Abstract
We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence-confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.
Highlights
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases
Samples from 2 patients were positive for R. felis (1 patient’s blood was positive for R. felis by 17kDa nested PCR (nPCR) and sequencing; the second patient was positive for O. tsutsugamushi by 47kDa and 56kDa nPCR and 56kDa gene sequencing from blood and eschar, and had a superficial eschar swab positive for R. felis by 17kDa nPCR and sequencing, suggestive of scrub typhus infection with possible skin carriage of R. felis on the skin or eschar)
Both of these patients with PCR evidence of R. felis infection were serologically negative by R. felis–specific immunofluorescence assays (IFA). In this prospective cohort of hospitalized febrile patients, 23.1% (96/416) of the fevers were attributable to rickettsial illnesses
Summary
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)TM. All other clinicians completing this activity will be issued a certificate of participation To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; and [4] view/print certificate. Disclosure: Jude Rutledge has disclosed no relevant financial relationships. MD, FAAFP, has disclosed the following relevant financial relationships: served as an advisor or consultant for Johnson & Johnson Healthcare; served as a speaker or a member of a speakers bureau for Shire Pharmaceuticals
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