Rickettsial infections and fever, Vientiane, Laos

Simaly Phongmany, Jean-Marc Rolain, Rattanaphone Phetsouvanh, Stuart D Blacksell, Vimone Soukkhaseum, Bouachanh Rasachack, Khamphong Phiasakha, Surn Soukkhaseum, Khamthavi Frichithavong, Vang Chu, Valy Keolouangkhot, Bertrand Martinez-Aussel, Ko Chang, Chirapha Darasavath, Oudayvone Rattanavong, Siho Sisouphone, Mayfong Mayxay, Sisouphane Vidamaly, Philippe Parola, Changpeng Thammavong, Mayboun Heuangvongsy, Bounkong Syhavong, Didier Raoult, Nicholas J White, Paul N Newton, Simaly Phongmany, Jean-Marc Rolain, Rattanaphone Phetsouvanh, Stuart D Blacksell, Vimone Soukkhaseum, Bouachanh Rasachack, Khamphong Phiasakha, Surn Soukkhaseum, Khamthavi Frichithavong, Vang Chu, Valy Keolouangkhot, Bertrand Martinez-Aussel, Ko Chang, Chirapha Darasavath, Oudayvone Rattanavong, Siho Sisouphone, Mayfong Mayxay, Sisouphane Vidamaly, Philippe Parola, Changpeng Thammavong, Mayboun Heuangvongsy, Bounkong Syhavong, Didier Raoult, Nicholas J White, Paul N Newton

Abstract

Rickettsial diseases have not been described previously from Laos, but in a prospective study, acute rickettsial infection was identified as the cause of fever in 115 (27%) of 427 adults with negative blood cultures admitted to Mahosot Hospital in Vientiane, Laos. The organisms identified by serologic analysis were Orientia tsutsugamushi (14.8%), Rickettsia typhi (9.6%), and spotted fever group rickettsia (2.6% [8 R. helvetica, 1 R. felis, 1 R. conorii subsp. indica, and 1 Rickettsia "AT1"]). Patients with murine typhus had a lower frequency of peripheral lymphadenopathy than those with scrub typhus (3% vs. 46%, p<0.001). Rickettsioses are an underrecognized cause of undifferentiated febrile illnesses among adults in Laos. This finding has implications for the local empiric treatment of fever.

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