title: First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua.
abstract: Rickettsial infections and Q fever present similarly to other acute febrile illnesses, but are infrequently diagnosed because of limited diagnostic tools. Despite sporadic reports, rickettsial infections and Q fever have not been prospectively studied in Central America.
  
  
  
  We enrolled consecutive patients presenting with undifferentiated fever in western Nicaragua and collected epidemiologic and clinical data and acute and convalescent sera. We used ELISA for screening and paired sera to confirm acute (≥4-fold rise in titer) spotted fever and typhus group rickettsial infections and Q fever as well as past (stable titer) infections. Characteristics associated with both acute and past infection were assessed.
  
  
  
  We enrolled 825 patients and identified acute rickettsial infections and acute Q fever in 0.9% and 1.3%, respectively. Clinical features were non-specific and neither rickettsial infections nor Q fever were considered or treated. Further study is warranted to define the burden of these infections in Central America.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Reller
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Ijeuru
authors.initials: I
authors.lastname: Chikeka
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, United States of America.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Miles
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
authors.affiliation: Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.|Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.affiliation: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors.forename: Orlando
authors.initials: O
authors.lastname: Mayorga
authors.affiliation: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Matute
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D011778:Q Fever / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D012282:Rickettsia Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D012612:Scrub Typhus / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D012698:Serologic Tests
chemical_list: D000907:Antibodies, Bacterial