CAUSES OF FEVER IN ADULTS ON THE THAI-MYANMAR BORDER

RUTH D. ELLIS Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by RUTH D. ELLIS in
Current site
Google Scholar
PubMed
Close
,
MARK M. FUKUDA Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by MARK M. FUKUDA in
Current site
Google Scholar
PubMed
Close
,
PHILIP MCDANIEL Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by PHILIP MCDANIEL in
Current site
Google Scholar
PubMed
Close
,
KATHERINE WELCH Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by KATHERINE WELCH in
Current site
Google Scholar
PubMed
Close
,
ANANDA NISALAK Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by ANANDA NISALAK in
Current site
Google Scholar
PubMed
Close
,
CLINTON K. MURRAY Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by CLINTON K. MURRAY in
Current site
Google Scholar
PubMed
Close
,
MICHAEL R. GRAY Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by MICHAEL R. GRAY in
Current site
Google Scholar
PubMed
Close
,
NICHAPAT UTHAIMONGKOL Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by NICHAPAT UTHAIMONGKOL in
Current site
Google Scholar
PubMed
Close
,
NILLAWAN BUATHONG Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by NILLAWAN BUATHONG in
Current site
Google Scholar
PubMed
Close
,
SABAITHIP SRIWICHAI Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by SABAITHIP SRIWICHAI in
Current site
Google Scholar
PubMed
Close
,
RUNGNAPHA PHASUK Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by RUNGNAPHA PHASUK in
Current site
Google Scholar
PubMed
Close
,
KRITSANAI YINGYUEN Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by KRITSANAI YINGYUEN in
Current site
Google Scholar
PubMed
Close
,
CHAIYAWAT MATHAVARAT Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by CHAIYAWAT MATHAVARAT in
Current site
Google Scholar
PubMed
Close
, and
ROBERT S. MILLER Armed Forces Research Institute for Medical Sciences (AFRIMS), Bangkok, Thailand; Kwai River Christian Hospital, Sangkhlaburi, Thailand; Brooke Army Medical Center and VETCOM Leptospirosis Reference Laboratory, Fort Sam Houston, Texas

Search for other papers by ROBERT S. MILLER in
Current site
Google Scholar
PubMed
Close
Restricted access

A hospital-based study was conducted along the Thai-Myanmar border to provide greater knowledge of the causes of febrile illness and to determine what zoonotic and vector-borne emerging infectious diseases might be present. A total of 613 adults were enrolled from June 1999 to March 2002. Cases were classified based on clinical findings and laboratory results. An etiologic diagnosis was made for 48% of subjects. Malaria was the most common diagnosis, accounting for 25% of subjects, with two-thirds Plasmodium falciparum. Serologic evidence for leptospirosis was found in 17% of subjects. Other etiologic diagnoses included rickettsial infections, dengue fever, and typhoid. The most frequent clinical diagnoses were nonspecific febrile illness, respiratory infections, and gastroenteritis. Clinical associations were generally not predictive of etiologic diagnosis. Apparent dual diagnoses were common, particularly for malaria and leptospirosis. Findings have been used to modify treatment of unspecified febrile illness in the area.

Author Notes

Reprint requests: Mark M. Fukuda, Department of Immunology and Medicine, Armed Forces Research Unit of Medical Sciences (AFRIMS), 315/6 Rajvithi Road, Bangkok 10400, Thailand, Telephone: 66-2-644-5775, Fax: 66-2-644-5775, E-mail: mark.fukuda@afrims.org.
  • 1

    Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, Oun SA, Mahoney FJ, 2003. Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerg Infect Dis 9 :539–544.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Archibald LK, Reller LB, 2001. Clinical microbiology in developing countries. Emerg Infect Dis 7 :302–305.

