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Febrile Illness in Malaysia— an Analysis of 1,629 Hospitalized Patients^*

Grahaem W. Brown, Akira Shirai, M. Jegathesan, Donald S. Burke, John C. Twartz, J. Peter Saunders AND David L. Huxsoll^||

We studied 1,629 febrile patients from a rural area of Malaysia, and made a laboratory diagnosis in 1,025 (62.9%) cases. Scrub typhus was the most frequent diagnosis (19.3% of all illnesses) followed by typhoid and paratyphoid (7.4%); flavivirus infection (7.0%); leptospirosis (6.8%); and malaria (6.2%). The hospital mortality was very low (0.5% of all febrile patients). The high prevalence of scrub typhus in oil palm laborers (46.8% of all febrile illnesses in that group) was confirmed. In rural Malaysia, therapy with chlor-amphenicol or a tetracycline would be appropriate for undiagnosed patients in whom malaria has been excluded. Failure to respond to tetracycline within 48 hours would usually suggest a diagnosis of typhoid, and indicate the need for a change in therapy.

Accepted for publication September 2, 1983.

^* This study was supported by Research Grant No. DAMD17-81-G-9481 from the U.S. Army Medical Research and Development Command, Fort Detrick, Frederick, Maryland 21701.

Grahaem W. Brown and J. Peter Saunders were supported by Ministry of Defence, U.K., and John C. Twartz by Ministry of Defence, Australia.

Address reprint requests to: Commander, U.S. Army Medical Research Unit, Institute for Medical Research, Jalan Pahang, Kuala Lumpur 02-14, Malaysia.

Present address: Glaxo Group Research Ltd., Greenford, Middlesex, U.K.

Lt. Col., RAAMC. Present address: 1st Malaria Research Unit, Ingleburn, N.S.W., Australia.

Present address: "Kerwood House," Eaton, Retford, Notts. DN 22-OPS, England.

^|| Present address: U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland 21701.

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