Challenges in tropical fever management

Amit Kalwar, MD, is an associate professor at the Department of Medicine of the Silchar Medical College, India.

What are the greatest challenges in the management of tropical fever?

To answer that question, first you have to know what the diseases are that come under tropical fever. In the Indian subcontinent, we especially encounter malaria, dengue, leptospirosis, scrub typhus, and typhoid fever. These are the common tropical fevers we encounter.

The greatest challenge in the management of tropical fever or the diagnosis of tropical fever is that the symptoms of these diseases overlap with each other and most of the patients that present to us have some atypical symptoms. So it’s very hard to diagnose from these symptoms. And in a tropical country like ours, where the patients cannot afford all the investigations, it’s very difficult for a clinician to diagnose on the basis of investigations, so we approach them syndromically: we have these common features and we manage them accordingly as per their symptomatology.

The second most important is that… to diagnose tropical fever, we need to culture the organisms. But in a resource-limited country like us, the culture of the organism is very difficult. It is costly and it is also a time-consuming procedure.

Coming to the serological test, when you go for the serological test, the test shows some cross-reactivity, especially in cases of dengue, where the sensitivity and specificity of the dengue tests are very low, so it’s hardly possible to diagnose it by doing a serological investigation.