work-up of AFI in children. However, the approach towards diagnosis needs to be syndromic with other modalities depending on the clinical suspicion.