Epidemiology of the acute fevers of unknown origin in South Vietnam: Effect of laboratory support upon clinical diagnosis

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  • 1 U.S. Naval Medical Research Unit No.2, Taipei, Taiwan, the Department of Medicine, University of Washington, Seattle, Washington, and the Department of Tropical Medicine and Medical Microbiology, University of Hawaii, Honolulu, Hawaii 96816

Acute fevers among American servicemen in South Vietnam were studied for a two-year period. The population included 524 patients with an acute fever of unknown origin (acute FUO) of at least four days' duration, and 269 patients who were given a tentative diagnosis of leptospirosis, scrub typhus or an arbovirus infection. Fifty-four per cent of the clinical diagnoses were serologically confirmed and 31 % of the patients with acute FUO were found to be infected with these same agents. Leptospirosis accounted for 20% of these acute fevers; scrub typhus and Japanese encephalitis were also common. Results of viral isolations and serologic testing for enteroviruses, rickettsiae, Toxoplasma, and influenza virus were of limited usefulness in the remaining patients. A correlation between the etiology of the acute FUO, seasonal incidence and environmental exposure was established. Epidemiologic data and laboratory reinforcement of clinical impressions resulted in a marked improvement in the accuracy of the attending physician's clinical diagnoses as the study progressed.

Author Notes

Present address: Department of Tropical Medicine and Medical Microbiology, University of Hawaii School of Medicine, 3675 Kilauea Avenue, Honolulu, Hawaii 96816.

Present address: Naval Medical Research Unit-2, Box 14, APO San Francisco 96263.