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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fever is associated with an increase in the hypothalamic set-point&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Contemporary understanding views fever as a cytokine-mediated response involving a rise in temperature alongside the production of acute phase reactants and the activation of various physiological&#44; endocrinological&#44; and immunological systems&#44; moving beyond the simplistic notion of merely an increase in core body temperature&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In developing countries&#44; fever is a prevalent ailment&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Accurately identifying the primary causes of acute fever is paramount&#44; especially in countries like India&#44; to reduce morbidity and mortality&#46; The etiology of short-term fevers varies with the population&#44; geography&#44; and seasonal changes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To clinicians&#44; diagnosing &#34;fever&#34; can be as complex and multifaceted as diagnosing &#34;abdominal pain&#34; is to surgeons&#44; often described metaphorically as opening a &#34;Pandora&#39;s box&#46;&#34;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A significant challenge in fever diagnosis is the inability to localize the cause&#44; primarily due to the shortage of diagnostic tools&#46; &#34;Acute undifferentiated fever&#34; refers to fevers that persist beyond two weeks without specific localized or organ-specific clinical symptoms or signs&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This term lacks a universally accepted definition&#44; unlike fever of unknown origin&#44; which is defined as a persistent fever of &#8805;38&#46;3&#8239;&#176;C on multiple occasions over more than three weeks without any immunocompromising conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In tropical regions&#44; infectious diseases are major contributors to morbidity and mortality&#46; The scarcity of diagnostic resources in low-resource settings often leads to empirical treatment of fever&#46; Local infection prevalence is critical for directing clinical assessments and resource allocation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Active fever surveillance is essential as clinical diagnoses alone are insufficient for identifying all febrile cases&#46; Determining the common causes of acute febrile illnesses and confirming them through laboratory tests are vital steps toward alleviating the disease burden&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The paucity of data on the epidemiology of acute febrile illnesses&#44; especially from South Asia&#44; hampers evidence-based clinical decision-making&#46; This scarcity of data is particularly notable in eastern India&#44; where reports on short-term fever are limited&#44; and robust surveillance data are lacking&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our study seeks to identify the etiology of short-duration fever and understand the pattern of fever and associated symptoms in patients admitted with short-duration fever to a government hospital in rural West Bengal &#40;India&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was conducted at Burdwan Medical College and Hospital &#40;BMCH&#41;&#44; a government hospital for tertiary care located in Burdwan&#44; West Bengal&#44; India&#46; BMCH has approximately 1500 beds&#44; making it one of the primary healthcare providers in the region&#46; The hospital serves a diverse population primarily from the Burdwan district and surrounding areas&#44; including both urban and rural communities&#44; with a mix of socioeconomic statuses&#46; Burdwan is situated at an elevation of approximately 30 meters &#40;98 feet&#41; above sea level&#46; The climate of Burdwan is tropical&#44; with hot summers&#44; a monsoon season&#44; and mild winters&#46; The region experiences significant rainfall during the monsoon season&#44; which influences the prevalence of vector-borne diseases such as dengue&#44; malaria&#44; scrub typhus&#44; and Japanese encephalitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Following institutional ethics committee approval&#44; we conducted a cross-sectional investigation&#46; From May 2021 to April 2022&#44; 150 consecutive adult patients with a short-duration fever &#40;defined as less than two weeks&#41; over 18 years of age&#44; regardless of sex and admitted to a male and a female medicine ward&#44; were enrolled according to predefined inclusion and