Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh

Hugh W. Kingston; Mosharraf Hossain; Stije Leopold; Tippawan Anantatat; Ampai Tanganuchitcharnchai; Ipsita Sinha; Katherine Plewes; Richard J. Maude; M. A. Hassan Chowdhury; Sujat Paul; Rabiul Alam Mohammed Erfan Uddin; Mohammed Abu Naser Siddiqui; Abu Shahed Md Zahed; Abdullah Abu Sayeed; Mohammed Habibur Rahman; Anupam Barua; Mohammed Jasim Uddin; Mohammed Abdus Sattar; Arjen M. Dondorp; Stuart D. Blacksell; Nicholas P.J. Day; Aniruddha Ghose; Amir Hossain; Daniel H. Paris

doi:10.3201/eid2404.170190

Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh

Hugh W. Kingston, Mosharraf Hossain, Stije Leopold, Tippawan Anantatat, Ampai Tanganuchitcharnchai, Ipsita Sinha, Katherine Plewes, Richard J. Maude, M. A. Hassan Chowdhury, Sujat Paul, Rabiul Alam Mohammed Erfan Uddin, Mohammed Abu Naser Siddiqui, Abu Shahed Md Zahed, Abdullah Abu Sayeed, Mohammed Habibur Rahman, Anupam Barua, Mohammed Jasim Uddin, Mohammed Abdus Sattar, Arjen M. Dondorp, Stuart D. BlacksellNicholas P.J. Day, Aniruddha Ghose, Amir Hossain, Daniel H. Paris

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Abstract

We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.

Original language	English
Pages (from-to)	638-645
Number of pages	8
Journal	Emerging Infectious Diseases
Volume	24
Issue number	4
DOIs	https://doi.org/10.3201/eid2404.170190
Publication status	Published - Apr 2018

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Kingston, H. W., Hossain, M., Leopold, S., Anantatat, T., Tanganuchitcharnchai, A., Sinha, I., Plewes, K., Maude, R. J., Hassan Chowdhury, M. A., Paul, S., Uddin, R. A. M. E., Siddiqui, M. A. N., Zahed, A. S. M., Sayeed, A. A., Rahman, M. H., Barua, A., Uddin, M. J., Sattar, M. A., Dondorp, A. M., ... Paris, D. H. (2018). Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh. Emerging Infectious Diseases, 24(4), 638-645. https://doi.org/10.3201/eid2404.170190

Kingston, Hugh W. ; Hossain, Mosharraf ; Leopold, Stije ; Anantatat, Tippawan ; Tanganuchitcharnchai, Ampai ; Sinha, Ipsita ; Plewes, Katherine ; Maude, Richard J. ; Hassan Chowdhury, M. A. ; Paul, Sujat ; Uddin, Rabiul Alam Mohammed Erfan ; Siddiqui, Mohammed Abu Naser ; Zahed, Abu Shahed Md ; Sayeed, Abdullah Abu ; Rahman, Mohammed Habibur ; Barua, Anupam ; Uddin, Mohammed Jasim ; Sattar, Mohammed Abdus ; Dondorp, Arjen M. ; Blacksell, Stuart D. ; Day, Nicholas P.J. ; Ghose, Aniruddha ; Hossain, Amir ; Paris, Daniel H. / Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh. In: Emerging Infectious Diseases. 2018 ; Vol. 24, No. 4. pp. 638-645.

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abstract = "We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.",

author = "Kingston, {Hugh W.} and Mosharraf Hossain and Stije Leopold and Tippawan Anantatat and Ampai Tanganuchitcharnchai and Ipsita Sinha and Katherine Plewes and Maude, {Richard J.} and {Hassan Chowdhury}, {M. A.} and Sujat Paul and Uddin, {Rabiul Alam Mohammed Erfan} and Siddiqui, {Mohammed Abu Naser} and Zahed, {Abu Shahed Md} and Sayeed, {Abdullah Abu} and Rahman, {Mohammed Habibur} and Anupam Barua and Uddin, {Mohammed Jasim} and Sattar, {Mohammed Abdus} and Dondorp, {Arjen M.} and Blacksell, {Stuart D.} and Day, {Nicholas P.J.} and Aniruddha Ghose and Amir Hossain and Paris, {Daniel H.}",

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Kingston, HW, Hossain, M, Leopold, S, Anantatat, T, Tanganuchitcharnchai, A, Sinha, I, Plewes, K, Maude, RJ, Hassan Chowdhury, MA, Paul, S, Uddin, RAME, Siddiqui, MAN, Zahed, ASM, Sayeed, AA, Rahman, MH, Barua, A, Uddin, MJ, Sattar, MA, Dondorp, AM, Blacksell, SD, Day, NPJ, Ghose, A, Hossain, A & Paris, DH 2018, 'Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh', Emerging Infectious Diseases, vol. 24, no. 4, pp. 638-645. https://doi.org/10.3201/eid2404.170190

Rickettsial illnesses as important causes of febrile illness in Chittagong, Bangladesh. / Kingston, Hugh W.; Hossain, Mosharraf; Leopold, Stije; Anantatat, Tippawan; Tanganuchitcharnchai, Ampai; Sinha, Ipsita; Plewes, Katherine; Maude, Richard J.; Hassan Chowdhury, M. A.; Paul, Sujat; Uddin, Rabiul Alam Mohammed Erfan; Siddiqui, Mohammed Abu Naser; Zahed, Abu Shahed Md; Sayeed, Abdullah Abu; Rahman, Mohammed Habibur; Barua, Anupam; Uddin, Mohammed Jasim; Sattar, Mohammed Abdus; Dondorp, Arjen M.; Blacksell, Stuart D.; Day, Nicholas P.J.; Ghose, Aniruddha; Hossain, Amir; Paris, Daniel H.

In: Emerging Infectious Diseases, Vol. 24, No. 4, 04.2018, p. 638-645.

Research output: Contribution to journal › Article

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AU - Kingston, Hugh W.

AU - Hossain, Mosharraf

AU - Leopold, Stije

AU - Anantatat, Tippawan

AU - Tanganuchitcharnchai, Ampai

AU - Sinha, Ipsita

AU - Plewes, Katherine

AU - Maude, Richard J.

AU - Hassan Chowdhury, M. A.

AU - Paul, Sujat

AU - Uddin, Rabiul Alam Mohammed Erfan

AU - Siddiqui, Mohammed Abu Naser

AU - Zahed, Abu Shahed Md

AU - Sayeed, Abdullah Abu

AU - Rahman, Mohammed Habibur

AU - Barua, Anupam

AU - Uddin, Mohammed Jasim

AU - Sattar, Mohammed Abdus

AU - Dondorp, Arjen M.

AU - Blacksell, Stuart D.

AU - Day, Nicholas P.J.

AU - Ghose, Aniruddha

AU - Hossain, Amir

AU - Paris, Daniel H.

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N2 - We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.

AB - We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.

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