1167. Changing spectrum of aetiology of Acute Fever with Jaundice (Tropical Jaundice) in Adults presenting to Emergency Care--- A study from a Tertiary Care Hospital in North India

Abstract Background The spectrum of infections causing the above acute onset fever with jaundice has changed over the last few years from the conventional hepatotropic viruses to new emerging infections. Methods 250 adult patients ≥ 14 years of age) with acute fever (body temperature > 101ᵒF of 14 days or less in duration) without any localized source of infection on initial clinical evaluation accompanied with jaundice (hyperbilirubinemia ≥ 1.5 mg/dl or elevation of ALT or AST ≥ three times upper limit) were enrolled.All these patients with fever and jaundice were evaluated on the basis of a standard proforma and were evaluated for malaria (peripheral smears/rapid diagnostic kits), scrub typhus( PCR /IgM ELISA), leptospirosis(IgM ELISA), enteric fever by blood cultures and dengue by dengue (NS1 antigen test and IgM ELISA), Hepatitis(IgM ELISA of EBV/HSV, IgM ELISA of HAV/HEV and HBsAg with IgM HBc ELISA if HBsAg positive) Results 62.5 % were males and 37.5 % were females. The mean duration of fever before the presentation was 8.1 ± 2.58 days. 10 patients (4%) died, while 133 patients (96%) improved with treatment. Scrub typhus 57 (22.8%), Hepatitis E 33 (13.2%), malaria 9 (3.6%), dengue fever, enteric fever, hepatitis A and leptospirosis in 26 (10.4%), 6 (2.4%), 6 (2.4%) patients and 4 (1.6%) patient respectively were the prominent aetiology a patient presenting with fever and jaundice. Probable sepsis (Fulfilling SIRS criteria with a negative culture) accounted for 40(16%) patients. In 69(27.6%) cases no diagnosis could be made on serological testing Conjunctival suffusion (OR=23.17), respiratory crepitations (OR=5.17), thrombocytopenia (OR=1.14), normal INR (OR=0.29) were significant predictors of a diagnosis of scrub typhus in patients with fever and jaundice. Severe anaemia (Hb< 8), Hypoalbuminemia, severe thrombocytopenia (Platelet count < 50,000) and a near-normal INR at admission were predictors of a malarial vs a viral aetiology of Tropical jaundice. Co-infection with scrub typhus and malaria was seen in 6 patients (vivax-5 and falciparum-1) and viral hepatitis A & E was observed in 10 patients. Conclusion Neglected Tropical diseases like Scrub typhus infection is emerging as common aetiology of acute onset tropical jaundice in adults presenting to emergency services. Disclosures All Authors: No reported disclosures.