Epidemiology of the acute fevers of unknown origin in South Vietnam: Effect of laboratory support upon clinical diagnosis *

Berman, Steven; Irving, G. S.; Kundin, W. D.; Gunning, Jean-Jacques; Watten, Raymond H.

doi:10.4269/ajtmh.1973.22.796

Cited by 36 publications

(20 citation statements)

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“…All these lead to clustering of dengue, malaria, typhoid and scrub typhus. Scrub typhus and leptospirosis have been reported in around 10%-20% cases of acute febrile illness in South east Asia [4][5][6][7]. …”

Section: Discussionmentioning

confidence: 99%

A study of Etiological Pattern in an Epidemic of Acute Febrile Illness During Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

Singh

Ahmad³

2014

JCDR

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Section: Discussionmentioning

confidence: 99%

A study of Etiological Pattern in an Epidemic of Acute Febrile Illness During Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

Singh

Ahmad³

2014

JCDR

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“…Leptospirosis is probably the most widespread zoonosis in the world and so it is not surprising that military cases have been reported from both World Wars [17], the conflicts in Malaya [18], Borneo [19] and Vietnam [20] and more recently from troops in Germany [17] and the UK [21]. Relapsing fever is a less common spirochaete infection, but the louse-borne form was a major problem during World War I [22] and the tick-borne form previously affected British troops in Palestine [23], Somaliland [24] and Cyprus [25] and military cases are still reported from Israel [26].…”

Section: Spirochaetesmentioning

confidence: 99%

“…Louse-borne typhus was a major problem in Europe during both World Wars [22,28] and scrub typhus was a problem for British troops in South-East Asia during World War II with smaller numbers of murine typhus and spotted fever occurring as well [29]. Military cases of scrub typhus were also reported from the Korean War [30], Malayan Emergency [31], Vietnam War [20] and Hong Kong [32]. More recently outbreaks of spotted fever have occurred during British military exercises in Africa and the USA [33].…”

Section: Rickettsiaementioning

confidence: 99%

Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan

Bailey

Trinick²,

Dunbar³

et al. 2011

J R Army Med Corps

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These cases probably represent the "tip of an iceberg" for British and Allied forces. More resources for diagnostic facilities and follow-up of patients are required to improve the management and surveillance of "Helmand Fever" cases; until then doxycycline 100 mg twice daily for 2 weeks should be given to all troops who present with an undifferentiated febrile illness in Helmand, Afghanistan. Patients with acute Q fever should be followed-up for at least 2 years to exclude chronic Q fever. Prevention of these diseases requires a better understanding of their epidemiology, but prophylaxis with doxycycline and possibly Q fever vaccine should be considered.

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“…Rural women are exposed to the infection when they perform agricultural tasks and may actually experience higher levels of exposure than men (23). Military activity can also result in a significant incidence of scrub typhus (4,7) because of the inherent disturbance of habitats and the contact of many troops with the vectors. Women in the U.S. military are currently performing many more duties which were traditionally performed by men (6) and may be expected to have increased contact with scrub typhus.…”

mentioning

confidence: 99%

In vitro effectiveness of azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus

Strickman

Sheer

Salata

et al. 1995

Antimicrob Agents Chemother

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In an effort to find a potential alternative treatment for scrub typhus, we evaluated the effectiveness of the standard drug doxycycline and the new macrolide azithromycin against a doxycycline-susceptible strain (Karp) and a doxycycline-resistant strain (AFSC-4) of Rickettsia tsutsugamushi. The antibiotics were tested in an in vitro assay system in which infected mouse fibroblast cells (L929) were incubated for 3 days in various concentrations of the drugs. Rickettsial growth was evaluated by direct visual counts of rickettsiae in Giemsastained cells or by flow cytometry. Initial tests were conducted at the concentration of each antibiotic considered to be the upper breakpoint for susceptibility (16 g/ml for doxycycline and 8 g/ml for azithromycin). Growth of both Karp and AFSC-4 was strongly inhibited with both antibiotics, as measured by visual counts, although the percentage of cells infected with AFSC-4 in the presence of doxycycline was three times greater than the percentage of cells infected with Karp but was only 60% as great as the percentage of cells infected with Karp in the presence of azithromycin. Flow cytometry confirmed that rickettsial growth occurred in the absence of antibiotics, but it failed to detect it in the presence of high concentrations of either drug. Visual counts of rickettsial growth at lower concentrations of the antibiotics (0.25 to 0.0078 g/ml) showed that the Karp strain was 16 times more susceptible that the AFSC-4 strain to doxycycline. Azithromycin was much more effective than doxycycline against AFSC-4, inhibiting rickettsial growth at 0.0156 g/ml to levels below that achieved by 0.25 g of doxycycline per ml. Azithromycin was also more effective than doxycycline against the Karp strain, causing greater reductions in the number of rickettsiae per cell at lower concentrations. If in vivo testing confirms the in vitro effectiveness of azithromycin, it may prove to be the drug of choice for the treatment of scrub typhus in children and pregnant women, who should not take doxycycline, and in patients with refractory disease from locations where doxycycline-resistant strains of R. tsutsugamushi have been found. When tested in an in vitro assay system, azithromycin was more effective than doxycycline against doxycyclinesusceptible and -resistant strains of R. tsutsugamushi.

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Epidemiology of the acute fevers of unknown origin in South Vietnam: Effect of laboratory support upon clinical diagnosis *

Cited by 36 publications

References 0 publications

A study of Etiological Pattern in an Epidemic of Acute Febrile Illness During Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

A study of Etiological Pattern in an Epidemic of Acute Febrile Illness During Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan

In vitro effectiveness of azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus

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