Publication: Etiologies of acute undifferentiated febrile illness in Bangkok, Thailand
Issued Date
2019-01-01
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ISSN
00029637
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2-s2.0-85062600552
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.100, No.3 (2019), 622-629
Suggested Citation
Viravarn Luvira, Udomsak Silachamroon, Watcharapong Piyaphanee, Saranath Lawpoolsri, Wirongrong Chierakul, Pornsawan Leaungwutiwong, Charin Thawornkuno, Yupaporn Wattanagoon Etiologies of acute undifferentiated febrile illness in Bangkok, Thailand. American Journal of Tropical Medicine and Hygiene. Vol.100, No.3 (2019), 622-629. doi:10.4269/ajtmh.18-0407 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51114
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Title
Etiologies of acute undifferentiated febrile illness in Bangkok, Thailand
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Abstract
Copyright © 2019 by The American Society of Tropical Medicine and Hygiene. Acute undifferentiated febrile illness (AUFI) has been a diagnostic dilemma in the tropics. Without accurate point-of-care tests, information on local pathogens and clinical parameters is essential for presumptive diagnosis. A prospective hospital-based study was conducted at the Bangkok Hospital for Tropical Diseases from 2013 to 2015 to determine common etiologies of AUFI. A total of 397 adult AUFI cases, excluding malaria by blood smear, were enrolled. Rapid diagnostic tests for tropical infections were performed on admission, and acute and convalescent samples were tested to confirm the diagnosis. Etiologies could be identified in 271 (68.3%) cases. Dengue was the most common cause, with 157 cases (39.6%), followed by murine typhus (20 cases; 5.0%), leptospirosis (16 cases; 4.0%), influenza (14 cases; 3.5%), and bacteremia (six cases; 1.5%). Concurrent infection by at least two pathogens was reported in 37 cases (9.3%). Furthermore, characteristics of dengue and bacterial infections (including leptospirosis and rickettsioses) were compared to facilitate dengue triage, initiate early antibiotic treatment, and minimize unnecessary use of antibiotics. In conclusion, dengue was the most common pathogen for AUFI in urban Thailand. However, murine typhus and leptospirosis were not uncommon. Empirical antibiotic treatment using doxycycline or azithromycin might be more appropriate, but cost–benefit studies are required. Physicians should recognize common causes of AUFI in their localities and use clinical and laboratory clues for provisional diagnosis to provide appropriate treatment while awaiting laboratory confirmation.