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 languageEnglish
    Pages (from-to)638-645
    Number of pages8
    JournalEmerging Infectious Diseases
    Volume24
    Issue number4
    DOIs
    Publication statusPublished - 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