Concurrent Infections in Acute Febrile Illness Patients in Egypt

Tina M. Parker United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Clinton K. Murray United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Allen L. Richards United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Ahmed Samir United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Tharwat Ismail United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Moustafa Abdel Fadeel United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Ju Jiang United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Momtaz O. Wasfy United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Guillermo Pimentel United States Naval Medical Unit No. 3, Cairo, Egypt; Brooke Army Medical Center, Fort Sam Houston, Texas; Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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We report the occurrence of concurrent infections with multiple acute febrile illness (AFI) pathogens during an ongoing prospective laboratory-based surveillance in four infectious disease hospitals in urban and rural areas of Egypt from June 2005 to August 2006. Patients were screened for Leptospira, Rickettsia typhi, Brucella, or Salmonella enterica serogroup Typhi by various methods including serology, culture, and PCR. One hundred eighty-seven of 1,510 patients (12.4%) evaluated had supporting evidence for the presence of coinfections; 20 (1%) of these patients had 2 or more pathogens based upon confirmatory 4-fold rise in antibody titer, culture, and/or PCR. Most coinfected patients lived or worked in rural agricultural areas. The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.

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