title: A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh.
abstract: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.
  
  
  
  Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.
  
  
  
  We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.
  
  
  
  Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Rapeephan R
authors.initials: RR
authors.lastname: Maude
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Ghose
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Rasheda
authors.initials: R
authors.lastname: Samad
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: de Jong
authors.affiliation: Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Masako
authors.initials: M
authors.lastname: Fukushima
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Lalith
authors.initials: L
authors.lastname: Wijedoru
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Mahtab Uddin
authors.initials: MU
authors.lastname: Hassan
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Md Amir
authors.initials: MA
authors.lastname: Hossain
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Md Rezaul
authors.initials: MR
authors.lastname: Karim
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Abdullah Abu
authors.initials: AA
authors.lastname: Sayeed
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Stannie
authors.initials: S
authors.lastname: van den Ende
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Sujat
authors.initials: S
authors.lastname: Pal
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: A S M
authors.initials: AS
authors.lastname: Zahed
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Wahid
authors.initials: W
authors.lastname: Rahman
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Rifat
authors.initials: R
authors.lastname: Karnain
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh.
authors.forename: Rezina
authors.initials: R
authors.lastname: Islam
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Dung Thi Ngoc
authors.initials: DT
authors.lastname: Tran
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Tuyen Thanh
authors.initials: TT
authors.lastname: Ha
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Anh Hong
authors.initials: AH
authors.lastname: Pham
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.
authors.forename: H Rogier
authors.initials: HR
authors.lastname: van Doorn
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Maude
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van der Poll
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: W Joost
authors.initials: WJ
authors.lastname: Wiersinga
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.|Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. chris.parry@lshtm.ac.uk.|Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. chris.parry@lshtm.ac.uk.|Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. chris.parry@lshtm.ac.uk.|School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan. chris.parry@lshtm.ac.uk.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Malaria Research Group and Dev Care Foundation, Chittagong, Bangladesh.
authors.forename: Md Abul
authors.initials: MA
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012485:Salmonella typhi / Q000302:isolation & purification / Q000502:physiology; D014435:Typhoid Fever / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
keywords: Bangladesh; Enteric fever; Non-malaria febrile illness