exclusion criteria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inclusion Criteria</span>&#58; Individuals admitted with a body temperature exceeding 37&#46;2&#176;C &#40;99&#176;F&#41;&#44; who had experienced fever for less than two weeks and provided informed consent&#44; were included&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion Criteria</span>&#58; Excluded were postpartum and peri-operative patients&#44; individuals with previously diagnosed febrile illnesses&#44; those suffering from collagen vascular diseases&#44; endocrine disorders&#44; malignancies&#44; or immunodeficiency states&#44; and patients with fevers related to skin infections such as boils or carbuncles&#44; or healthcare-associated fevers&#44; including those induced by catheters&#44; ventilators&#44; drugs&#44; or devices&#46; Patients who declined participation were also excluded&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Participants underwent comprehensive evaluations&#44; including a detailed demographic profile and an assessment of fever characteristics &#40;type&#44; grade&#44; duration&#41;&#44; travel history&#44; presenting symptoms &#40;localizing vs&#46; non-localizing&#41;&#44; and any comorbidities&#46; A thorough physical examination was conducted to identify signs such as pallor&#44; icterus&#44; lymphadenopathy&#44; skin rashes&#47;eschars&#44; and other signs indicative of specific organ involvement&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A standard set of investigations was carried out for all patients&#44; encompassing complete blood counts&#44; liver and renal function tests&#44; electrolyte levels&#44; and a fever profile&#46; Additional diagnostic tests&#44; including hepatitis panels&#44; urine cultures&#44; neuroimaging&#44; and cerebrospinal fluid analysis&#44; were performed based on clinical indications and initial test results&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Data gathered from investigation reports were systematically documented and subjected to statistical analysis&#44; focusing on demographic characteristics&#44; clinical presentations&#44; and the diverse etiologies of fever identified in this cohort&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analyses</span><p id="par0065" class="elsevierStylePara elsevierViewall">The data collected from the study were systematically organized&#44; tabulated&#44; and prepared for statistical evaluation employing conventional statistical methodologies&#46; For analysis&#44; data were input into a Microsoft Excel spreadsheet and subsequently analyzed using SPSS &#40;version 27&#46;0&#41; alongside Graph Pad Prism version 5&#46; Numerical variables were summarized using mean and standard deviation&#44; while categorical variables were presented as counts and percentages&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical considerations</span><p id="par0070" class="elsevierStylePara elsevierViewall">Ethical approval was obtained from our institution&#39;s Ethics Committee&#46; Informed written consent was obtained from all participants&#44; ensuring their voluntary participation&#46; Throughout the research process&#44; stringent measures were taken to uphold privacy and confidentiality&#44; guaranteeing that the participants&#39; identities remained confidential&#46; Patient care and treatment protocols were strictly aligned with the established Indian guidelines and tailored according to the findings from the investigations conducted during the study&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">In our study&#44; the predominant age group among the 150 patients was 21&#8211;40 years&#46; The average age was calculated at 42&#46;6 years&#44; with a standard deviation of 14&#46;6 years&#46; The demographic breakdown showed that 34&#46;0&#37; were female and 66&#46;0&#37; were male&#44; leading to a male-to-female ratio of 1&#46;9&#46; Regarding religious affiliations&#44; 64&#46;7&#37; &#40;97 patients&#41; identified as Hindu&#44; 33&#46;3&#37; &#40;50 patients&#41; as Muslim&#44; and 2&#46;0&#37; &#40;three patients&#41; belonged to other religions&#46; Occupational analysis revealed that 31&#46;3&#37; &#40;47 patients&#41; were engaged in farming&#44; 25&#46;3&#37; &#40;38 patients&#41; managed household duties&#44; 15&#46;3&#37; &#40;23 patients&#41; were laborers&#44; 2&#46;7&#37; &#40;4 patients&#41; were retired&#44; 12&#46;7&#37; &#40;19 patients&#41; were employed in various services&#44; and an equal percentage were students&#46; The residential background showed that 60&#37; hailed from rural settings&#44; while 