Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

Abstract

Acute undifferentiated febrile illness (AUFI) has been a diagnostic dilemma in the tropics. Without accurate point-of-care tests, information on local pathogens and clinical parameters is essential for presumptive diagnosis. A prospective hospital-based study was conducted at the Bangkok Hospital for Tropical Diseases from 2013 to 2015 to determine common etiologies of AUFI. A total of 397 adult AUFI cases, excluding malaria by blood smear, were enrolled. Rapid diagnostic tests for tropical infections were performed on admission, and acute and convalescent samples were tested to confirm the diagnosis. Etiologies could be identified in 271 (68.3%) cases. Dengue was the most common cause, with 157 cases (39.6%), followed by murine typhus (20 cases; 5.0%), leptospirosis (16 cases; 4.0%), influenza (14 cases; 3.5%), and bacteremia (six cases; 1.5%). Concurrent infection by at least two pathogens was reported in 37 cases (9.3%). Furthermore, characteristics of dengue and bacterial infections (including leptospirosis and rickettsioses) were compared to facilitate dengue triage, initiate early antibiotic treatment, and minimize unnecessary use of antibiotics. In conclusion, dengue was the most common pathogen for AUFI in urban Thailand. However, murine typhus and leptospirosis were not uncommon. Empirical antibiotic treatment using doxycycline or azithromycin might be more appropriate, but cost-benefit studies are required. Physicians should recognize common causes of AUFI in their localities and use clinical and laboratory clues for provisional diagnosis to provide appropriate treatment while awaiting laboratory confirmation.

An investig-ation into the epidemiology of chikungunya virus across neglected regions of Indonesia

“…= 0.0-2.7%) across the three study sites were associated with CHIKV infection (RNA or IgM positive). In comparison, similar studies of febrile patients in a non-outbreak setting have reported CHIKV infection rates of 0.6% in Cambodia [39], 1.1% in Thailand [40] and 7.5% in the Philippines [41]. Within Indonesia, a prospective study, conducted at a single site in Bandung, central Java, between 2000-2004 and 2006-2008 reported CHIKV infections in 7.1% of febrile patients outside of any outbreak [42], while another recent multi-site study conducted in Java and Bali between 2013-16 reported a prevalence of 3.7% in febrile, dengue-negative patients [43] suggesting that, at present, CHIKV transmission is more common in these areas.…”

Case Report: COVID-19 Presenting as Acute Undifferentiated Febrile Illness—A Tropical World Threat

“…Dengue and murine typhus had to be included in the differential diagnosis of this case because he stayed in a suburban area of Bangkok for a week. 5 His history of living on the Thai-Myanmar border raised the possibilities of malaria, scrub typhus, and leptospirosis. 6 Whereas malaria and dengue could be easily evaluated by point-of-care tests, tests for rickettsiosis and leptospirosis were not available.…”

“…The Hospital for Tropical Diseases in Bangkok established a fever clinic in 2012 to facilitate the management of febrile patients and separate patients with possibly infectious etiologies from other outpatient department care. 5 Since the start of the COVID-19 outbreak in January 2020, history screening and an isolation room for suspected COVID-19 cases have been implemented. An acute respiratory tract clinic was set up later, according to the national Thai policy.…”

When and what to test for: A cost-effectiveness analysis of febrile illness test-and-treat strategies in the era of responsible antibiotic use

“…We selected two contrasting settings in Thailand with varying infection occurrence probabilities (Table 1): Northern Thailand, where leptospirosis, scrub typhus (bacterial infections) are more endemic-Scenario A [1], and Bangkok, where dengue (viral) is the most common cause of acute fever-Scenario B [21].…”

“…We determined the optimal decision by considering the tradeoff between antibiotic underuse (i.e., higher disability-adjusted life years (DALYs) and health care cost) and antibiotic overuse (i.e., unnecessary courses of antibiotics prescribed). We selected Thailand as an exemplary setting because it is endemic for several pathogens of interest, including dengue, leptospirosis, and scrub typhus at varying occurrence probabilities and immediate availability of published data for model development [1,21].…”