Observational studyBMC infectious diseases2020
Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results.
Observational study in BMC infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The trial behind it
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Who cites it
17 citing papers in PubMed, 22 citations in OpenAlex.
- Clinical and Laboratory Features of Scrub Typhus among Adult Patients with Acute Febrile Illness in Tak and Nakhon Phanom Provinces, Thailand, 2017-2020.The American journal of tropical medicine and hygiene · 2026Article
- Early diagnostic performance of real-time PCR versus serology for murine typhus and Q fever in a public health setting.BMC infectious diseases · 2026Article
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Acute Rickettsiosis TriggeringPathogens (Basel, Switzerland) · 2025Review
- Beyond the Fever: A Serial Report on Moderate to Severe Murine Typhus Cases and Diagnostic Hurdles in Indonesia.Tropical medicine and infectious disease · 2025Article
- History of scrub typhus in Indonesia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2025Review
- Article
- Review
- Scrub typhus in Indonesia: A cross-sectional analysis of archived fever studies samples.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2024Article
- From fever to action: diagnosis, treatment, and prevention of acute undifferentiated febrile illnesses.Pathogens and disease · 2024Review
- Perception of Ticks and Tick-Borne Diseases Worldwide.Pathogens (Basel, Switzerland) · 2023Review
- Geographical distribution of scrub typhus and risk of Orientia tsutsugamushi infection in Indonesia: Evidence mapping.PLoS neglected tropical diseases · 2023Review
- Indoor Bacterial and Fungal Burden in "Moldy" versus "Non-Moldy" Homes: A Case Study Employing Advanced Sequencing Techniques in a US Metropolitan Area.Pathogens (Basel, Switzerland) · 2023Article
- Article
- Systematic Surveillance of Rickettsial Diseases in 27 Hospitals from 26 Provinces throughout Vietnam.Tropical medicine and infectious disease · 2022Article
- An Update on the Laboratory Diagnosis ofPathogens (Basel, Switzerland) · 2021Review
- Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses.Dermatologic therapy · 2021Review
Corrections and comments
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Authors and funding
16 authors at 10 institutions in 2 countries.
Funding
Abstract
backgroundReports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia.
methodsAcute and convalescent blood from 975 hospitalized non-dengue patients was tested for Rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for Rickettsia IgM and IgG by IFA and Rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management.
resultsR. typhi, R. rickettsii, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of samples, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea (72%), headache (69%), vomiting (43%), lethargy (33%), anorexia (32%), arthralgia (30%), myalgia (28%), chills (28%), epigastric pain (28%), and rash (17%). No acute rickettsioses cases were suspected during hospitalization. Discharge diagnoses included typhoid fever (44), dengue fever (20), respiratory infections (7), leptospirosis (6), unknown fever (6), sepsis (5), hepatobiliary infections (3), UTI (3), and others (9). Fatalities occurred in 7 (6.8%) patients, mostly with co-morbidities.
conclusionsRickettsial infections are consistently misdiagnosed, often as leptospirosis, dengue, or Salmonella typhi infection. Clinicians should include rickettsioses in their differential diagnosis of fever to guide empiric management; laboratories should support evaluation for rickettsial etiologies; and public policy should be implemented to reduce burden of disease.
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