39&#46;3&#37; came from urban locales&#46; Travel history was noted in 19&#46;3&#37; of the patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Fever patterns indicated that 42&#37; of patients experienced fevers lasting up to seven days&#44; and 58&#37; reported fevers spanning 8&#8211;14 days&#46; The average fever duration was 7&#46;8 days&#44; with a standard deviation of 1&#46;2 days&#46; Fever types varied&#44; with 47&#46;3&#37; experiencing continuous fever&#44; 44&#46;7&#37; intermittent fever&#44; and 8&#37; remittent fever&#46; Fever severity classifications included high grade in 22&#46;7&#37; of patients&#44; low grade in 22&#46;6&#37;&#44; and moderate in 54&#46;7&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Symptom analysis showed that 80&#46;0&#37; of the patients reported no specific localizing symptoms&#46; Among those with symptoms&#44; 14&#46;7&#37; exhibited respiratory issues&#44; and equal percentages &#40;13&#46;3&#37;&#41; presented with gastrointestinal and urinary tract symptoms&#44; followed by central nervous system symptoms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Clinical findings revealed pallor in 14&#46;0&#37; of patients&#44; icterus in 4&#46;0&#37;&#44; lymphadenopathy in 12&#46;7&#37;&#44; and skin rash&#47;eschar in 11&#46;3&#37;&#46; Concerning localizing signs&#44; 20&#46;0&#37; had gastrointestinal signs&#44; making them the most frequent&#44; followed by 16&#46;0&#37; with respiratory symptoms&#44; 12&#46;7&#37; with urinary tract signs&#44; and 8&#37; showing central nervous system-meningeal signs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Microbiological evaluations primarily detected scrub typhus&#44; followed by dengue and typhoid fever&#46; Specifically&#44; 25&#46;3&#37; of the patients showed positivity for scrub typhus immunoglobulin M &#40;IgM&#41; antibodies&#46; Dengue serology &#40;NS1&#47;IgM&#41; was positive in 15&#46;3&#37; of cases&#44; while 13&#46;3&#37; tested positive for Typhidot IgM or the Widal test&#46; <span class="elsevierStyleItalic">Plasmodium vivax</span> was identified in 8&#46;7&#37; &#40;13 patients&#41;&#44; and <span class="elsevierStyleItalic">Plasmodium falciparum</span> in 3&#46;3&#37; &#40;five patients&#41;&#46; Comprehensive screening for triple serology &#40;<span class="elsevierStyleItalic">hepatitis B</span> surface antigen&#44; <span class="elsevierStyleItalic">hepatitis C</span> virus antibodies&#44; and <span class="elsevierStyleItalic">human immunodeficiency virus</span> 1 and 2&#41; yielded negative results&#46; A small fraction&#44; 1&#46;3&#37;&#44; had sputum samples positive for acid-fast bacilli&#46; SARS-CoV-2 was detected via reverse transcription polymerase chain reaction &#40;RT-PCR&#41; in 9&#46;3&#37; &#40;14 patients&#41;&#46; Of the blood cultures conducted&#44; 3&#46;4&#37; were positive&#44; with one case &#40;0&#46;7&#37;&#41; showing <span class="elsevierStyleItalic">Staphylococcus aureus</span> growth and four cases &#40;2&#46;7&#37;&#41; identifying <span class="elsevierStyleItalic">Salmonella typhi</span>&#46; Chest X-rays indicated infective changes in 12&#46;7&#37; of the patient group&#46; Ultrasonography of the entire abdomen revealed organomegaly in 12&#37;&#44; cystitis in 3&#46;3&#37;&#44; and pyelonephritis in two cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Urinary tract infections were found in 10&#37; &#40;15 patients&#41;&#44; with <span class="elsevierStyleItalic">Escherichia coli</span> identified in 6&#46;7&#37; &#40;10 patients&#41;&#46; <span class="elsevierStyleItalic">Klebsiella</span> was isolated in 1&#46;3&#37; &#40;two patients&#41;&#44; and 2&#37; &#40;three patients&#41; had culture-negative urinary tract infections&#46; Acute meningitis&#47;meningoencephalitis cases totaled 6&#46;7&#37; &#40;ten patients&#41;&#44; with a viral cause in 4&#46;7&#37; &#40;seven patients&#41; and scrub typhus in 2&#37; &#40;three patients&#41;&#46; Acute viral hepatitis was confirmed in 4&#46;7&#37; &#40;seven patients&#41;&#44; including 2&#46;7&#37; &#40;four patients&#41; with <span class="elsevierStyleItalic">hepatitis A</span> and 1&#46;3&#37; &#40;two patients&#41; with <span class="elsevierStyleItalic">hepatitis E</span>&#46; Nonspecific or undiagnosed fevers were observed in 2&#37; &#40;three patients&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study involving 150 subjects&#44; a significant proportion&#44; 32 &#40;21&#46;3&#37;&#41;&#44; were included within the 21&#8211;30 and 31&#8211;40 age groups&#46; The average age of the cohort was 42&#46;6 years&#44; with a standard