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Volume 26, Number 7—July 2020
CME ACTIVITY - Research

Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia

Matthew J. Grigg, Timothy William, Emily G. Clemens, Kaajal Patel, Arjun Chandna, Christopher S. Wilkes, Bridget E. Barber, Nicholas M. Anstey, J. Stephen Dumler, Tsin W. Yeo, and Megan E. RellerComments to Author 
Author affiliations: Infectious Diseases Society Sabah–Menzies School of Health Research, Kota Kinabalu, Malaysia (M.J. Grigg, T. William, K. Patel, A. Chanda, C.S. Wilkes, B.E. Barber, N.M. Anstey, T.W. Yeo); Menzies School of Health Research–Charles Darwin University, Darwin, Northern Territory, Australia (M.J. Grigg, K. Patel, A. Chanda, C.S. Wilkes, B.E. Barber, N.M. Anstey, T.W. Yeo); Gleneagles Hospital, Kota Kinabalu (T. William); Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu (T. William); QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia (B.E. Barber); Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (J.S. Dumler); Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (T.W. Yeo); Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore (T.W. Yeo); Duke University, Durham, North Carolina, USA (M.E. Reller); Duke Global Health Institute, Durham (M.E. Reller)

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Table 2

Clinical features of patients with acute rickettsioses versus no rickettsioses in a prospective cohort study of acute febrile illness attributable to rickettsioses, Sabah, East Malaysia, 2013–2015*

Characteristic Confirmed acute rickettsial infection Probable acute rickettsial infection p value for
confirmed vs. probable acute infection No rickettsial infection p value for
confirmed or probable acute vs. no infection p value for
confirmed acute vs. no infection
No. patients
 49
 77
 NA
 102
 NA
 NA
Demographics
Age, median, y (IQR) 39 (2–56) 43 (28–62) 0.32 29 (8–55) 0.007 0.15
Child <15 y of age 8 (16) 3 (4) 0.023 29 (28) <0.001 0.22
Sex
M 31 (63) 48 (62) 0.92 48 (47) 0.029 0.20
F
 18 (37)
 29 (38)
54 (53)
Symptoms
Symptoms data available 48 (98) 75 (97) 0.99 102 (100) 0.99 0.99
Fever duration, median days (IQR) 2 (2–4) 3 (2–5) 0.46 3 (1–4) 0.64 0.89
Headache 36 (75) 60 (80) 0.65 60 (59) 0.004 0.05
Dizziness 33 (69) 44 (59) 0.23 49 (48) 0.029 0.017
Confusion 5 (10) 5 (7) 0.34 9 (9) 0.75 0.75
Vision changes 8 (17) 10 (13) 0.56 11 (11) 0.42 0.31
Retro-orbital pain 11 (23) 19 (25) 0.99 22 (22) 0.82 0.85
Hearing loss 7 (15) 4 (5) 0.11 2 (2) 0.023 0.005
Coryza 16 (33) 22 (30) 0.50 32 (31) 0.82 0.81
Cough 23 (48) 34 (45) 0.59 41 (40) 0.48 0.37
Dyspnea 16 (33) 13 (17) 0.047 27 (26) 0.64 0.39
Joint pain 20 (42) 29 (39) 0.62 36 (35) 0.57 0.45
Muscle pain 14 (29) 13 (17) 0.08 23 (23) 0.81 0.38
Lethargy 32 (67) 45 (60) 0.37 59 (58) 0.54 0.30
Nausea 16 (33) 34 (46) 0.16 44 (44) 0.71 0.23
Vomiting 13 (27) 27 (36) 0.32 47 (46) 0.035 0.027
Abdominal pain 20 (42) 33 (44) 0.56 41 (40) 0.48 0.86
Loss of appetite 34 (71) 49 (66) 0.43 70 (68) 0.76 0.79
Diarrhea 12 (25) 20 (27) 0.67 32 (31) 0.49 0.42
Dysuria
 4 (8)
 6 (8)
 0.99
 6 (6)
 0.61
 0.46
Signs
Conjunctival suffusion 0/46 (0) 0/73 (0) NA 2/95 (2) 0.21 0.99
Respiratory distress† 10 (21) 21 (27) 0.67 34 (33) 0.21 0.17
Respiratory crepitations on auscultation 5 (10) 12/74 (16) 0.25 18 (18) 0.32 0.33
Abnormal chest radiograph result 8/14 (57) 18/31 (58) 0.50 23/39 (59) 0.70 0.99
Maculopapular rash 4 (8) 10/75 (13) 0.37 6 (6) 0.23 0.73
Eschar 0/47 (0) 0/74 (0) NA 0/101 (0) NA NA
Lymphadenopathy 0/46 (0) 2/72 (3) 0.53 3/98 (3) 0.67 0.55
Abdominal tenderness 7/44 (16) 5/49 (10) 0.36 11/91 (12) 0.76 0.59
Hepatomegaly 10 (21) 9/75 (12) 0.13 10 (10) 0.17 0.06
Splenomegaly 3/41 (7) 2/73 (3) 0.33 2/89 (2) 0.46 0.33

*Values are no. (%) unless indicated. Bold indicates a statistically significant difference (p<0.05). Results are from time of study enrolment unless indicated. IQR, interquartile range; NA, not applicable.
†Respiratory rate >30 breaths/min or tissue oxygen saturation <96% on room air.

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Page created: April 28, 2020
Page updated: June 18, 2020
Page reviewed: June 18, 2020
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