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Volume 24, Number 4—April 2018

Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh

Hugh W. Kingston, Mosharraf Hossain, Stije Leopold, Tippawan Anantatat, Ampai Tanganuchitcharnchai, Ipsita Sinha, Katherine Plewes, Richard J. Maude, M.A. Hassan Chowdhury, Sujat Paul, Rabiul Alam Mohammed Erfan Uddin, Mohammed Abu Naser Siddiqui, Abu Shahed Zahed, Abdullah Abu Sayeed, Mohammed Habibur Rahman, Anupam Barua, Mohammed Jasim Uddin, Mohammed Abdus Sattar, Arjen M. Dondorp, Stuart D. Blacksell, Nicholas P.J. Day, Aniruddha Ghose, Amir Hossain, and Daniel H. ParisComments to Author 
Author affiliations: Charles Darwin University, Casuarina, Northern Territory, Australia (H.W. Kingston); Mahidol University, Bangkok, Thailand (H.W. Kingston, S. Leopold, T. Anantatat, A. Tanganuchitcharnchai, I. Sinha, K. Plewes, R.J. Maude, A.M. Dondorp, S.D. Blacksell, N.P.J. Day, D.H. Paris); Chittagong Medical College Hospital, Chittagong, Bangladesh (M. Hossain, M.A.H. Chowdhury, S. Paul, R.A.M.E. Uddin, M.A.N. Siddiqui, A.S. Zahed, A.A. Sayeed, M.H. Rahman, A. Barua, M.J. Uddin, M.A. Sattar, A. Ghose, A. Hossain); Oxford University, Oxfordshire, UK (I. Sinha, R.J. Maude, A.M. Dondorp, S.D. Blacksell, N.P.J. Day, D.H. Paris); Harvard University, Boston, Massachusetts, USA (R.J. Maude); Swiss Tropical and Public Health Institute, Basel, Switzerland (D.H. Paris); University of Basel, Basel (D.H. Paris)

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Results of PCR and serologic tests for rickettsial illness among 416 patients, Chittagong Medical College Hospital, Chittagong, Bangladesh, August 2014–September 2015*

Organism and test type No. positive/no. tested (%)
Orientia tsutsugamushi 70/416 (16.8)
Blood PCR, rPCR 47-kDa positive 45/414 (10.9)
nPCR 47 kDa positive 45/45 (100)
nPCR 56 kDa positive 45/45 (100)
Eschar swab, rPCR 47 kDa and n56kDa positive; crust (n = 1), swab (n = 3) 3/416 (0.7)
Indirect immunofluorescence assay 57/415 (13.7)
Admission titer >3,200 54/415 (13.0)
4-fold rise to >3,200 31/255 (12.1)
PCR+ and serology+, 32/70 (45.7% of ST positives) 32/413 (7.7)
PCR+ and serology–, 13/70 (18.6% ST positives) 13/413 (3.1)
PCR– and serology+, 25/70 (35.7% of ST positives)
25/413 (6.0)
Rickettsia spp. 29/416 (7.0)
Blood PCR, rPCR 17 kDa positive 23/414 (5.6)
nPCR 17 kDa positive 16/23 (69.6)
Rickettsia typhi, 24/29 (83.0%) of Rickettsia spp. 24/416 (5.8)
Blood PCR 17/414 (4.1)
rPCR OmpB positive 12/414 (2.9)
nPCR 17-kDa sequencing 15/16 (93.8)
Indirect immunofluorescence assay 15/415 (3.6)
Admission titer >3,200 11/415 (2.7)
4-fold rise to >3,200 5/255 (2.0)
PCR+ and serology+, 8/24 (33.3% of MT positives) 8/413 (1.9)
PCR+ and serology–, 9/24 (37.5% of MT positives) 9/413 (2.2)
PCR– and serology+, 7/24 (29.1% of MT positives) 7/413 (1.7)
Undifferentiated Rickettsia spp., 3/29 (10.3% of Rickettsia spp.) 3/416 (0.7)
rPCR 17-kDa positive, ompB negative 3/416 (0.7)
nPCR 17-kDa negative, gltA negative 3/416 (0.7)
MT serology negative 3/416 (0.7)
Rickettsia felis 2/416 (0.5)
Blood PCR, 17-kDa rPCR and nPCR 1/416 (0.2)
Eschar swab, 17-kDa rPCR and nPCR
1/416 (0.2)
All rickettsial illnesses† 96/416 (23.1)

*MT, murine typhus; nPCR, nested PCR; rPCR, real-time PCR; ST, scrub typhus.
†Twenty-nine patients had evidence of Rickettsia spp. Infection; 70 had evidence of O. tsutsugamushi infection. Because 2 case-patients had mixed blood O. tsutsugamushi and Rickettsia spp. infections and 1 case-patient with O. tsutsugamushi infection in addition to an eschar-positive swab for R. felis, the total number of rickettsial illness cases was 96.

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Page created: March 16, 2018
Page updated: March 16, 2018
Page reviewed: March 16, 2018
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