deviation of 14&#46;6 years&#46; Comparatively&#44; in the research conducted by Pal et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> most participants were identified within the 31&#8211;40-year age range&#44; whereas Satpathy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> found a predominant age group of 21&#8211;30 years&#46; The sex distribution revealed a predominance of male patients &#91;99 &#40;66&#46;0&#37;&#41;&#93; over females &#91;51 &#40;34&#46;0&#37;&#41;&#93;&#44; with a male-to-female ratio of 1&#46;9&#58;1&#46; This sex disparity aligns with the observations made by Goyal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and might be attributed to behavioral differences between genders&#44; such as the extent of body coverage and preferences for indoor activities&#44; as suggested by Guha-Sapir and Schimmer&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">A notable majority of the cases &#91;91 &#40;60&#46;7&#37;&#41;&#93; originated from rural areas&#44; and 19&#46;3&#37; of the individuals had a travel history&#44; highlighting the increased risk of contracting vector-borne diseases due to movement from or to endemic zones&#46; This pattern of disease distribution and risk factors adds to our understanding of the epidemiology of febrile illnesses and underscores the importance of targeted public health strategies to mitigate the impact of such conditions&#44; especially in vulnerable populations&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our study&#44; a larger proportion of patients&#44; 87 &#40;58&#37;&#41;&#44; reported experiencing fever for 8&#8211;14 days&#44; exceeding those 63 &#40;42&#37;&#41; who had fever for 7 days or less&#46; The average fever duration across the cohort was approximately 7&#46;8 days&#44; with a standard deviation of 1&#46;2 days&#44; indicating a tendency towards longer fever durations&#46; This observation contrasts with the findings from Satpathy et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> where most patients presented with a fever lasting less than 7 days&#46; Regarding the pattern of fever&#44; the most prevalent type identified in our cohort was continuous fever &#91;71 &#40;47&#46;3&#37;&#41;&#93;&#44; succeeded by intermittent fever &#91;67 &#40;44&#46;7&#37;&#41;&#93; and remittent fever &#91;12 &#40;8&#37;&#41;&#93;&#46; The distribution of fever severity predominantly featured moderate-grade fever in 82 &#40;54&#46;7&#37;&#41; patients&#44; while high-grade fever was observed in 34 &#40;22&#46;7&#37;&#41; of cases&#46; This pattern aligns with the outcomes reported in several studies<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> yet diverges from Satpathy et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which noted that nearly half of the patients experienced high-grade&#44; intermittent fever&#44; followed by a lesser prevalence of low-grade fever&#46; This discrepancy underscores the variability in fever characteristics and severity among different patient populations&#44; highlighting the complexity of febrile illness presentation and the need for tailored diagnostic and therapeutic approaches&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We observed that a significant majority of the participants&#44; accounting for 120 &#40;80&#37;&#41;&#44; exhibited non-localizing symptoms&#44; such as headache&#44; body ache&#44; malaise&#44; and chills&#46; This was followed by a smaller group&#44; with 22 &#40;14&#46;7&#37;&#41; individuals presenting symptoms related to the respiratory system&#46; Equal percentages &#40;13&#46;3&#37;&#41; presented with gastrointestinal and urinary tract symptoms&#44; followed by central nervous system symptoms involvement&#46; These observations concord with findings from the study conducted by Satpathy et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which also highlighted chills&#44; headache&#44; and body aches as the most prevalent presenting symptoms&#44; followed by manifestations concerning the respiratory tract&#46; Such data underscore the predominance of nonspecific symptomatic presentations in febrile illnesses&#44; emphasizing the necessity for comprehensive diagnostic evaluations to ascertain the underlying etiologies effectively&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our research observed a diverse range of clinical signs among the participants&#46; Specifically&#44; 21 &#40;14&#37;&#41; patients exhibited pallor&#44; indicating potential underlying causes such as anemia or acute blood loss&#46; Icterus was present in 6 &#40;4&#37;&#41; individuals&#44; suggesting