Table 2.

Syndromic approach to tropical infections in the ICU

Syndrome	Diseases
Fever and toxic appearance Fever and rash	Dengue fever, malaria, typhoid fever, early shigellosis, leptospirosis, and anicteric hepatitis. The presence of a haemorrhagic rash may indicate arboviral, rickettsial, and meningococcal aetiologies. Aetiologies of VHF that have been known to cause person-to-person transmission are Lassa virus, Ebola virus, Marburg virus, and Crimean-Congo haemorrhagic fever virus
Fever and thrombocytopenia	Malaria, dengue, leptospirosis, rickettsiosis
Fever with eosinophilia	Schistosomiasis (Katayama fever or acute neurological sequelae of myelitis or encephalitis), visceral larva migrans, tropical pulmonary eosinophilia, acute fascioliasis, acute trichinosis
Severe pneumonia or ARDS	Streptococcus pneumoniae, Legionella pneumophila, bacterial sepsis with other pathogens, tuberculosis, Burkholderia pseudomallei (melioidosis), plague, histoplasmosis, malaria, typhoid fever, leptospirosis, scrub typhus, hantaviruses, coronaviruses, highly pathogenic avian influenza A (H5N1)
Pulmonary renal syndrome	Falciparum malaria, leptospirosis, hantavirus infection, scrub typhus, severe pneumonia
Hepatorenal dysfunction	Falciparum malaria, leptospirosis, scrub typhus, hepatitis E or A with fulminant hepatic failure and the hepatorenal syndrome, yellow fever virus
Acute abdomen	Appendicitis, cholecystitis, diverticulitis, perforated peptic ulcer, enteric fever, amoebic liver abscess
Dysentery and severe gastrointestinal fluid losses	Amoebic (Entamoeba histolytica) and bacillary (Shigella spp, especially S. dysenteriae and S. flexneri, Campylobacter jejuni, non-typhoidal Salmonella spp, Yersinia enterocolitica, enteroinvasive Escherichia coli, and enterohaemorrhagic E. coli (EHEC))
Altered sensorium	Cerebral malaria, meningitis, typhoid fever, viral encephalitis (Japanese encephalitis virus, Rift Valley fever virus, Murray Valley encephalitis virus, West Nile virus, St. Louis encephalitis virus, rabies virus, Nipah virus). Eosinophilic meningoencephalitis (Angiostrongylus cantonensis, Gnathostoma spinigerum, migrating ascarids, and schistosomiasis)

ICU, intensive care unit; VHF, viral haemorrhagic fever; ARDS, acute respiratory distress syndrome.