1921
Volume 100, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Acute undifferentiated febrile illness (AUFI) has been a diagnostic dilemma in the tropics. Without accurate point-of-care tests, information on local pathogens and clinical parameters is essential for presumptive diagnosis. A prospective hospital-based study was conducted at the Bangkok Hospital for Tropical Diseases from 2013 to 2015 to determine common etiologies of AUFI. A total of 397 adult AUFI cases, excluding malaria by blood smear, were enrolled. Rapid diagnostic tests for tropical infections were performed on admission, and acute and convalescent samples were tested to confirm the diagnosis. Etiologies could be identified in 271 (68.3%) cases. Dengue was the most common cause, with 157 cases (39.6%), followed by murine typhus (20 cases; 5.0%), leptospirosis (16 cases; 4.0%), influenza (14 cases; 3.5%), and bacteremia (six cases; 1.5%). Concurrent infection by at least two pathogens was reported in 37 cases (9.3%). Furthermore, characteristics of dengue and bacterial infections (including leptospirosis and rickettsioses) were compared to facilitate dengue triage, initiate early antibiotic treatment, and minimize unnecessary use of antibiotics. In conclusion, dengue was the most common pathogen for AUFI in urban Thailand. However, murine typhus and leptospirosis were not uncommon. Empirical antibiotic treatment using doxycycline or azithromycin might be more appropriate, but cost–benefit studies are required. Physicians should recognize common causes of AUFI in their localities and use clinical and laboratory clues for provisional diagnosis to provide appropriate treatment while awaiting laboratory confirmation.

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References

  1. Prasad N, Murdoch DR, Reyburn H, Crump JA, 2015. Etiology of severe febrile illness in low- and middle-income countries: a systematic review. PLoS One 10: e0127962.
    [Google Scholar]
  2. Crump JA, Kirk MD, 2015. Estimating the burden of febrile illnesses. PLoS Negl Trop Dis 9: e0004040.
    [Google Scholar]
  3. Suaya JA 2009. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg 80: 846855.
    [Google Scholar]
  4. Tomashek KM 2017. Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015. PLoS Negl Trop Dis 11: e0005859.
    [Google Scholar]
  5. Pappas G, Papadimitriou P, Siozopoulou V, Christou L, Akritidis N, 2008. The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis 12: 351357.
    [Google Scholar]
  6. Chierakul W, 2014. Leptospirosis. Farrar J, Junghanss J, Lalloo D, Hotez PJ, Kang G, White NJ, eds. Manson’s Tropical Diseases. 23rd ed. China: Elsevier, 433440.
    [Google Scholar]
  7. Suputtamongkol Y, Suttinont C, Niwatayakul K, Hoontrakul S, Limpaiboon R, Chierakul W, Losuwanaluk K, Saisongkork W, 2009. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci 1166: 172179.
    [Google Scholar]
  8. McGready R 2010. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis 4: e888.
    [Google Scholar]
  9. Hamaguchi S 2015. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in northern Vietnam. Am J Trop Med Hyg 92: 972978.
    [Google Scholar]
  10. Manock SR 2009. Etiology of acute undifferentiated febrile illness in the Amazon basin of Ecuador. Am J Trop Med Hyg 81: 146151.
    [Google Scholar]
  11. Naing C, Kassim AI, 2012. Scaling-up attention to nonmalaria acute undifferentiated fever. Trans R Soc Trop Med Hyg 106: 331332.
    [Google Scholar]
  12. Phuong HL, de Vries PJ, Nagelkerke N, Giao PT, Hung le Q, Binh TQ, Nga TT, Nam NV, Kager PA, 2006. Acute undifferentiated fever in Binh Thuan province, Vietnam: imprecise clinical diagnosis and irrational pharmaco-therapy. Trop Med Int Health 11: 869879.
    [Google Scholar]
  13. Thipmontree W, Suputtamongkol Y, Tantibhedhyangkul W, Suttinont C, Wongswat E, Silpasakorn S, 2014. Human leptospirosis trends: northeast Thailand, 2001–2012. Int J Environ Res Public Health 11: 85428551.
    [Google Scholar]
  14. Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87: 464472.
    [Google Scholar]
  15. Suttinont C 2006. Causes of acute, undifferentiated, febrile illness in rural Thailand: results of a prospective observational study. Ann Trop Med Parasitol 100: 363370.
