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Volume 18, Number 5—May 2012

Dispatch

Unsuspected Rickettsioses among Patients with Acute Febrile Illness, Sri Lanka, 2007

Megan E. RellerComments to Author , Champica Bodinayake, Ajith Nagahawatte, Vasantha Devasiri, Wasantha Kodikara-Arachichi, John J. Strouse, Judith E. Flom, Truls Østbye, Christopher W. Woods, and J. Stephen Dumler
Author affiliations: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (M. E. Reller, J.J. Strouse, J.S. Dumler); Johns Hopkins School of Public Health, Baltimore (J.E. Flom); Medical Faculty of University of Ruhuna, Galle, Sri Lanka (C. Bodinayake, A. Nagahawatte, V. Devasiri, W. Kodikara-Arachichi); Duke University School of Medicine, Durham, North Carolina, USA (T. Østbye, C.W. Woods)

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Table 1

Clinical and laboratory characteristics of febrile patients with and without acute rickettsial infections, southern Sri Lanka, 2007*

Characteristic Rickettsial infection
None,
n = 727 SFGR,
n = 86 TGR,
n = 29 Orientia tsutsugamushi,
n = 9 SFGR/TGR,
n = 24 SFGR or TGR + O. tsutsugamusi, n = 8 p value†
Median age, y (IQR) 28 (18–47) 31 (22–46) 44 (21–59) 37 (19–58) 39 (22–48) 37 (22–56) 0.06
Male sex 86 8 2 0.3 2 1 0.10
Admitted to hospital
71
78
69
89
71
88
0.51
Symptoms
Headache 78 79 79 67 79 63 0.86
Sore throat 29 28 21 22 29 13 0.82
Cough 60 49 54 56 30 63 0.048
Dyspnea 18 8 21 22 29 25 0.14
Joint pain 44 41 52 44 52 57 0.83
Muscle pain 48 52 57 56 42 43 0.83
Fatigue 66 69 66 56 71 63 0.96
Abdominal pain 19 19 21 33 30 0 0.43
Emesis 37 36 34 44 54 43 0.65
Diarrhea 12 9 7 22 13 0 0.66
Dysuria 13 23 7 22 25 13 0.07
Oliguria
8
17
3
11
21
13
0.02
Signs
Conjunctivitis 13 21 24 22 13 50 0.008
Throat exudate 15 12 21 0 8 0 0.41
Lymphadenopathy 23 20 14 22 21 38 0.74
Jaundice 2 0 4 0 0 0 0.70
Pulmonary rales 15 5 14 22 8 0 0.09
Tender abdomen 10 8 10 0 17 0 0.63
Hepatomegaly 5 6 3 22 0 13 0.19
Rash‡
9
15
0
50
0
0
0.18
Laboratory measures, mean ± SD
Leukocytes, cells/μL 8,893 ± 4,634 8,253 ± 3,774 10,341 ± 7,931 9,778 ± 4,800 9,129 ± 3,925 9,943 ± 4,527 0.96
ANC, cells/μL 6,325 ± 4,054 5,825 ± 3,263 7,114 ± 4,905 7,280 ± 3,890 6,494 ± 3,887 6,514 ± 3,762 0.57
ALC, cells/μL 2,317 ± 1,234 2,284 ± 1,378 2,822 ± 3,170 2,380 ± 1,291 2,460 ± 1,215 3,036 ± 1,526 0.33
Hemoglobin, g/dL 12.6 ± 1.7 12.6 ± 1.5 12.7 ± 1.6 13.0 ± 2.2 12.7 ± 1.6 12.4 ± 2.0 0.98
Platelets × 1,000/μL 249 ± 99 228 ± 84 237 ± 81 187 ± 74 219 ± 72 301 ± 119 0.05

*Values are % patients except as indicated. SFGR, spotted fever group rickettsiae; TGR, typhus group rickettsiae; IQR, intraquartile range; ANC, absolute neutrophil count; ALC, absolute lymphocyte count.
†Kruskal-Wallis test to compare proportions and non-normally distributed continuous variables. Analysis of variance test to compare normally distributed continuous variables.
‡n = 309; 6/6 with rickettsioses and rash had eschars, compared with 11/22 of those without rickettsioses (p<0.001).

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