Emerging Infectious Diseases (Jul 2020)

Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia

  • Matthew J. Grigg,
  • Timothy William,
  • Emily G. Clemens,
  • Kaajal Patel,
  • Arjun Chandna,
  • Christopher S. Wilkes,
  • Bridget E. Barber,
  • Nicholas M. Anstey,
  • J. Stephen Dumler,
  • Tsin W. Yeo,
  • Megan E. Reller

DOI
https://doi.org/10.3201/eid2607.191722
Journal volume & issue
Vol. 26, no. 7
pp. 1409 – 1419

Abstract

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Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013–2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to >160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.

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