liver dysfunction or hemolytic conditions&#46; Lymphadenopathy&#44; malignancy&#44; or other diseases&#44; were noted in 19 &#40;12&#46;7&#37;&#41; cases&#46; Furthermore&#44; 17 &#40;11&#46;3&#37;&#41; patients displayed skin rash&#47;eschar&#44; a sign associated with various infectious and non-infectious conditions&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Comparatively&#44; the findings by Satpathy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> highlighted pallor as the most common clinical sign&#44; observed in 35 cases &#40;17&#46;5&#37;&#41;&#44; followed by icterus and lymphadenopathy&#46; Our study aligns with these observations&#44; underscoring the prevalence of nonspecific clinical signs in patients with febrile illnesses&#46; These findings emphasize the importance of thorough clinical examination and diagnostic testing to accurately identify the underlying etiologies of fever and related symptoms&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In our cohort of 150 patients&#44; malaria was identified in 18 cases &#40;12&#37;&#41;&#44; with <span class="elsevierStyleItalic">Plasmodium vivax</span> being the more prevalent species in 13 out of these 18 cases&#44; accounting for 8&#46;7&#37; of the total cases&#46; This contrasted with <span class="elsevierStyleItalic">Plasmodium falciparum</span>&#44; which was found in 3&#46;3&#37; of the cases&#46; This distribution echoes findings from Abrahamsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> in Vellore&#44; India&#44; highlighting a similar trend in the predominance of Plasmodium vivax over <span class="elsevierStyleItalic">Plasmodium falciparum</span>&#46; Likewise&#44; research conducted by Pal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in Kolkata also reported a higher incidence of <span class="elsevierStyleItalic">Plasmodium vivax</span> malaria&#44; further corroborating our observations&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The predominance of <span class="elsevierStyleItalic">Plasmodium vivax</span> challenges the traditional perception of <span class="elsevierStyleItalic">Plasmodium falciparum</span> as the most concerning species due to its potential for severe disease&#46; Moreover&#44; the propensity of the Plasmodium parasite to develop resistance to medications complicates treatment strategies and elevates the cost of management&#44; particularly with the increasing necessity for artemisinin-based combination therapies&#46; This situation underscores malaria&#39;s ongoing status as a significant global health burden&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> necessitating sustained efforts in monitoring&#44; prevention&#44; and the development of effective treatment protocols to combat this disease effectively&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our study&#44; each patient underwent a blood culture upon admission prior to the administration of any antimicrobials&#46; Results showed a positivity rate of 3&#46;3&#37; &#40;five patients&#41;&#44; with <span class="elsevierStyleItalic">Salmonella typhi</span> detected in four &#40;2&#46;7&#37;&#41; patients and <span class="elsevierStyleItalic">Staphylococcus aureus</span> in one &#40;0&#46;7&#37;&#41;&#44; echoing findings from M&#248;rch et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> which identified <span class="elsevierStyleItalic">Salmonella typhi</span> or paratyphi as a significant isolate&#46; The emergence of <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; known for its versatility and virulence&#44; alongside the increasing prevalence of multidrug-resistant strains&#44; underscores the challenges in treating such infections&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The modest blood culture positivity rate in our cohort suggests the impact of prior antibiotic treatments&#44; either self-administered or prescribed outside the hospital&#44; on the diagnostic yield&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Urinary tract infections were prominently featured&#44; with significant pus cells observed in 15 &#40;10&#37;&#41; patients&#39; urine&#44; leading to further urine culture-sensitivity testing&#46; <span class="elsevierStyleItalic">Escherichia coli</span> emerged as the predominant pathogen in 10 &#40;6&#46;7&#37;&#41; cases&#44; followed by <span class="elsevierStyleItalic">Klebsiella</span> in 2 &#40;1&#46;3&#37;&#41;&#44; in alignment with Hooton&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> highlighting <span class="elsevierStyleItalic">Escherichia coli</span>&#39;s