title: Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh.
abstract: We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh.
  
  
  
  We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC).
  
  
  
  Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever.
  
  
  
  Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.
authors.affiliation: International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh. labibimran@yahoo.com.
authors.forename: Labib Imran
authors.initials: LI
authors.lastname: Faruque
authors.affiliation: International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Rashid Uz
authors.initials: RU
authors.lastname: Zaman
authors.affiliation: International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Massung
authors.affiliation: Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
authors.forename: A S M
authors.initials: AS
authors.lastname: Alamgir
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Renee L
authors.initials: RL
authors.lastname: Galloway
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Powers
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kosoy
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Nicholson
authors.affiliation: Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh.
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001459:Bangladesh / Q000453:epidemiology; D001473:Bartonella / Q000302:isolation & purification; D002487:Centers for Disease Control and Prevention, U.S.; D065632:Chikungunya Fever / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D003381:Coxiella / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000382:microbiology*; D019084:Fluorescent Antibody Technique, Indirect; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D007919:Leptospira / Q000302:isolation & purification; D008297:Male; D015995:Prevalence; D012281:Rickettsia / Q000302:isolation & purification; D012612:Scrub Typhus / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D016036:Seroepidemiologic Studies; D014481:United States; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial
keywords: Bangladesh; Bartonella; Chikungunya virus; Coxiella; Febrile illness; Leptospira; Rickettsia