1921
Volume 92, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Undifferentiated febrile illnesses (UFIs) are common in low- and middle-income countries. We prospectively investigated the causes of UFIs in 627 patients presenting to a tertiary referral hospital in Kathmandu, Nepal. Patients with microbiologically confirmed enteric fever (218 of 627; 34.8%) randomized to gatifloxacin or ofloxacin treatment were previously reported. We randomly selected 125 of 627 (20%) of these UFI patients, consisting of 96 of 409 (23%) cases with sterile blood cultures and 29 of 218 (13%) cases with enteric fever, for additional diagnostic investigations. We found serological evidence of acute murine typhus in 21 of 125 (17%) patients, with 12 of 21 (57%) patients polymerase chain reaction (PCR)-positive for . Three UFI cases were quantitative PCR-positive for spp., two UFI cases were seropositive for Hantavirus, and one UFI case was seropositive for Q fever. Fever clearance time (FCT) for rickettsial infection was 44.5 hours (interquartile range = 26–66 hours), and there was no difference in FCT between ofloxacin or gatifloxacin. Murine typhus represents an important cause of predominantly urban UFIs in Nepal, and fluoroquinolones seem to be an effective empirical treatment.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.14-0709
2015-04-01
2017-11-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/92/4/875.html?itemId=/content/journals/10.4269/ajtmh.14-0709&mimeType=html&fmt=ahah

References

  1. Chrispal A, Boorugu H, Gopinath K, Chandy S, Prakash J, Thomas E, Abraham A, Abraham O, Thomas K, , 2010. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors—an experience from a teriary care hospital in South India. Trop Doct 40: 230234.[Crossref]
  2. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, Scott RM, Basnyat B, Archibald LK, Reller LB, , 2004. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Trop Med Hyg 70: 670675.
  3. Koirala S, Basnyat B, Arjyal A, Shilpakar O, Shrestha K, Shrestha R, Shrestha UM, Agrawal K, Koirala KD, Thapa SD, Karkey A, Dongol S, Giri A, Shakya M, Pathak KR, Campbell J, Baker S, Farrar J, Wolbers M, Dolecek C, , 2013. Gatifloxacin versus ofloxacin for the treatment of uncomplicated enteric fever in Nepal: an open-label, randomized, controlled trial. PLoS Negl Trop Dis 7: e2523.[Crossref]
  4. Arjyal A, Basnyat B, Koirala S, Karkey A, Dongol S, Agrawaal KK, Shakya N, Shrestha K, Sharma M, Lama S, Shrestha K, Khatri NS, Shrestha U, Campbell JI, Baker S, Farrar J, Wolbers M, Dolecek C, , 2011. Gatifloxacin versus chloramphenicol for uncomplicated enteric fever: an open-label, randomised, controlled trial. Lancet Infect Dis 11: 445454.[Crossref]
  5. Pandit A, Arjyal A, Day JN, Paudyal B, Dangol S, Zimmerman MD, Yadav B, Stepniewska K, Campbell JI, Dolecek C, Farrar JJ, Basnyat B, , 2007. An open randomized comparison of gatifloxacin versus cefixime for the treatment of uncomplicated enteric fever. PLoS ONE 2: e542.[Crossref]
  6. Zimmerman MD, Murdoch DR, Rozmajzl PJ, Basnyat B, Woods CW, Richards AL, Belbase RH, Hammer DA, Anderson TP, Reller LB, , 2008. Murine typhus and febrile illness, Nepal. Emerg Infect Dis 14: 16561659.[Crossref]
  7. Mandell GL, Bennett JE, Dolin R, , 2010. Principles and Practice of Infectious Diseases, 7th Ed. Philadelphia, PA: Churchill Livingstone Elsevier, 25252527.
  8. Raoult D, Drancourt M, , 1991. Antimicrobial therapy of rickettsial diseases. Antimicrob Agents Chemother 35: 24572462.[Crossref]
  9. Laferl H, Fournier P, Seiberl G, Pichler H, Raoult D, , 2002. Murine typhus poorly responsive to ciprofloxacin: a case report. J Travel Med 9: 103104.[Crossref]
  10. Gikas A, Doukakis S, Pediaditis J, Kastanakis S, Manios A, Tselentis Y, , 2004. Comparison of the effectiveness of five different antibiotic regimens on infection with Rickettsia typhi: therapeutic data from 87 cases. Am J Trop Med Hyg 70: 576579.
  11. Richards A, Rahardjo E, Rusjdi A, Kelly D, Dasch G, Church C, Bangs M, , 2002. Evidence of Rickettsia typhi and the potential for murine typhus in Jayapura, Irian Jaya, Indonesia. Am J Trop Med Hyg 66: 431434.
  12. Phetsouvanh R, Thojaikong T, Phoumin P, Sibounheuang B, Phommasone K, Chansamouth V, Lee S, Newton P, Blacksell S, , 2013. Inter- and intra-operator variability in the reading of indirect immunofluorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg 88: 932936.[Crossref]
  13. Jiang J, Maina AN, Knobel DL, Cleaveland S, Laudisoit A, Wamburu K, Ogola E, Parola P, Breiman RF, Njenga MK, Richards AL, , 2013. Molecular detection of Rickettsia felis and Candidatus rickettsia asemboensis in fleas from human habitats, Asembo, Kenya. Vector Borne Zoonotic Dis 13: 550558.[Crossref]
  14. Henry K, Jiang J, Rozmajzl P, Azad A, Macaluso K, Richards A, , 2007. Development of quantitative real-time PCR assays to detect Rickettsia typhi and Rickettsia felis, the causative agents of murine typhus and flea-borne spotted fever. Mol Cell Probes 21: 1723.[Crossref]
  15. Cole J, Sulzer C, Pursell A, , 1973. Improved microtechnique for the leptospiral microscopic agglutination test. Appl Microbiol 25: 976980.
  16. OIE, 2009. OIE Terrestrial Manual: Bovine Brucellosis. Paris, France: OIE.
  17. Blacksell S, Jarman R, Gibbons R, Tanqanuchitcharnchai A, Mammen M, Nisalak A, Kalayanarooj S, Bailey M, Premaratna R, de Silva HJ, Day NP, Lalloo DG, , 2012. Comparison of seven commercial antigen and antibody enzyme-linked immunosorbent assays for detection of acute dengue infection. Clin Vaccine Immunol 19: 804810.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.14-0709
Loading
/content/journals/10.4269/ajtmh.14-0709
Loading

Data & Media loading...

  • Received : 09 Nov 2014
  • Accepted : 16 Dec 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error