Yuhana Muhamad Yazli, Hanboonkunupakarn Borimas, Tanganuchitcharnchai Ampai, Sujariyakul Pimpan, Sonthayanon Piengchan, Chotivanich Kesinee, Pukrittayakamee Sasithon, Blacksell Stuart D, Paris Daniel H
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Department of Infectious Diseases and Tropical Medicine, School of Medicine, Universiti Teknologi MARA (UiTM), Sg Buloh Campus, Sungai Buloh 40600, Selangor, Malaysia.
Trop Med Infect Dis. 2022 May 18;7(5):77. doi: 10.3390/tropicalmed7050077.
Rickettsial infections are among the leading etiologies of acute febrile illness in Southeast Asia. However, recent data from Malaysia are limited. This prospective study was conducted in Teluk Intan, Peninsular Malaysia, during January to December 2016. We recruited 309 hospitalized adult patients with acute febrile illness. Clinical and biochemistry data were obtained, and patients were stratified into mild and severe infections based on the sepsis-related organ failure (qSOFA) scoring system. Diagnostic assays including blood cultures, real-time PCR, and serology (IFA and MAT) were performed. In this study, pathogens were identified in 214 (69%) patients, of which 199 (93%) patients had a single etiology, and 15 (5%) patients had >1 etiologies. The top three causes of febrile illness requiring hospitalization in this Malaysian study were leptospirosis (68 (32%)), dengue (58 (27%)), and rickettsioses (42 (19%)). Fifty-five (18%) patients presented with severe disease with a qSOFA score of ≥2. Mortality was documented in 38 (12%) patients, with the highest seen in leptospirosis (16 (42%)) followed by rickettsiosis (4 (11%)). While the significance of leptospirosis and dengue are recognized, the impact of rickettsial infections in Peninsular Malaysia remains under appreciated. Management guidelines for in-patient care with acute febrile illness in Peninsular Malaysia are needed.
立克次体感染是东南亚急性发热性疾病的主要病因之一。然而，马来西亚的最新数据有限。这项前瞻性研究于2016年1月至12月在马来西亚半岛的安顺进行。我们招募了309名因急性发热性疾病住院的成年患者。获取了临床和生化数据，并根据脓毒症相关器官功能衰竭（qSOFA）评分系统将患者分为轻度和重度感染。进行了包括血培养、实时PCR和血清学（间接免疫荧光法和显微凝集试验）在内的诊断检测。在本研究中，214名（69%）患者中鉴定出病原体，其中199名（93%）患者有单一病因，15名（5%）患者有多种病因。在这项马来西亚研究中，需要住院治疗的发热性疾病的前三大病因是钩端螺旋体病（68例（32%））、登革热（58例（27%））和立克次体病（42例（19%））。55名（18%）患者出现qSOFA评分≥2的严重疾病。38名（12%）患者有死亡记录，钩端螺旋体病患者中死亡率最高（16例（42%）），其次是立克次体病（4例（11%））。虽然钩端螺旋体病和登革热的重要性已得到认可，但马来西亚半岛立克次体感染的影响仍未得到充分认识。马来西亚半岛需要制定急性发热性疾病住院治疗的管理指南。
