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Am. J. Trop. Med. Hyg., 68(6), 2003, pp. 704-706
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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ACUTE UNDIFFERENTIATED FEVER CAUSED BY INFECTION WITH JAPANESE ENCEPHALITIS VIRUS

GEORGE WATT AND KRISADA JONGSAKUL
Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

To determine the proportion of acute undifferentiated fevers without neurologic deficits related to infection with Japanese encephalitis (JE) virus, flavivirus serology (dengue and JE) was performed in a cohort of 156 adults presenting to a hospital in Chiangrai, Thailand. Recent flavivirus infection was diagnosed for any individual with an IgM result > 40 units. A ratio of dengue virus IgM to JE virus IgM < 0.91 defined a JE virus infection. Diagnostic criteria for Japanese encephalitis were met in 22 individuals (14%), and were unequivocal in 8 patients. The admission findings in these eight subjects were similar to those described for other flavivirus infections. Thrombocytopenia was the most striking laboratory abnormality (median platelet count = 119,000/mm3, range = 44,000–236,000/mm3). Headache (75%), nausea (50%), myalgia (38%), rash (38%), and diarrhea (25%) were the most frequently encountered signs and symptoms. Infection with Japanese encephalitis virus is an underappreciated cause of acute undifferentiated fever in Asia.

Received October 14, 2002. Accepted for publication April 2, 2003.

Acknowledgments: We thank Dr. Mike Benenson for his careful review of the manuscript and suggestions for improvement, and Dr. Ananda Nisaluk for sharing her insights and diagnostic information about flavivirus infections in Thailand.

Authors’ address: George Watt and Krisada Jongsakul, Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, APO AP 96546, USA, Telephone: 66-2-644-6735, Fax: 66-2-246-8908, E-mail: wattgh{at}thai.amedd.army.mil




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R. Joshi, J. M. Colford Jr., A. L. Reingold, and S. Kalantri
Nonmalarial Acute Undifferentiated Fever in a Rural Hospital in Central India: Diagnostic Uncertainty and Overtreatment with Antimalarial Agents
Am J Trop Med Hyg, March 1, 2008; 78(3): 393 - 399.
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Copyright © 2003 by the American Society of Tropical Medicine and Hygiene.