title: Undifferentiated febrile illness in Kathmandu, Nepal.
abstract: Undifferentiated febrile illnesses (UFIs) are common in low- and middle-income countries. We prospectively investigated the causes of UFIs in 627 patients presenting to a tertiary referral hospital in Kathmandu, Nepal. Patients with microbiologically confirmed enteric fever (218 of 627; 34.8%) randomized to gatifloxacin or ofloxacin treatment were previously reported. We randomly selected 125 of 627 (20%) of these UFI patients, consisting of 96 of 409 (23%) cases with sterile blood cultures and 29 of 218 (13%) cases with enteric fever, for additional diagnostic investigations. We found serological evidence of acute murine typhus in 21 of 125 (17%) patients, with 12 of 21 (57%) patients polymerase chain reaction (PCR)-positive for Rickettsia typhi. Three UFI cases were quantitative PCR-positive for Rickettsia spp., two UFI cases were seropositive for Hantavirus, and one UFI case was seropositive for Q fever. Fever clearance time (FCT) for rickettsial infection was 44.5 hours (interquartile range = 26-66 hours), and there was no difference in FCT between ofloxacin or gatifloxacin. Murine typhus represents an important cause of predominantly urban UFIs in Nepal, and fluoroquinolones seem to be an effective empirical treatment.
authors: Corinne N
authors: CN
authors: Thompson
authors: Stuart D
authors: SD
authors: Blacksell
authors: Daniel H
authors: DH
authors: Paris
authors: Amit
authors: A
authors: Arjyal
authors: Abhilasha
authors: A
authors: Karkey
authors: Sabina
authors: S
authors: Dongol
authors: Abhishek
authors: A
authors: Giri
authors: Christiane
authors: C
authors: Dolecek
authors: Nick
authors: N
authors: Day
authors: Stephen
authors: S
authors: Baker
authors: Guy
authors: G
authors: Thwaites
authors: Jeremy
authors: J
authors: Farrar
authors: Buddha
authors: B
authors: Basnyat
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005334:Fever; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D015242:Ofloxacin / Q000627:therapeutic use; D011446:Prospective Studies; D011778:Q Fever / Q000188:drug therapy / Q000453:epidemiology*; D012282:Rickettsia Infections / Q000188:drug therapy / Q000453:epidemiology*; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology*; D014437:Typhus, Endemic Flea-Borne / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015242:Ofloxacin; D000077734:Gatifloxacin