role in causing fever and dysuria&#46; A notable finding was the lack of bacterial growth in urine cultures of 3 &#40;2&#37;&#41; patients&#44; likely due to prior antibiotic exposure&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Additionally&#44; sputum analysis for acid-fast bacillus was positive in two &#40;1&#46;3&#37;&#41; cases&#44; and RT-PCR confirmed COVID-19 in 14 &#40;9&#46;3&#37;&#41; patients&#44; a reflection of the high tuberculosis prevalence and ongoing COVID-19 pandemic&#46; Digital chest X-rays revealed infective changes in 19 &#40;12&#46;7&#37;&#41; patients&#44; aiding in the diagnosis of lower respiratory tract infections&#46; Ultrasound examinations frequently detected organomegaly &#40;18 cases&#44; 12&#37;&#41;&#44; corroborating findings by Satpathy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Etiological diagnoses&#44; guided by comprehensive clinical and laboratory assessments&#44; identified scrub typhus&#44; dengue&#44; and enteric fever as the leading causes of short-duration fever in our patients&#46; This is consistent with the regional emergence of scrub typhus as a significant infectious threat&#44; possibly attributed to improved diagnostic capabilities&#46; Our study also notes the prevalence of lower respiratory tract infections&#44; with COVID-19 contributing significantly alongside other pathogens like tuberculosis&#46; <span class="elsevierStyleItalic">Escherichia coli</span> was the most isolated pathogen in urinary tract infections&#44; reaffirming its significant role in such infections&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Notably&#44; acute meningitis&#47;meningoencephalitis was diagnosed in several patients&#44; with viral etiologies and scrub typhus being the predominant causes&#46; The observation of overlapping infections highlights the complexity of diagnosing febrile illnesses and the caution needed when relying solely on serological tests&#46; The diversity of endemic diseases like leptospirosis&#44; scrub typhus&#44; dengue&#44; and malaria in India&#44; coupled with diagnostic challenges&#44; underscores the necessity for enhanced diagnostic approaches and a nuanced understanding of local epidemiology to improve patient care and disease management strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Despite our efforts&#44; our study encountered several limitations that warrant acknowledgment&#46; Firstly&#44; the relatively small sample size and the fact that the study was conducted in a single center might have restricted the breadth of our findings&#46; A larger&#44; multicentric study could potentially have provided a more comprehensive understanding of the infectious disease landscape&#46; Financial constraints limited our ability to routinely test for a range of potential pathogens&#44; such as <span class="elsevierStyleItalic">Leptospira</span> and Chikungunya virus&#44; and similarly restricted the use of polymerase chain reaction testing&#44; which could have enhanced the accuracy of our diagnostic processes&#46; Additionally&#44; conducting the study within a tertiary care hospital introduces the possibility of hospital bias&#44; affecting the generalizability of our results to broader community settings&#46; These limitations underscore the need for further research with expanded resources to capture the spectrum of febrile illnesses in the population fully&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In closing&#44; the convergence of clinical manifestations across various etiologies underscores the diagnostic challenge presented by short-duration fever&#46; Our study&#39;s insights into the etiological landscape can significantly inform the creation of targeted guidelines for the management and control of acute febrile illnesses&#46; Notably&#44; scrub typhus emerged as the predominant cause of short-duration fever in our region of West Bengal&#44; marking it as an ascending threat&#46; This underscores the necessity for enhanced diagnostic capabilities&#44; explicitly advocating for the availability of scrub typhus testing in remote primary healthcare centers and its inclusion in the diagnostic criteria for febrile illnesses in endemic areas&#46; Given the potential for severe complications and the risk to a patient&#39;s life due to delayed diagnosis and treatment of scrub typhus&#44; there is a compelling argument for the consideration of empirical doxycycline therapy&#46; This approach should be predicated on a strong clinical suspicion of scrub typhus&#44; balanced against a risk-benefit analysis by treating physicians&#44; especially