  • 3

    Guerin PJ, Olliaro P, Nosten F, Druilhe P, Laxminarayan R, Binka F, Kilama WL, Ford N, White NJ, 2002. Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development. Lancet Infect Dis 2 :564–573.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Ssali FN, Kamya MR, Wabwire-Mangen F, Kasasa S, Joloba M, Williams D, Mugerwa RD, Ellner JJ, Johnson JL, 1998. A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda. J Acquir Immune Defic Syndr Hum Retrovirol 19 :484–489.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Archibald LK, McDonald LC, Rheanpumikankit S, Tan-suphaswadikul S, Chaovanich A, Eampokalap B, Banerjee SN, Reller LB, Jarvis WR, 1999. Fever and human immunodeficiency virus infection as sentinels for emerging mycobacterial and fungal bloodstream infections in hospitalized patients ≥15 years old, Bangkok. J Infect Dis 180 :87–92.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Archibald LK, McDonald LC, Nwanyanwu O, Kazembe P, Dobbie H, Tokars J, Reller LB, Jarvis WR, 2000. A hospital-based prevalence survey of bloodstream infections in febrile patients in Malawi: implications for diagnosis and therapy. J Infect Dis 181 :1414–1420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bell M, Archibald LK, Nwanyanwu O, Dobbie H, Tokars J, Kazembe PN, Reller LB, Jarvis WR, 2001. Seasonal variation in the etiology of bloodstream infections in a febrile inpatient population in a developing country. Int J Infect Dis 5 :63–69.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Anderson KE, Joseph SW, Nasution R, Sunoto, Butler T, Van Peenen PF, Irving GS, Saroso JS, Watten RH, 1976. Febrile illnesses resulting in hospital admission: a bacteriological and serological study in Jakarta, Indonesia. Am J Trop Med Hyg 25 :116–121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    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 :670–675.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87 :464–472.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Pradutkanchana J, Pradutkanchana S, Kemapanmanus M, Wuthipum N, Silpapojakul K, 2003. The etiology of acute pyrexia of unknown origin in children after a flood. Southeast Asian J Trop Med Public Health 34 :175–178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    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 :418–427.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Lanciotti RS, Calisher CH, Gubler DJ, Chang G, Vorndam AV, 1992. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 30 :545–551.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Parola P, Miller RS, McDaniel P, Telford SR 3rd, Rolain JM, Wongsrichanalai C, Raoult D, 2003. Emerging rickettsioses of the Thai-Myanmar border. Emerg Infect Dis 9 :592–595.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    World Health Organization Recommended Surveillance Standards. Second edition. WHO/CDS/CSR/ISR/99.2.

    • PubMed
    • Export Citation
  • 16

    Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14 :296–326.

  • 17

    Laras K, Cao VC, Bounlu K, Nguyen TKT, Olson JG, Thongchanh S, Tran NVA, Hoang KL, Punjabi N, Khiem HB, Ung SA, Insisiengmay S, Watts DM, Beecham HJ, Corwin AL, 2002. The importance of leptospirosis in Southeast Asia. Am J Trop Med Hyg 67 :278–286.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Tangkanakul W, Smits HL, Jatanasen S, Ashford DA, 2005. Leptospirosis: an emerging health problem in Thailand. Southeast Asian J Trop Med Public Health 36 :281–288.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Sejvar J, Rangkanakul W, Ratanasang P, Dowell SF, Sangjun N, Bragg S, Ashford D, Tappero J, 2005. An outbreak of leptospirosis, Thailand – the importance of the laboratory. Southeast Asian J Trop Med Public Health 36 :289–295.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    LaRocque RC, Breiman RF, Ari MD, Morey RE, Janan FA, Hayes JM, Hossain JA, Brooks WA, Levett PN, 2005. Leptospirosis during dengue outbreak, Bangladesh. Emerg Inf Dis 11 :766–769.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Watt G, Parola P, 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16 :429–436.

  • 22

    Sirisanthana T, Pinyopornpanit V, Sirisanthana V, Strickman D, Kelly DJ, Dasch GA, 1994. First cases of spotted fever group rickettsiosis in Thailand. Am J Trop Med Hyg 50 :682–686.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Parry CM, Tran TH, Dougan G, White NJ, Farrar JJ, 2002. Typhoid fever. N Engl J Med 347 :1770–1782.

  • 24

    Walsh AL, Wuthiekanun V, 1996. The laboratory diagnosis of melioidosis. Br J Biomed Sci 53 :249–253.

  • 25

    Zysk G, Splettstosser WD, Neubauer H, 2000. A review on melioidosis with special respect on molecular and immunological diagnostic techniques. Clin Lab 46 :119–130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    White NJ, 2003. Melioidosis. Lancet 361 :1715–1722.

  • 27

    LaScola B, Raoult D, 1997. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol 35 :2715–2727.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Vaughn DW, Nisalak A, Solomon T, Kalayanarooj S, Nguyen MD, Kneen R, Cuzzubbo A, Devine PL, 1999. Rapid serologic diagnosis of dengue virus infection using a commercial capture ELISA that distinguishes primary and secondary infections. Am J Trop Med Hyg 60 :693–698.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Wongsrichanalai C, Murray CK, Gray M, Miller RS, McDaniel P, Liao WJ, Pickard AL, Magill AJ, 2003. Co-infection with malaria and leptospirosis. Am J Trop Med Hyg 68 :583–585.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Stevenson MM, 1989. Malaria: Host Responses to Infection. Boca Raton: CRC Press, 19–21.

    • PubMed
    • Export Citation
  • 31

    Ghosh K, Javeri KN, Mohanty D, Parmar BD, Surati RR, Joshi SH, 2001. False-positive serological tests in acute malaria. Br J Biomed Sci 58 :20–23.

  • 32

    Watt G, Jongsakul K, Suttinont C, 2003. Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis. Am J Trop Med Hyg 68 :89–91.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 506 448 32
Full Text Views 338 9 0
PDF Downloads 128 10 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save