Volume 14, Number 10—October 2008
Dispatch
Murine Typhus and Febrile Illness, Nepal
Mark D. Zimmerman, David R. Murdoch
, Patrick J. Rozmajzl, Buddha Basnyat, Christopher W. Woods, Allen L. Richards, Ram Hari Belbase, David A. Hammer, Trevor P. Anderson, and L. Barth Reller
, Patrick J. Rozmajzl, Buddha Basnyat, Christopher W. Woods, Allen L. Richards, Ram Hari Belbase, David A. Hammer, Trevor P. Anderson, and L. Barth RellerTable
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.
