Rickettsioses as major etiologies of unrecognized acute febrile illness, Sabah, East Malaysia

Matthew J. Grigg, Timothy William, Emily G. Clemens, Kaajal Patel, Arjun Chandna, Christopher S. Wilkes, Bridget E. Barber, Nicholas M. Anstey, J. Stephen Dumler, Tsin W. Yeo, Megan E. Reller

    Research output: Contribution to journalArticle

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)1409-1419
    Number of pages11
    JournalEmerging Infectious Diseases
    Volume26
    Issue number7
    DOIs
    Publication statusPublished - Jul 2020

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