TY - JOUR
T1 - Rickettsioses as major etiologies of unrecognized acute febrile illness, Sabah, East Malaysia
AU - Grigg, Matthew J.
AU - William, Timothy
AU - Clemens, Emily G.
AU - Patel, Kaajal
AU - Chandna, Arjun
AU - Wilkes, Christopher S.
AU - Barber, Bridget E.
AU - Anstey, Nicholas M.
AU - Dumler, J. Stephen
AU - Yeo, Tsin W.
AU - Reller, Megan E.
PY - 2020/7
Y1 - 2020/7
N2 - Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013-2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to ≥160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/ spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/ plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.
AB - Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013-2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to ≥160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/ spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/ plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.
UR - http://www.scopus.com/inward/record.url?scp=85086931246&partnerID=8YFLogxK
U2 - 10.3201/eid2607.191722
DO - 10.3201/eid2607.191722
M3 - Article
C2 - 32568664
AN - SCOPUS:85086931246
VL - 26
SP - 1409
EP - 1419
JO - Emerging Infectious Diseases
JF - Emerging Infectious Diseases
SN - 1080-6040
IS - 7
ER -