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Concurrent Infections in Acute Febrile Illness Patients in Egypt

Tina M. ParkerUnited 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. MurrayUnited 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. RichardsUnited 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 SamirUnited 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 IsmailUnited 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 FadeelUnited 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 JiangUnited 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. WasfyUnited 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 PimentelUnited 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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