title: Emerging rickettsial infections in Sri Lanka: the pattern in the hilly Central Province.
abstract: OBJECTIVE
  To identify different rickettsial infections using a specific immunofluorescent technique in patients clinically diagnosed as 'typhus fever' in the Central Province of Sri Lanka, and to define the clinical picture, assess the severity of infection and to determine the pattern of geographical distribution of the infections of the hospital-based patients.
  
  
  METHODS
  A specific indirect immunofluorescent antibody technique was used on the sera of two groups of patients in laboratories in Japan and Thailand.
  
  
  RESULTS
  We serodiagnosed infections with Orientia tsutsugamushi, Rickettsia typhi and spotted fever group in 56 of 118 clinically investigated patients. There were eight infections with O. tsutsugamushi, two with R. typhi and 10 spotted fever group patients with IgM antibodies suggestive of acute infection. Nineteen patients had antibodies against these three rickettsial species, suggestive of past exposure, co-infection or cross-reactivity of antigens. Discrete, erythematous maculopapular rash was common to all three types of infection except for five patients who had no rash. Five patients positive for spotted fever antibodies developed fern-leaf type skin necrosis with severe illness. Duration of the febrile period ranged from 4 to 23 days with defervescence occurring after specific antibiotic treatment.
  
  
  CONCLUSIONS
  The study has shown the presence of different types of rickettsial infections in the Central Province of Sri Lanka. The characterization of the clinical picture and the severity of infection provide useful information for the proper management of the patients in the future.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. samkul@sltnet.lk
authors.forename: S A M
authors.initials: SA
authors.lastname: Kularatne
authors.forename: J S
authors.initials: JS
authors.lastname: Edirisingha
authors.forename: I B
authors.initials: IB
authors.lastname: Gawarammana
authors.forename: H
authors.initials: H
authors.lastname: Urakami
authors.forename: M
authors.initials: M
authors.lastname: Chenchittikul
authors.forename: I
authors.initials: I
authors.lastname: Kaiho
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001907:Boutonneuse Fever / Q000453:epidemiology / Q000276:immunology; D021821:Communicable Diseases, Emerging / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect / Q000379:methods; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012282:Rickettsia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D012612:Scrub Typhus / Q000453:epidemiology; D012698:Serologic Tests; D012871:Skin Diseases / Q000150:complications / Q000453:epidemiology; D012959:Socioeconomic Factors; D013188:Sri Lanka / Q000453:epidemiology; D014437:Typhus, Endemic Flea-Borne / Q000453:epidemiology / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M