TY - JOUR AU - Grigg, Matthew AU - William, Timothy AU - Clemens, Emily AU - Patel, Kaajal AU - Chandna, Arjun AU - Wilkes, Christopher AU - Barber, Bridget AU - Anstey, Nicholas AU - Dumler, J. Stephen AU - Yeo, Tsin AU - Reller, Megan T1 - Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia T2 - Emerging Infectious Disease journal PY - 2020 VL - 26 IS - 7 SP - 1409 SN - 1080-6059 AB - Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013–2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to >160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered. KW - rickettsioses KW - acute febrile illness KW - Sabah KW - East Malaysia KW - Orientia tsutsugamushi KW - spotted-fever group rickettsiosis KW - typhus-group rickettsioses KW - tickborne diseases KW - vector-borne infections DO - 10.3201/eid2607.191722 UR - https://wwwnc.cdc.gov/eid/article/26/7/19-1722_article ER - End of Reference