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. 2019 Jul 3;19(1):572.
doi: 10.1186/s12879-019-4161-6.

Dengue, chikungunya, and scrub typhus are important etiologies of non-malarial febrile illness in Rourkela, Odisha, India

Affiliations

Dengue, chikungunya, and scrub typhus are important etiologies of non-malarial febrile illness in Rourkela, Odisha, India

Pavitra N Rao et al. BMC Infect Dis. .

Abstract

Background: We conducted a diagnostic surveillance study to identify Plasmodium, dengue virus, chikungunya virus, and Orientia tsutsugamushi infections among febrile patients who underwent triage for malaria in the outpatient department at Ispat General Hospital, Rourkela, Odisha, India.

Methods: Febrile patients were enrolled from January 2016-January 2017. Blood smears and small volumes or vacutainers of blood were collected from study participants to carry out diagnostic assays. Malaria was diagnosed using rapid diagnostic tests (RDT), microscopy, and PCR. Dengue, chikungunya, and scrub typhus infections were identified using rapid diagnostic test kits and ELISA.

Results: Nine hundred and fifty-four patients were prospectively enrolled in our study. The majority of patients were male (58.4%) and more than 15 years of age (66.4%). All 954 enrollees underwent additional testing for malaria; a subset of enrollees (293/954) that had larger volumes of plasma available was also tested for dengue, chikungunya and scrub typhus by either RDT or ELISA or both tests. Fifty-four of 954 patients (5.7%) were positive for malaria by RDT, or microscopy, or PCR. Seventy-four of 293 patients (25.3%) tested positive for dengue by either RDT or ELISA, and 17 of 293 patients (5.8%) tested positive for chikungunya-specific IgM by either ELISA or RDT. Ten of 287 patients tested (3.5%) were positive for scrub typhus by ELISA specific for scrub typhus IgM. Seventeen patients among 290 (5.9%) with results for ≥3 infections tested positive for more than one infection. Patients with scrub typhus and chikungunya had high rates of co-infection: of the 10 patients positive for scrub typhus, six were positive for dengue (p = 0.009), and five of 17 patients positive for chikungunya (by RDT or ELISA) were also diagnosed with malaria (p < 0.001).

Conclusions: Dengue, chikungunya and scrub typhus are important etiologies of non-malarial febrile illness in Rourkela, Odisha, and comorbidity should be considered. Routine febrile illness surveillance is required to accurately establish the prevalence of these infections in this region, to offer timely treatment, and to implement appropriate methods of control.

Keywords: Chikungunya; Dengue; Febrile illness; India; Malaria; Scrub typhus; Surveillance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient testing for febrile illness. A total of 954 patients in the outpatient department at IGH, Rourkela, with reported fever up to 48 h prior to enrollment or on day of enrollment (body temperature ≥ 37.5 °C), were enrolled. All study participants were tested for Plasmodium by RDT and microscopy, and a subset of patients was tested by PCR. Patients from whom a larger volume of blood was available were tested for dengue, chikungunya and scrub typhus by RDT and ELISA
Fig. 2
Fig. 2
Clinical features of study participants. A graphical distribution of clinical features of study participants in the outpatient department at IGH, Rourkela is presented with features on the x-axis and proportion of patients on y-axis. The patients were categorized as children (15 years and below) and adults (16 years and above), with an asterisk to denote statistically significant differences between children and adults (*p = < 0.05 comparing children vs. adults)
Fig. 3
Fig. 3
Venn diagram of malaria test results among OPD patients, Rourkela, 2016–2017. A proportional Venn diagram representing Plasmodium positivity among 852 study participants each tested by three different assays: RDT, microscopy and PCR. Each circle represents positives by the different assays, with the numbers also shown in Table 2
Fig. 4
Fig. 4
Venn diagram of select dengue test results among OPD patients, Rourkela, 2016–2017. A proportional Venn diagram representing dengue positivity among 288 study participants tested by three different assays: J. Mitra NS1 RDT, NS1 ELISA, and DENV-specific IgM ELISA. The numbers in each compartment of the Venn diagram are depicted on the graph

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