title: Q fever, spotted fever group, and typhus group rickettsioses among hospitalized febrile patients in northern Tanzania.
abstract: BACKGROUND
  The importance of Q fever, spotted fever group rickettsiosis (SFGR), and typhus group rickettsiosis (TGR) as causes of febrile illness in sub-Saharan Africa is unknown; the putative role of Q fever as a human immunodeficiency virus (HIV) coinfection is unclear.
  
  
  METHODS
  We identified febrile inpatients in Moshi, Tanzania, from September 2007 through August 2008 and collected acute- and convalescent-phase serum samples. A ≥4-fold increase in immunoglobulin (Ig) G immunfluorescence assay (IFA) titer to Coxiella burnetii phase II antigen defined acute Q fever. A ≥4-fold increase in IgG IFA titer to Rickettsia conorii or Rickettsia typhi antigen defined SFGR and TGR, respectively.
  
  
  RESULTS
  Among 870 patients, 483 (55.5%) were tested for acute Q fever, and 450 (51.7%) were tested for acute SFGR and TGR. Results suggested acute Q fever in 24 (5.0%) patients and SFGR and TGR in 36 (8.0%) and 2 (0.5%) patients, respectively. Acute Q fever was associated with hepato- or splenomegaly (odds ratio [OR], 3.1; P = .028), anemia (OR, 3.0; P = .009), leukopenia (OR, 3.9; P = .013), jaundice (OR, 7.1; P = .007), and onset during the dry season (OR, 2.7; P = .021). HIV infection was not associated with acute Q fever (OR, 1.7; P = .231). Acute SFGR was associated with leukopenia (OR, 4.1; P = .003) and with evidence of other zoonoses (OR, 2.2; P = .045).
  
  
  CONCLUSIONS
  Despite being common causes of febrile illness in northern Tanzania, Q fever and SFGR are not diagnosed or managed with targeted antimicrobials. C. burnetii does not appear to be an HIV-associated co-infection.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Duke University, Durham, North Carolina 27710, USA.
authors.forename: Malavika
authors.initials: M
authors.lastname: Prabhu
authors.forename: William L
authors.initials: WL
authors.lastname: Nicholson
authors.forename: Aubree J
authors.initials: AJ
authors.lastname: Roche
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Kersh
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Fitzpatrick
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Oliver
authors.forename: Robert F
authors.initials: RF
authors.lastname: Massung
authors.forename: Anne B
authors.initials: AB
authors.lastname: Morrissey
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: Jecinta J
authors.initials: JJ
authors.lastname: Onyango
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
authors.forename: Grace D
authors.initials: GD
authors.lastname: Kinabo
authors.forename: Wilbrod
authors.initials: W
authors.lastname: Saganda
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016997:Coxiella burnetii / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011778:Q Fever / Q000453:epidemiology* / Q000382:microbiology; D012282:Rickettsia Infections / Q000453:epidemiology* / Q000382:microbiology; D020114:Rickettsia conorii / Q000302:isolation & purification; D012286:Rickettsia typhi / Q000302:isolation & purification; D013636:Tanzania / Q000453:epidemiology