Publication: Undifferentiated febrile illness in Kathmandu, Nepal
Issued Date
2015-01-01
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ISSN
00029637
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2-s2.0-84926313074
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.92, No.4 (2015), 875-878
Suggested Citation
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 Undifferentiated febrile illness in Kathmandu, Nepal. American Journal of Tropical Medicine and Hygiene. Vol.92, No.4 (2015), 875-878. doi:10.4269/ajtmh.14-0709 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/36156
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Undifferentiated febrile illness in Kathmandu, Nepal
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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.