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Title: Undifferentiated febrile illness in Kathmandu, Nepal
Authors: Corinne N. Thompson
Stuart D. Blacksell
Daniel H. Paris
Amit Arjyal
Abhilasha Karkey
Sabina Dongol
Abhishek Giri
Christiane Dolecek
Nick Day
Stephen Baker
Guy Thwaites
Jeremy Farrar
Buddha Basnyat
University of Oxford
Wellcome Trust
Mahidol University
Keywords: Immunology and Microbiology
Issue Date: 1-Jan-2015
Citation: American Journal of Tropical Medicine and Hygiene. Vol.92, No.4 (2015), 875-878
Abstract: Copyright © 2015 by The American Society of Tropical Medicine and Hygiene. Undifferentiated febrile illnesses (UFIs) are common in low- and middle-income countries.We prospectively investigated the causes of UFIs in 627 patients presenting to a tertiary referral hospital in Kathmandu, Nepal. Patients with microbiologically confirmed enteric fever (218 of 627; 34.8%) randomized to gatifloxacin or ofloxacin treatment were previously reported. We randomly selected 125 of 627 (20%) of these UFI patients, consisting of 96 of 409 (23%) cases with sterile blood cultures and 29 of 218 (13%) cases with enteric fever, for additional diagnostic investigations. We found serological evidence of acute murine typhus in 21 of 125 (17%) patients, with 12 of 21 (57%) patients polymerase chain reaction (PCR)-positive for Rickettsia typhi. Three UFI cases were quantitative PCR-positive for Rickettsia spp., two UFI cases were seropositive for Hantavirus, and one UFI case was seropositive for Q fever. Fever clearance time (FCT) for rickettsial infection was 44.5 hours (interquartile range = 26-66 hours), and there was no difference in FCT between ofloxacin or gatifloxacin. Murine typhus represents an important cause of predominantly urban UFIs in Nepal, and fluoroquinolones seem to be an effective empirical treatment.
ISSN: 00029637
Appears in Collections:Scopus 2011-2015

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