ABSTRACT
Twenty-eight febrile Sri Lankan patients with undiagnosed fever for 7 days after hospital admission, who responded to empirical treatment with doxycycline, were retrospectively investigated using microimmunofluorescence assay to verify whether they had rickettsial infection. Eleven (39%) patients were confirmed as having spotted fever group rickettsioses and 10 (36%) as having Orientia tsutsugamushi. Seven were negative for all tests. This suggests that greater use of doxycycline appears justified for patients with undiagnosed fever in settings where rickettsial diseases are endemic or re-emerging with inadequate diagnostic facilities.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Fever of Unknown Origin/microbiology , Rickettsia Infections/complications , Rickettsia/isolation & purification , Adult , Female , Fever of Unknown Origin/drug therapy , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Male , Orientia tsutsugamushi/isolation & purification , Rickettsia Infections/diagnosis , Rickettsia Infections/drug therapy , Scrub Typhus/diagnosis , Sri Lanka , Young AdultABSTRACT
We report two patients who presented with a long-lasting febrile illness associated with pancytopenia. Both of them had evidence of hypercellular marrow with haemophagocytosis. They were confirmed as having rickettsial infections by serology and had a rapid haematological recovery with anti-rickettsial antibiotics. We highlight the importance of considering rickettsial infections in patients with such clinical presentations, especially in areas where these infections are endemic or re-emerging. Empirical use of anti-rickettsial antibiotics in such situations could be beneficial, when facilities to diagnose rickettsial diseases are not readily available.
