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Volume 14, Number 10—October 2008

Dispatch

Murine Typhus and Febrile Illness, Nepal

Mark D. Zimmerman, David R. MurdochComments to Author , Patrick J. Rozmajzl, Buddha Basnyat, Christopher W. Woods, Allen L. Richards, Ram Hari Belbase, David A. Hammer, Trevor P. Anderson, and L. Barth Reller
Author affiliations: Patan Hospital, Kathmandu, Nepal (M.D. Zimmerman, B. Basnyat, R.H. Belbase); University of Otago, Christchurch, New Zealand (D.R. Murdoch); Canterbury Health Laboratories, Christchurch (D.R. Murdoch, D.A. Hammer, T.P. Anderson); Naval Medical Research Center, Silver Spring, Maryland, USA (P.J. Rozmajzl, A.L. Richards); Duke University Medical Center, Durham, North Carolina, USA (C.W. Woods, L.B. Reller); Durham VA Medical Center, Durham (C.W. Woods);

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Table

Demographic, clinical, and laboratory features of patients with murine typhus and enteric fever, Nepal*

Variable Murine typhus, n = 50 Enteric fever, n = 94 p value
Demographics
Age, y, median (range) 28 (15–85) 22 (14–72) 0.0001
Male gender
18 (36)
61 (65)
0.001
Occupation 0.001
Housewife
17 (41)
10 (12)

Student
7 (17)
36 (42)

Business person 2 (5) 7 (8)
Government employee 2 (5) 8 (9)
Other
13 (32)
24 (28)

Residence


<0.001
Kathmandu
31 (86)
27 (32)

Patan 0 28 (33)
Kathmandu Valley 4 (11) 10 (12)
Other
1 (3)
20 (24)

Winter season
45 (90)
27 (29)
<0.001
Admission diagnosis <0.001
Enteric fever 21 (42) 66 (70)
Lower respiratory tract infection 13 (26) 3 (3)
Urinary tract infection 6 (12) 3 (3)
Upper respiratory tract infection 3 (6) 1 (1)
Other
7 (14)
21 (22)

Symptoms
Cough 33 (66) 30 (33) <0.001
Shortness of breath 16 (32) 6 (7) <0.001
Nausea 14 (28) 34 (37) 0.26
Diarrhea 5 (10) 16 (18) 0.24
Abdominal pain 16 (33) 25 (28) 0.58
Headache 41 (82) 78 (86) 0.56
Joint pain 12 (24) 11 (12) 0.07
Duration of symptoms, d, median (range)
5 (1–10)
5 (1–30)
0.23
Examination findings
Temperature, °C, mean (SD) 38.9 (0.7) 38.8 (0.6) 0.54
Respiratory rate, breaths/min, mean (SD) 26 (9) 21 (5) 0.0002
Heart rate, beats/min, mean (SD) 112 (17) 105 (15) 0.02
Systolic blood pressure, mm Hg, mean (SD) 109 (17) 107 (11) 0.52
Diastolic blood pressure, mm Hg, mean (SD) 70 (10) 70 (8) 0.88
Crackles
13 (26)
8 (9)
0.006
Hepatomegaly 2 (4) 9 (10) 0.22
Splenomegaly 2 (4) 12 (13) 0.09
Rash
0
1 (1)
0.46
Laboratory findings
Hematocrit, %, mean (SD) 39 (6) 39 (5) 0.70
Leukocyte count, cells × 109/L, median (IQR) 8.9 (6.2–11.1) 5.8 (4.8–7.6) <0.001
Neutrophils, %, median (IQR) 83 (74–87) 68 (60–73) <0.001
Lymphocytes, %, median (IQR) 13 (9–22) 27 (20–35) <0.001
Monocytes, %, median (IQR) 2.5 (1–5) 2 (0–4) 0.57
Eosinophils, %, median (IQR) 0.5 (0–2) 0 (0–2) 0.80

*Data are no. (%) unless otherwise stated. SD, standard deviation; IQR, interquartile range.

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