    [Google Scholar]
  16. Ellis RD 2006. Causes of fever in adults on the Thai-Myanmar border. Am J Trop Med Hyg 74: 108113.
    [Google Scholar]
  17. World Health Organization, 1997. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Available at: http://apps.who.int/iris/bitstream/handle/10665/41988/9241545003_eng.pdf. Accessed June 17, 2018.
    [Google Scholar]
  18. Kotepui M, PhunPhuech B, Phiwklam N, Uthaisar K, Thirarattanasunthon P, 2017. Prevalence of scrub typhus infection among patients infected with malaria in Phop Phra Hospital, Tak province, Thailand. J Med Tech Assoc Thailand 45: 59095916.
    [Google Scholar]
  19. Chansamouth V 2016. The aetiologies and impact of fever in pregnant inpatients in Vientiane, Laos. PLoS Negl Trop Dis 10: e0004577.
    [Google Scholar]
  20. Brownlow T, Kavanagh OV, Logan EF, Hartskeerl RA, Savage R, Palmer MF, Krahl M, Mackie DP, Ellis WA, 2014. ‘Leptorapide’–a one-step assay for rapid diagnosis of human leptospirosis. Epidemiol Infect 142: 11821187.
    [Google Scholar]
  21. Surase PV, Nataraj G, Pattamadai K, Mehta PR, Pazare AR, Agarwal MC, Nanavati RN, 2016. An appropriately performed conventional blood culture can facilitate choice of therapy in resource-constrained settings-comparison with BACTEC 9050. J Postgrad Med 62: 228234.
    [Google Scholar]
  22. Isenberg HI, 1998. Essential Procedures for Clinical Microbiology. Washington, DC: ASM Press.
    [Google Scholar]
  23. Johnson BW, Russell BJ, Lanciotti RS, 2005. Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay. J Clin Microbiol 43: 49774983.
    [Google Scholar]
  24. Nga TT, Thai KT, Phuong HL, Giao PT, Hung le Q, Binh TQ, Mai VT, Van Nam N, de Vries PJ, 2007. Evaluation of two rapid immunochromatographic assays for diagnosis of dengue among Vietnamese febrile patients. Clin Vaccine Immunol 14: 799801.
    [Google Scholar]
  25. World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Available at: http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf. Accessed April 12, 2018.
    [Google Scholar]
  26. Innis BL, Nisalak A, Nimmannitya S, Kusalerdchariya S, Chongswasdi V, Suntayakorn S, Puttisri P, Hoke CH, 1989. An enzyme-linked immunosorbent assay to characterize dengue infections where dengue and Japanese encephalitis co-circulate. Am J Trop Med Hyg 40: 418427.
    [Google Scholar]
  27. Stenos J, Graves SR, Unsworth NB, 2005. A highly sensitive and specific real-time PCR assay for the detection of spotted fever and typhus group Rickettsiae. Am J Trop Med Hyg 73: 10831085.
    [Google Scholar]
  28. Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP, Peacock SJ, 2009. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol 47: 430434.
    [Google Scholar]
  29. Smythe LD, Smith IL, Smith GA, Dohnt MF, Symonds ML, Barnett LJ, McKay DB, 2002. A quantitative PCR (TaqMan) assay for pathogenic Leptospira spp. BMC Infect Dis 2: 13.
    [Google Scholar]
  30. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V, 2008. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr 28: 149154.
    [Google Scholar]
  31. Crump JA 2013. Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 7: e2324.
    [Google Scholar]
  32. Reller ME, Chikeka I, Miles JJ, Dumler JS, Woods CW, Mayorga O, Matute AJ, 2016. First identification and description of rickettsioses and Q fever as causes of acute febrile illness in Nicaragua. PLoS Negl Trop Dis 10: e0005185.
    [Google Scholar]
  33. Chimsumang S, Chettanadee S, Jitrathai S, Wongchotigul V, 2005. Indirect immunoperoxidase test for the diagnosis of leptospirosis. Southeast Asian J Trop Med Public Health 36: 296301.
    [Google Scholar]
  34. World Health Organization, 2013. Laboratory Procedures: Serological Detection of Avian Influenza A(H7N9) Infections by Microneutralization Assay. Available at: http://www.who.int/influenza/gisrs_laboratory/cnic_serological_diagnosis_microneutralization_a_h7n9.pdf. Accessed September 11, 2018.
    [Google Scholar]
  35. Parker TM, Murray CK, Richards AL, Samir A, Ismail T, Fadeel MA, Jiang J, Wasfy MO, Pimentel G, 2007. Concurrent infections in acute febrile illness patients in Egypt. Am J Trop Med Hyg 77: 390392.
