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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.
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