in contexts where advanced diagnostic facilities are lacking due to economic constraints&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The need for additional research is clear&#44; with a global call for studies that further elucidate the clinical&#44; diagnostic&#44; and treatment paradigms for common causes of short-duration fever&#46; Such efforts can elevate clinician awareness and refine patient care protocols&#46; Furthermore&#44; community education is crucial in mitigating the premature or inappropriate use of antibiotics&#44; advocating for a more informed public approach to fever management and antibiotic stewardship&#46; This dual strategy of enhancing healthcare provider knowledge and community awareness is pivotal in addressing the challenges posed by short-duration fevers and mitigating the impact of emerging infectious threats like scrub typhus&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0200" class="elsevierStylePara elsevierViewall">J&#46; Benito-Le&#243;n is supported by the <span class="elsevierStyleGrantSponsor" id="gs0005">National Institutes of Health&#44; Bethesda&#44; MD&#44; USA</span> &#40;NINDS <span class="elsevierStyleGrantNumber" refid="gs0005">&#35;R01 NS39422</span>&#41;&#44; the <span class="elsevierStyleGrantSponsor" id="gs0010">European Commission</span> &#40;grant <span class="elsevierStyleGrantNumber" refid="gs0010">ICT-2011- 287739</span>&#44; NeuroTREMOR&#41;&#44; and <span class="elsevierStyleGrantSponsor" id="gs0025">The Recovery&#44; Transformation and Resilience Plan at the Ministry of Science and Innovation</span> &#40;grant <span class="elsevierStyleGrantNumber" refid="gs0025">TED2021-130174B-C33</span>&#44; NETremor&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making&#46; Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal&#44; India&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital &#40;West Bengal&#44; India&#41;&#46; We performed comprehensive clinical assessments&#44; including microbiological&#44; serological&#44; and other specific investigations&#44; to identify the causes of the fever&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The demographic profile predominantly included individuals aged 21&#8211;40 years&#44; with a male-to-female ratio of 1&#46;9&#58;1&#59; 60&#46;7&#37; of participants were from rural areas&#46; The primary etiological agents identified were scrub typhus &#40;25&#46;3&#37;&#41;&#44; dengue &#40;15&#46;3&#37;&#41;&#44; and enteric fever &#40;13&#46;3&#37;&#41;&#46; Notably&#44; 80&#37; of patients presented with non-localizing symptoms&#44; while 14&#46;7&#37; had respiratory symptoms&#46; Blood cultures pinpointed <span class="elsevierStyleItalic">Salmonella typhi</span> and <span class="elsevierStyleItalic">Staphylococcus aureus</span> in a minority of cases &#40;3&#46;3&#37;&#41;&#59; malaria&#44; primarily <span class="elsevierStyleItalic">Plasmodium vivax</span>&#44; was diagnosed in 12&#37; of the cases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our findings highlight the complexity of diagnosing short-duration fevers&#44; dominated by a wide range of etiological agents&#44; with a notable prevalence of scrub typhus&#46; These results underscore the urgent need for enhanced diagnostic facilities&#44; including the availability of scrub typhus testing at primary healthcare centers&#46; We recommend empirical doxycycline therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses&#46; This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La escasez de datos epidemiol&#243;gicos sobre enfermedades febriles agudas en el sur de Asia dificulta la toma de decisiones cl&#237;nicas basadas en la evidencia&#46; Nuestro estudio tuvo como objetivo explorar el espectro etiol&#243;gico de la fiebre de corta duraci&#243;n en pacientes ingresados en un hospital de atenci&#243;n terciaria en Bengala Occidental&#44; India&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio transversal desde mayo de 2021 hasta abril de 2022 que involucr&#243; a 150 pacientes adultos que presentaban fiebre de menos de dos semanas de duraci&#243;n ingresados en el Burdwan Medical College and Hospital &#40;Bengala Occidental&#44; India&#41;&#46; Realizamos evaluaciones cl&#237;nicas exhaustivas&#44; incluidas investigaciones microbiol&#243;gicas&#44; serol&#243;gicas y otras espec&#237;ficas&#44; para identificar las causas de la fiebre&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El perfil demogr&#225;fico incluy&#243; predominantemente a individuos de 21 a 40 a&#241;os&#44; con una proporci&#243;n de hombres a mujeres de 