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Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study.
Int J Infect Dis. 2008 Mar; 12(2):198-202.IJ

Abstract

BACKGROUND

Rickettsial infections are re-emerging. A study of the geographical distribution of rickettsial infections, their clinical manifestations, and their complications would facilitate early diagnosis.

METHODS

Thirty-one selected patients from the Western Province of Sri Lanka were studied for rickettsial species, clinical manifestations, and complications.

RESULTS

Of 31 patients with possible rickettsioses, 29 (94%) fell into the categories of confirmed, presumptive, or exposed cases of acute rickettsial infections (scrub typhus was diagnosed in 19 (66%), spotted fever group in eight (28%)). Early acute infection or past exposure was suggested in two (7%) cases; cross-reactivity of antigens or past exposure to one or more species was suggested in nine (31%). Seventeen out of 19 (89%) patients with scrub typhus had eschars. Nine out of 29 (32%) patients had a discrete erythematous papular rash: seven caused by spotted fever group, two by scrub typhus. Severe complications were pneumonitis in eight (28%), myocarditis in five (17%), deafness in four (14%), and tinnitus in two (7%). The mean duration of illness before onset of complications was 12.0 (SD 1.4) days. All patients except one made a good clinical recovery with doxycycline or a combination of doxycycline and chloramphenicol.

CONCLUSIONS

In a region representing the low country wet zone of Sri Lanka, the main rickettsial agent seems to be Orientia tsutsugamushi. Delay in diagnosis may result in complications. All species responded well to current treatment.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Rd, Ragama, Sri Lanka. ranjan_premaratna@lycos.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17900956

Citation

Premaratna, R, et al. "Rickettsial Infections and Their Clinical Presentations in the Western Province of Sri Lanka: a Hospital-based Study." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 12, no. 2, 2008, pp. 198-202.
Premaratna R, Loftis AD, Chandrasena TG, et al. Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study. Int J Infect Dis. 2008;12(2):198-202.
Premaratna, R., Loftis, A. D., Chandrasena, T. G., Dasch, G. A., & de Silva, H. J. (2008). Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 12(2), 198-202.
Premaratna R, et al. Rickettsial Infections and Their Clinical Presentations in the Western Province of Sri Lanka: a Hospital-based Study. Int J Infect Dis. 2008;12(2):198-202. PubMed PMID: 17900956.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: a hospital-based study. AU - Premaratna,R, AU - Loftis,A D, AU - Chandrasena,T G A N, AU - Dasch,G A, AU - de Silva,H J, Y1 - 2007/09/27/ PY - 2006/09/18/received PY - 2007/02/21/revised PY - 2007/06/18/accepted PY - 2007/9/29/pubmed PY - 2008/9/23/medline PY - 2007/9/29/entrez SP - 198 EP - 202 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 12 IS - 2 N2 - BACKGROUND: Rickettsial infections are re-emerging. A study of the geographical distribution of rickettsial infections, their clinical manifestations, and their complications would facilitate early diagnosis. METHODS: Thirty-one selected patients from the Western Province of Sri Lanka were studied for rickettsial species, clinical manifestations, and complications. RESULTS: Of 31 patients with possible rickettsioses, 29 (94%) fell into the categories of confirmed, presumptive, or exposed cases of acute rickettsial infections (scrub typhus was diagnosed in 19 (66%), spotted fever group in eight (28%)). Early acute infection or past exposure was suggested in two (7%) cases; cross-reactivity of antigens or past exposure to one or more species was suggested in nine (31%). Seventeen out of 19 (89%) patients with scrub typhus had eschars. Nine out of 29 (32%) patients had a discrete erythematous papular rash: seven caused by spotted fever group, two by scrub typhus. Severe complications were pneumonitis in eight (28%), myocarditis in five (17%), deafness in four (14%), and tinnitus in two (7%). The mean duration of illness before onset of complications was 12.0 (SD 1.4) days. All patients except one made a good clinical recovery with doxycycline or a combination of doxycycline and chloramphenicol. CONCLUSIONS: In a region representing the low country wet zone of Sri Lanka, the main rickettsial agent seems to be Orientia tsutsugamushi. Delay in diagnosis may result in complications. All species responded well to current treatment. SN - 1201-9712 UR - https://www.unboundmedicine.com/medline/citation/17900956/Rickettsial_infections_and_their_clinical_presentations_in_the_Western_Province_of_Sri_Lanka:_a_hospital_based_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(07)00149-X DB - PRIME DP - Unbound Medicine ER -