Ong A K, Tambyah P A, Ooi S, Kumarasinghe G, Chow C
Division of Infectious Diseases, Department of Medicine, Stanford University, USA.
Singapore Med J. 2001 Dec;42(12):549-52.
Singapore is a modern urban city and endemic typhus is thought to be a disease of the past. This may be due to lack of specific serological testing as indirect immunoperoxidase testing using specific rickettsial antigens (U.S. Army Medical Research Unit, Institute of Medical Research, Kuala Lumpur, Malaysia) has only recently become available. In the last fourteen months, twenty-one cases of endemic typhus were diagnosed in patients hospitalised for acute febrile illnesses at the National University Hospital. We conducted a case control study to define the clinical and laboratory features of endemic typhus in Singapore.
Demographic, clinical and laboratory data were reviewed for cases and twenty-one age and sex matched controls who had negative serologic tests as part of a work-up for fever of unknown origin.
Apart from a higher initial temperature (39 degrees C vs 37.9 degrees C (p < 0.001)) and ALT(p = 0.002), cases and controls had similar presentations of fever, myalgia, headache, cough, normal WBC and platelet counts. Singapore residents and migrant workers were represented in both groups (p = ns).
Endemic typhus remains an important cause of acute febrile illness in Singaporein both the local and migrant worker populations. The presentation is similar to other causes of acute febrile illnesses and the diagnosis will be missed unless it is specifically sought.
新加坡是一座现代化的城市，地方性斑疹伤寒被认为是一种过去的疾病。这可能是由于缺乏特定的血清学检测，因为使用特定立克次氏体抗原的间接免疫过氧化物酶检测（美国陆军医学研究单位，马来西亚吉隆坡医学研究所）直到最近才可用。在过去的14个月里，新加坡国立大学医院收治的急性发热疾病患者中诊断出21例地方性斑疹伤寒病例。我们进行了一项病例对照研究，以确定新加坡地方性斑疹伤寒的临床和实验室特征。
回顾了病例以及21名年龄和性别匹配的对照者的人口统计学、临床和实验室数据，这些对照者作为不明原因发热检查的一部分，血清学检测呈阴性。
除了初始体温较高（39摄氏度对37.9摄氏度（p < 0.001））和谷丙转氨酶较高（p = 0.002）外，病例组和对照组在发热、肌痛、头痛、咳嗽、白细胞和血小板计数正常方面表现相似。两组中都有新加坡居民和外来务工人员（p = 无显著性差异）。
在新加坡，地方性斑疹伤寒仍然是急性发热疾病的一个重要原因，在本地人和外来务工人员中均有发生。其表现与其他急性发热疾病的病因相似，除非专门进行检查，否则会漏诊。