    [Google Scholar]
  36. Bharaj P, Chahar HS, Pandey A, Diddi K, Dar L, Guleria R, Kabra SK, Broor S, 2008. Concurrent infections by all four dengue virus serotypes during an outbreak of dengue in 2006 in Delhi, India. Virol J 5: 1.
    [Google Scholar]
  37. Dhanoa A, Hassan SS, Ngim CF, Lau CF, Chan TS, Adnan NA, Eng WW, Gan HM, Rajasekaram G, 2016. Impact of dengue virus (DENV) co-infection on clinical manifestations, disease severity and laboratory parameters. BMC Infect Dis 16: 406.
    [Google Scholar]
  38. Suputtamongkol Y 2010. Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis. PLoS Negl Trop Dis 4: e610.
    [Google Scholar]
  39. Phimda K 2007. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother 51: 32593263.
    [Google Scholar]
  40. Libraty DH 2007. A comparative study of leptospirosis and dengue in Thai children. PLoS Negl Trop Dis 1: e111.
    [Google Scholar]
  41. Pok KY, Lai YL, Sng J, Ng LC, 2010. Evaluation of nonstructural 1 antigen assays for the diagnosis and surveillance of dengue in Singapore. Vector Borne Zoonotic Dis 10: 10091016.
    [Google Scholar]
  42. Pal S, Dauner AL, Mitra I, Forshey BM, Garcia P, Morrison AC, Halsey ES, Kochel TJ, Wu SJ, 2014. Evaluation of dengue NS1 antigen rapid tests and ELISA kits using clinical samples. PLoS One 9: e113411.
    [Google Scholar]
  43. Potts JA, Rothman AL, 2008. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health 13: 13281340.
    [Google Scholar]
  44. Tanner L 2008. Decision tree algorithms predict the diagnosis and outcome of dengue fever in the early phase of illness. PLoS Negl Trop Dis 2: e196.
    [Google Scholar]
  45. Low JG 2011. The early clinical features of dengue in adults: challenges for early clinical diagnosis. PLoS Negl Trop Dis 5: e1191.
    [Google Scholar]
  46. Daumas RP, Passos SR, Oliveira RV, Nogueira RM, Georg I, Marzochi KB, Brasil P, 2013. Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil. BMC Infect Dis 13: 77.
    [Google Scholar]
  47. Ho TS, Wang SM, Lin YS, Liu CC, 2013. Clinical and laboratory predictive markers for acute dengue infection. J Biomed Sci 20: 75.
    [Google Scholar]
  48. Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S, Sahassananda D, Jittmittraphap A, Suwannakudt P, Desakorn V, Wattanathum A, 2015. Identification of clinical factors associated with severe dengue among Thai adults: a prospective study. BMC Infect Dis 15: 420.
    [Google Scholar]
  49. Gregory CJ 2011. Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room. PLoS Negl Trop Dis 5: e1400.
    [Google Scholar]
  50. Civen R, Ngo V, 2008. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 46: 913918.
    [Google Scholar]
  51. Jampangern W, Vongthoung K, Jittmittraphap A, Worapongpaiboon S, Limkittikul K, Chuansumrit A, Tarunotai U, Chongsa-nguan M, 2007. Characterization of atypical lymphocytes and immunophenotypes of lymphocytes in patients with dengue virus infection. Asian Pac J Allergy Immunol 25: 2736.
    [Google Scholar]
  52. Treeprasertsuk S, Kittitrakul C, 2015. Liver complications in adult dengue and current management. Southeast Asian J Trop Med Public Health 46 (Suppl 1): 99107.
    [Google Scholar]
  53. Kittitrakul C, Silachamroon U, Phumratanaprapin W, Krudsood S, Wilairatana P, Treeprasertsuk S, 2015. Liver function tests abnormality and clinical severity of dengue infection in adult patients. J Med Assoc Thai 98 (Suppl 1): S1S8.
    [Google Scholar]
  54. Sa-Ngamuang C, Haddawy P, Luvira V, Piyaphanee W, Iamsirithaworn S, Lawpoolsri S, 2018. Accuracy of dengue clinical diagnosis with and without NS1 antigen rapid test: comparison between human and Bayesian network model decision. PLoS Negl Trop Dis 12: e0006573.
    [Google Scholar]
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  • Received : 14 May 2018
  • Accepted : 28 Nov 2018
  • Published online : 07 Jan 2019

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