Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia.

Journal Article (Journal Article)

Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013-2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to >160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.

Full Text

Duke Authors

Cited Authors

  • Grigg, MJ; William, T; Clemens, EG; Patel, K; Chandna, A; Wilkes, CS; Barber, BE; Anstey, NM; Dumler, JS; Yeo, TW; Reller, ME

Published Date

  • July 2020

Published In

Volume / Issue

  • 26 / 7

PubMed ID

  • 32568664

Pubmed Central ID

  • PMC7323546

Electronic International Standard Serial Number (EISSN)

  • 1080-6059

Digital Object Identifier (DOI)

  • 10.3201/eid2607.191722


  • eng

Conference Location

  • United States