1&#44;9&#58;1&#59; el 60&#44;7&#37; de los participantes proven&#237;an de &#225;reas rurales&#46; Los principales agentes etiol&#243;gicos identificados fueron el tifus de la maleza &#40;25&#44;3&#37;&#41;&#44; el dengue &#40;15&#44;3&#37;&#41; y la fiebre ent&#233;rica &#40;13&#44;3&#37;&#41;&#46; Cabe destacar que el 80&#37; de los pacientes presentaron s&#237;ntomas no localizados&#44; mientras que el 14&#44;7&#37; tuvo s&#237;ntomas respiratorios&#46; Los hemocultivos identificaron <span class="elsevierStyleItalic">Salmonella typhi</span> y <span class="elsevierStyleItalic">Staphylococcus aureus</span> en una minor&#237;a de casos &#40;3&#44;3&#37;&#41;&#59; la malaria&#44; principalmente <span class="elsevierStyleItalic">Plasmodium vivax</span>&#44; se diagnostic&#243; en el 12&#37; de los casos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Nuestros hallazgos resaltan la complejidad del diagn&#243;stico de fiebres de corta duraci&#243;n&#44; dominadas por una amplia gama de agentes etiol&#243;gicos&#44; con una prevalencia notable del tifus de la maleza&#46; Estos resultados subrayan la urgente necesidad de mejorar las instalaciones de diagn&#243;stico&#44; incluida la disponibilidad de pruebas para el tifus de la maleza en los centros de atenci&#243;n primaria&#46; Recomendamos terapia emp&#237;rica con doxiciclina para casos sospechosos y enfatizamos la necesidad de m&#225;s investigaciones para desarrollar gu&#237;as de manejo para enfermedades febriles agudas&#46; Este estudio tambi&#233;n destaca la importancia de aumentar la conciencia tanto en la comunidad como en los m&#233;dicos para prevenir el uso irracional de antibi&#243;ticos&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TYPHIDOT Immunoglobulin M&#47; WIDAL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hepatitis E</span> virus immunoglobulin M antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sputum acid-fast bacillus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive blood culture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Salmonella typhi</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urine routine examination&#47;microscopic examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinary tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Escherichia coli</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Klebsiella</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Culture negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cerebrospinal fluid study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Scrub typhus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Digital chest radiography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infective changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;12&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasonography of the whole abdomen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Organomegaly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other findings in ultrasonography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Cystitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Pyelonephritis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of routine microbiological and radiological investigations&#44; along with special investigations&#44; in our cohort of patients with short-duration fever&#46;</p>"
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        "etiqueta" => "Table 2"
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          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malaria &#40;vivax and falciparum&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;12&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;8&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dengue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;15&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scrub typhus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;25&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enteric fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urinary tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lower respiratory tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;12&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-COVID-19 &#40;including tuberculosis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meningitis&#47;meningoencephalitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Acute viral hepatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Undiagnosed fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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