An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia

for INA-RESPOND

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.

Original languageEnglish
Pages (from-to)e0007927
JournalPLoS Neglected Tropical Diseases
Volume14
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020

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Indonesia
Rickettsia
Epidemiology
Cohort Studies
Fever
Prospective Studies
Standard of Care
Seoul virus
Hospitalization
Chikungunya virus
Dengue Virus
Mortality
Orthomyxoviridae
Routine Diagnostic Tests
Teaching Hospitals
Salmonella
Observational Studies
Referral and Consultation
Central Nervous System
Pediatrics

Cite this

@article{268c82c1cad54d5fb10329c691e16028,
title = "An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia",
abstract = "BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7{\%}), gastrointestinal (497, 33.0{\%}), respiratory (114, 7.7{\%}), constitutional (62, 4.2{\%}), skin and soft-tissue (24, 1.6{\%}), central nervous system (17, 1.1{\%}), or genitourinary (4, 0.3{\%}) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5{\%}) participants, of which 351/1,003 (35.0{\%}) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6{\%}), Salmonella spp. (103, 10.3{\%}), and Rickettsia spp. (103, 10.3{\%}). The overall mortality was 89 (5.9{\%}). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.",
author = "{for INA-RESPOND} and Gasem, {Muhammad Hussein} and Herman Kosasih and Emiliana Tjitra and Bachti Alisjahbana and Muhammad Karyana and Dewi Lokida and Aaron Neal and Liang, {C. Jason} and Aman, {Abu Tholib} and Mansyur Arif and Pratiwi Sudarmono and Suharto and Merati, {Tuti Parwati} and Vivi Lisdawati and Siswanto and Sophia Siddiqui and Lane, {H. Clifford}",
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language = "English",
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An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia. / for INA-RESPOND.

In: PLoS Neglected Tropical Diseases, Vol. 14, No. 1, 01.01.2020, p. e0007927.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia

AU - for INA-RESPOND

AU - Gasem, Muhammad Hussein

AU - Kosasih, Herman

AU - Tjitra, Emiliana

AU - Alisjahbana, Bachti

AU - Karyana, Muhammad

AU - Lokida, Dewi

AU - Neal, Aaron

AU - Liang, C. Jason

AU - Aman, Abu Tholib

AU - Arif, Mansyur

AU - Sudarmono, Pratiwi

AU - Suharto,

AU - Merati, Tuti Parwati

AU - Lisdawati, Vivi

AU - Siswanto,

AU - Siddiqui, Sophia

AU - Lane, H. Clifford

PY - 2020/1/1

Y1 - 2020/1/1

N2 - BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.

AB - BACKGROUND: The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. METHODOLOGY/PRINCIPAL FINDINGS: This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%). CONCLUSIONS/SIGNIFICANCE: Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.

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DO - 10.1371/journal.pntd.0007927

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