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We conducted a longitudinal observational study of 533 patients presenting to two hospitals in the Ecuadorean Amazon basin with acute undifferentiated febrile illness (AUFI) from 2001 through 2004. Viral isolation, reverse transcription-polymerase chain reaction (RT-PCR), IgM seroconversion, and malaria smears identified pathogens responsible for fever in 122 (40.1%) of 304 patients who provided both acute and convalescent blood samples. Leptospirosis was found in 40 (13.2%), malaria in 38 (12.5%), rickettsioses in 18 (5.9%), dengue fever in 16 (5.3%), Q fever in 15 (4.9%), brucellosis in 4 (1.3%), Ilhéus infection in 3 (1.0%), and Venezuelan equine encephalitis (VEE), Oropouche, and St. Louis encephalitis virus infections in less than 1% of these patients. Viral isolation and RT-PCR on another 229 participants who provided only acute samples identified 3 cases of dengue fever, 2 of VEE, and 1 of Ilhéus. None of these pathogens, except for malaria, had previously been detected in the study area.
Received March 13, 2009. Accepted for publication March 22, 2009.
Acknowledgments: We are grateful to Cristina Guevara, Patricia Sanchez, and Monica Gonzalez for obtaining historical data from study subjects and coordinating follow-up visits, to Abigail Esperanza, Juan Carlos Vieira, Maria Pesantez, and Angel Guevara for their invaluable assistance in collecting, storing, and shipping samples from Ecuador to Peru, and to the dedicated laboratory staff of the U.S. Naval Medical Research Center Detachment-Lima, Hospital Vozandes del Oriente and Hospital de la IV División de Amazonas.
Financial support: This study was funded by the United States Department of Defense Global Emerging Infections Systems Research Program, WORK UNIT NUMBER: 847705.82000.25GB.B0016.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
Disclosure: None of the authors has a financial or personal conflict of interest related to this study. Tadeusz J. Kochel had full access to all data in the study and serves as the guarantor for this publication.
* Address correspondence to Kathryn H. Jacobsen, Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030. E-mail: kjacobse{at}gmu.edu
Authors’ addresses: Stephen R. Manock, Rural Medical Services, PO Box 99, Parrottsville, TN 37843, Tel: 423-625-1170, Fax: 423-625-3618, E-mail: stevemanock{at}yahoo.com. Kathryn H. Jacobsen and Lila C. Fleming, Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, Tel: 703-993-9168, Fax: 703-993-1908, E-mails: kjacobse{at}gmu.edu and lflemin1{at}gmu.edu. Narcisa Brito de Bravo, Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador, Tel: 593-2795-171, Fax: 593-2795-173, E-mail: nbrito{at}hcjb.org.ec. Kevin L. Russell and José L. Sanchez, Department of Defense Global Emerging Surveillance and Response System (DoD-GEIS), Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910-7500, Tel: 301-319-3041, Fax: 301-319-9213, E-mails: kevin.russell4{at}us.army.mil and toti.sanchez{at}us.army.mil. Monica Negrete, I-TECH, Mozambique, Rua Cahora Bassa, 106, Maputo – Mozambique, Tel: 258 2148 6590, Fax: 258 2148 5943, E-mail: monican{at}itech-mozambique.org. James G. Olson, 1801 Hatfield Rd., Huntington, MD 20639, Tel: 410-414-3419, E-mail: payara{at}comcast.net. Patrick J. Blair, Naval Health Research Center, San Diego, CA 92106, Tel: 619-261-9713, E-mail: Patrick.Blair{at}med.navy.mil. Roger D. Smalligan, Quillen College of Medicine, East Tennessee State University, VA Building 1, Internal Medicine, Room 118, Johnson City, TN 37604, Tel: 423-439-7280, Fax: 723-439-8110, E-mail: smalliga{at}mail.etsu.edu. Brad K. Quist, Community Development Department, HCJB Global, Casilla 17-17-691, Quito, Ecuador, Tel: 593-2-226-2124, ext. 3451, Fax: 593-2-226-9234, E-mail: bquist{at}hcjb.org.ec. Juan Freire Espín, Departamento de Medicina Interna, Hospital General de las Fuerzas Armadas, Queseras del Medio sin Numero, Quito, Ecuador, Tel: 593-2-256-8008, E-mail: juanfreire52{at}yahoo.es. Willan R. Espinoza, Policlínico Militar San Jorge, Avenida General Enriquez, Sangolqui, Pichincha, Ecuador, Tel: 593-2-207-4406, E-mail: wrespinozas{at}yahoo.com. Fiona MacCormick, North Cumbria Acute Hospitals NHS Trust, West Cumberland Hospital, Hensingham, Whitehaven, Cumbria, CA28 8JG, UK, Tel: 01946-693181, E-mail: fionamaccormick{at}doctors.org.uk. Tadeusz Kochel, U.S. Medical Research Center Detachment, Lima, Peru, Tel: 51-1-614-4157, Fax: 51-1-614-4174, E-mail: Tad.Kochel{at}med.navy.mil.
Copyright Statement: Authors Tadeusz J. Kochel, Kevin Russell, James G. Olson, Jose L. Sanchez, and Patrick Blair are military service members or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C.
105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. 101 defines a U.S. Government work as work prepared by a military service members or employees of the U.S. Government as part of those person’s official duties.
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