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Volume 31, Number 6—June 2025

CME ACTIVITY - Synopsis

Clinical Manifestations, Risk Factors, and Disease Burden of Rickettsiosis, Cambodia, 2007–2020

Gerard C. Kelly, Agus Rachmat, Long Khanh Tran, Chonthida Supaprom, Hip Phireak, Satharath Prom, Heng Sopheab, Nora Cleary, Michael von Fricken, Christina M. Farris, and Andrew G. LetiziaComments to Author 
Author affiliation: Culmen International, LLC, Alexandria, Virginia, USA (G.C. Kelly, L.K. Tran); AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia (A. Rachmat, C. Supaprom, H. Phireak); Oxford University Clinical Research Unit, Jakarta, Indonesia (A. Rachmat); Cambodia Ministry of National Defense Department of Health, Phnom Penh (S. Prom); Cambodia National Institute of Public Health, Phnom Penh (H. Sopheab); University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA (N. Cleary, M. von Fricken); US Naval Medical Research Command Viral and Rickettsial Diseases Department, Silver Spring, Maryland, USA (C.M Farris); US Naval Medical Research Unit INDO PACIFIC, Singapore (A.G. Letizia)

Main Article

Table 4

Association between reported symptoms and rickettsial infection among patients with acute undifferentiated febrile illness who tested positive for rickettsioses as part of study of rickettsiosis in Cambodia, 2007–2020*

Symptom Present Rickettsial infection
Total, n = 10,243 Negative, n = 9,441 Positive, n = 802 Unadjusted†
 Adjusted‡
OR (95% CI) p value OR (95% CI) p value
Fever
 Yes
 10,243
 9,441 (92.2)
 802 (7.8)
Malaise
 No 3,373 3,204 (95.0) 169 (5.0) Referent Referent
Yes
 6,870
 6,237 (90.8)
 633 (9.2)
1.92 (1.62–2.30)
 <0.001
0.76 (0.60–0.96)
 0.019
Chills
 No 4,475 4,260 (95.2) 215 (4.8) Referent Referent
Yes
 5,768
 5,181 (89.8)
 587 (10.2)
2.24 (1.91–2.64)
 <0.001
1.39 (1.16–1.68)
 <0.001
Joint Pain
 No 7,359 6,921 (94.1) 438 (5.9) Referent Referent
Yes
 2,884
 2,520 (87.4)
 364 (12.6)
2.28 (1.97–2.64)
 <0.001
1.15 (0.95–1.38)
 0.2
Nausea
 No 7,594 7,104 (93.6) 490 (6.4) Referent Referent
Yes
 2,649
 2,337 (88.2)
 312 (11.8)
1.94 (1.67–2.25)
 <0.001
0.79 (0.62–1.00)
 0.056
Vomit
 No 8,347 7,820 (93.7) 527 (6.3) Referent Referent
Yes
 1,896
 1,621 (85.5)
 275 (14.5)
2.52 (2.15–2.94)
 <0.001
1.64 (1.29–2.07)
 <0.001
Abdominal cramps
 No 9,083 8,349 (91.9) 734 (8.1) Referent Referent
Yes
 1,160
 1,092 (94.1)
 68 (5.9)
0.71 (0.54–0.91)
 0.008
0.77 (0.55–1.04)
 0.10
Diarrhea
 No 9,813 9,048 (92.2) 765 (7.8) Referent Referent
Yes
 430
 393 (91.4)
 37 (8.6)
1.11 (0.78–1.55)
 0.5
1.57 (1.02–2.38)
 0.036
Bloody stool
 No 10,203 9,403 (92.2) 800 (7.8) Referent Referent
Yes
 40
 38 (95.0)
 2 (5.0)
0.62 (0.10–2.02)
 0.5
0.52 (0.08–1.87)
 0.4
Cough
 No 3,362 3,099 (92.2) 263 (7.8) Referent Referent
Yes
 6,881
 6,342 (92.2)
 539 (7.8)
0.86–1.17
 >0.9
0.95 (0.77–1.18)
 0.7
Headache
 No 1,615 1,566 (97.0) 49 (3.0) Referent Referent
Yes
 8,628
 7,875 (91.3)
 753 (8.7)
3.06 (2.30–4.15)
 <0.001
1.47 (1.07–2.07)
 0.020
Sore throat
 No 4,348 4,040 (92.9) 308 (7.1) Referent Referent
Yes
 5,895
 5,401 (91.6)
 494 (8.4)
1.20 (1.04–1.39)
 0.016
0.99 (0.81–1.21)
 >0.9
Muscle aches
 No 6,223 5,944 (95.5) 279 (4.5) Referent Referent
Yes
 4,020
 3,497 (87.0)
 523 (13.0)
3.19 (2.74–3.71)
 <0.001
1.39 (1.12–1.74)
 0.004
Shortness of breath
 No 9,430 8,681 (92.1) 749 (7.9) Referent Referent
Yes
 813
 760 (93.5)
 53 (6.5)
0.81 (0.60–1.07)
 0.15
0.84 (0.62–1.13)
 0.3
Rash
 No 9,909 9,183 (92.7) 726 (7.3) Referent Referent
Yes
 334
 258 (77.3)
 76 (22.7)
3.73 (2.84–4.84)
 <0.001
2.21 (1.63–2.97)
 <0.001
Lesion
 No 9,684 9,011 (93.1) 673 (6.9) Referent Referent
Yes
 559
 430 (76.9)
 129 (23.1)
4.02 (3.24–4.95)
 <0.001
1.63 (1.25–2.12)
 <0.001
Seizure
 No 10,172 9,375 (92.2) 797 (7.8) Referent Referent
Yes
 71
 66 (93.0)
 5 (7.0)
0.89 (0.31–2.01)
 0.8
1.00 (0.34–2.35)
 >0.9
Other symptoms No 9,670 8,881 (91.8) 789 (8.2) Referent Referent
Yes 573 560 (97.7) 13 (2.3) 0.26 (0.14–0.44) <0.001 0.36 (0.19–0.60) <0.001

*Values are no. (%) except as indicated. OR, odds ratio. †Unadjusted generalized linear model for binomial regression. ‡Generalized linear model for binomial regression adjusted by age, gender, and enrollment year.

Main Article

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