Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand
Tropical infectious diseases like dengue, scrub typhus, murine typhus, leptospirosis, and enteric fever continue to contribute substantially to the febrile disease burden throughout Southeast Asia while malaria is declining. Recently, there has been increasing focus on biomarkers (i.e. C-reactive pr...
| Main Authors: | , , , , , , , , , |
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| Formato: | Journal article |
| Idioma: | English |
| Publicado em: |
Public Library of Science
2018
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| _version_ | 1826281076801142784 |
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| author | Wangrangsimakul, T Althaus, T Mukaka, M Kantipong, P Wuthiekanun, V Chierakul, W Blacksell, S Day, N Laongnualpanich, A Paris, D |
| author_facet | Wangrangsimakul, T Althaus, T Mukaka, M Kantipong, P Wuthiekanun, V Chierakul, W Blacksell, S Day, N Laongnualpanich, A Paris, D |
| author_sort | Wangrangsimakul, T |
| collection | OXFORD |
| description | Tropical infectious diseases like dengue, scrub typhus, murine typhus, leptospirosis, and enteric fever continue to contribute substantially to the febrile disease burden throughout Southeast Asia while malaria is declining. Recently, there has been increasing focus on biomarkers (i.e. C-reactive protein (CRP) and procalcitonin) in delineating bacterial from viral infections.A prospective observational study was performed to investigate the causes of acute undifferentiated fever (AUF) in adults admitted to Chiangrai Prachanukroh hospital, northern Thailand, which included an evaluation of CRP and procalcitonin as diagnostic tools. In total, 200 patients with AUF were recruited. Scrub typhus was the leading bacterial cause of AUF (45/200, 22.5%) followed by leptospirosis (15/200, 7.5%) and murine typhus (7/200, 3.5%), while dengue was the leading viral cause (23/200, 11.5%). Bloodstream infections contributed to 7/200 (3.5%) of the study cohort. There were 9 deaths during this study (4.5%): 3 cases of scrub typhus, 2 with septicaemia (Talaromyces marneffei and Haemophilus influenzae), and 4 of unknown aetiologies. Rickettsioses, leptospirosis and culture-attributed bacterial infections, received a combination of 3rd generation cephalosporin plus a rickettsia-active drug in 53%, 73% and 67% of cases, respectively. Low CRP and white blood count were significant predictors of a viral infection (mainly dengue) while the presence of an eschar and elevated aspartate aminotransferase and alkaline phosphatase were important predictors of scrub typhus.Scrub typhus and dengue are the leading causes of AUF in Chiangrai, Thailand. Eschar, white blood count and CRP were beneficial in differentiating between bacterial and viral infections in this study. CRP outperformed procalcitonin although cut-offs for positivity require further assessment. The study provides evidence that accurate, pathogen-specific rapid diagnostic tests coupled with biomarker point-of-care tests such as CRP can inform the correct use of antibiotics and improve antimicrobial stewardship in this setting. |
| first_indexed | 2024-03-07T00:23:21Z |
| format | Journal article |
| id | oxford-uuid:7d47ec2d-cdce-4d64-a3f3-d592e20bf8f9 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:23:21Z |
| publishDate | 2018 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:7d47ec2d-cdce-4d64-a3f3-d592e20bf8f92022-03-26T21:02:40ZCauses of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern ThailandJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:7d47ec2d-cdce-4d64-a3f3-d592e20bf8f9EnglishSymplectic Elements at OxfordPublic Library of Science2018Wangrangsimakul, TAlthaus, TMukaka, MKantipong, PWuthiekanun, VChierakul, WBlacksell, SDay, NLaongnualpanich, AParis, DTropical infectious diseases like dengue, scrub typhus, murine typhus, leptospirosis, and enteric fever continue to contribute substantially to the febrile disease burden throughout Southeast Asia while malaria is declining. Recently, there has been increasing focus on biomarkers (i.e. C-reactive protein (CRP) and procalcitonin) in delineating bacterial from viral infections.A prospective observational study was performed to investigate the causes of acute undifferentiated fever (AUF) in adults admitted to Chiangrai Prachanukroh hospital, northern Thailand, which included an evaluation of CRP and procalcitonin as diagnostic tools. In total, 200 patients with AUF were recruited. Scrub typhus was the leading bacterial cause of AUF (45/200, 22.5%) followed by leptospirosis (15/200, 7.5%) and murine typhus (7/200, 3.5%), while dengue was the leading viral cause (23/200, 11.5%). Bloodstream infections contributed to 7/200 (3.5%) of the study cohort. There were 9 deaths during this study (4.5%): 3 cases of scrub typhus, 2 with septicaemia (Talaromyces marneffei and Haemophilus influenzae), and 4 of unknown aetiologies. Rickettsioses, leptospirosis and culture-attributed bacterial infections, received a combination of 3rd generation cephalosporin plus a rickettsia-active drug in 53%, 73% and 67% of cases, respectively. Low CRP and white blood count were significant predictors of a viral infection (mainly dengue) while the presence of an eschar and elevated aspartate aminotransferase and alkaline phosphatase were important predictors of scrub typhus.Scrub typhus and dengue are the leading causes of AUF in Chiangrai, Thailand. Eschar, white blood count and CRP were beneficial in differentiating between bacterial and viral infections in this study. CRP outperformed procalcitonin although cut-offs for positivity require further assessment. The study provides evidence that accurate, pathogen-specific rapid diagnostic tests coupled with biomarker point-of-care tests such as CRP can inform the correct use of antibiotics and improve antimicrobial stewardship in this setting. |
| spellingShingle | Wangrangsimakul, T Althaus, T Mukaka, M Kantipong, P Wuthiekanun, V Chierakul, W Blacksell, S Day, N Laongnualpanich, A Paris, D Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title | Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title_full | Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title_fullStr | Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title_full_unstemmed | Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title_short | Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand |
| title_sort | causes of acute undifferentiated fever and the utility of biomarkers in chiangrai northern thailand |
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