Undifferentiated Febrile Illness in Kathmandu, Nepal

被引:49
作者
Thompson, Corinne N. [3 ]
Blacksell, Stuart D. [2 ]
Paris, Daniel H. [2 ]
Arjyal, Amit [4 ]
Karkey, Abhilasha [4 ]
Dongol, Sabina [4 ]
Giri, Abhishek [4 ]
Dolecek, Christiane [3 ]
Day, Nick [2 ]
Baker, Stephen [3 ]
Thwaites, Guy [3 ]
Farrar, Jeremy [1 ]
Basnyat, Buddha [4 ]
机构
[1] Wellcome Trust Res Labs, London, England
[2] Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand
[3] Oxford Univ Clin Res Unit Vietnam, Hosp Trop Dis, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
[4] Patan Hosp, Patan Acad Hlth Sci, Oxford Clin Res Unit Nepal, Lalitpur, Nepal
基金
英国惠康基金;
关键词
UNCOMPLICATED ENTERIC FEVER; MURINE TYPHUS; RICKETTSIA-TYPHI; OPEN-LABEL; ASSAYS; GATIFLOXACIN; FELIS;
D O I
10.4269/ajtmh.14-0709
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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 0 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.
引用
收藏
页码:875 / 878
页数:4
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