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Am. J. Trop. Med. Hyg., 68(5), 2003, pp. 536-538
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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DIFFERENTIATING DENGUE VIRUS INFECTION FROM SCRUB TYPHUS IN THAI ADULTS WITH FEVER

GEORGE WATT, KRISADA JONGSAKUL, CHAROEN CHOURIYAGUNE, AND ROBERT PARIS
Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Internal Medicine, Chiangrai Regional Hospital, Chiangrai, Thailand

Dengue fever and scrub typhus are common infections in Asia that often present as acute febrile illness of unclear etiology. We prospectively evaluated febrile adults presenting to the outpatient department of a hospital in northern Thailand to attempt to identify distinguishing characteristics between the two infections. Fifty-four patients were infected with scrub typhus and 35 were infected with dengue virus. Dengue virus infection was associated with hemorrhagic manifestations, particularly bleeding from the gums, which was reported by 27% of the dengue patients, but by none of the scrub typhus patients (P < 0.001, by Fisher’s exact test). A low platelet count (< 140,000/mm3) and low white blood cell count (< 5,000/mm3) were strongly associated with dengue infections: odds ratio = 26.3 (95% confidence interval [CI] = 7.4–93.2) for platelet count and 8.2 (95% CI = 2.6–25.5) for leukocyte count. Prospective evaluations of the usefulness of these simple criteria to differentiate scrub typhus from dengue infection are needed in other areas, particularly where rapid confirmatory diagnostic tests are not available.

Received October 14, 2002. Accepted for publication January 27, 2003.

Authors’ addresses: George Watt, Krisada Jongsakul, and Robert Paris, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, APO AP 96546, Bangkok, Thailand, Telephone: 66-2-644-6735, Fax: 66-2-246-8908, E-mail: wattgh{at}thai.amedd.army.mil. Charoen Chouriyagune, Department of Internal Medicine, Chiangrai Regional Hospital, Chiangrai, Thailand.




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Copyright © 2003 by the American Society of Tropical Medicine and Hygiene.