Table 2.
Clinical and Laboratory Details of Definitive-Confirmed and Definitive-Suspected Cases
| Patient No. | Sex, Age (y) | Destination | Main Symptoms | Initial Diagnosis | Antibiotics Administered? | Convalescent Sample? | Day of Sample Collection* | IFA Positive for: | Laboratory Findings |
|---|---|---|---|---|---|---|---|---|---|
| Definitive-Confirmed cases | |||||||||
| 81 | Male, 33 | Malaysia and Borneo | Fever, headache, arthralgia, myalgia, rash | Arbovirus or nematode infection | Yes (doxycycline) | Yes | 6 + 27 | Orientia tsutsugamushi | Day 6: IgM−, IgG− Day 27: IgM 1:512, IgG 1:128 |
| 79 | Male, 35 | Thailand | Fever, chills, headache, arthralgia, myalgia, rash, nausea, vomiting, diarrhea, abdominal pain, elevated CRP | Leptospirosis | Yes (ceftriaxone) | Yes | 4 + 18 | TG | Day 4: IgM−, IgG− Day 18: IgM+, IgG− |
| 27 | Female, 61 | Indonesia | Fever, chills, arthralgia, myalgia, cough, dyspnea, nausea, diarrhea, rectal blood loss, anorexia, elevated CRP | TG rickettsial disease | Yes (amoxicillin, ceftriaxone, and doxycycline) | Yes | 10 + 20 | TG | Day 10: IgM 1:64, IgG− Day 20: IgM 1:64, IgG 1:128 |
| 32 | Female, 58 | Congo | Fever, chills, headache, myalgia, cough, throat pain, conjunctival suffusion, improvement after treatment with doxycycline for 2 d | Rickettsial disease or flulike illness | Yes (doxycycline) | Yes | 9 + 20 | TG | Day 9: IgM−, IgG− Day 20: IgM 1:64, IgG 1:128 |
| 44 | Female, 29 | Uganda | Presentation after hospital admission for malaria. Headache, arthralgia, myalgia, abdominal pain, cough, dyspnea, icterus, splenomegaly (Hb 4.7 mmol/L [or 7.57 g/dL]), elevated liver enzymes and bilirubin | Hemolytic anemia after malaria | Yes (ciprofloxacin) | Yes | 18 + 85 | TG | Day 18: IgM 1:64, IgG− Day 85: IgM 1:64, IgG 1:128 |
| 92 | Male, 62 | South Africa | Fever, chills headache, arthralgia, myalgia | Rickettsial disease | Yes (doxycycline) | Yes | 6 + 72 | SFG | Day 6: SFG and TG IgM 1:64 Day 72: SFG IgG 1:128 |
| 63 | Male, 68 | Morocco | Fever, chills, nausea, petechiae | SFG rickettsial disease | No | Yes | 19 + 39 | SFG | Day 19: IgM 1:64, IgG− Day 39: IgM 1:64, IgG 1:128 |
| 23 | Male, 29 | Indonesia | Fever, myalgia, headache, itchy rash | Viral infection | Yes (doxycycline) | Yes | 4 + 18 | Mixed TG/SFG | Day 4: IgM− Day 18: IgM 1:512 TG/SFG |
| Definitive-suspected cases | |||||||||
| 25 | Female, 47 | Thailand | Fever, nausea, vomiting, diarrhea | Leptospirosis | Yes (ceftriaxone, gentamicin) | No | 1 | SFG | IgM 1:512 |
| 66 | Male, 40 | Suriname | Fever, chills, arthralgia, myalgia, rash, red eyes, lymphadenopathy, elevated CRP | Self-limiting arboviral infection | No | No | 5 | SFG | IgM 1:64 |
| 51 | Female, 60 | Thailand | Fever, cough | Viral infection (not specified) | No | No | 16 | Mixed TG/SFG | IgM 1:64 TG/SFG |
| 69 | Male, 24 | French Guyana | Headache, myalgia, chills, anorexia, rash | Dermatomycosis | No | No | 36 | Mixed TG/SFG | IgM 1:64, IgG 1:128 TG/SFG |
| 88 | Male, 30 | Puerto Rico | Fever, headache, arthralgia, dyspnea, nausea, rash | Viral infection (not specified) | No | No | 14 | Mixed TG/SFG | IgM 1:64 TG/SFG |
| 11 | Male, 42 | Thailand | Headache, myalgia, rash, lymphadenopathy, aminotransferase elevation | CMV | No | No | 22 | O. tsutsugamushi | IgM 1:256 |
| 4 | Male, 48 | Indonesia | Headache, myalgia, sore throat | TG rickettsial disease | Yes (doxycycline) | No | 24 | TG | IgM 1:256 |
| 26 | Male, 51 | Thailand and Cambodia | Fever, chills, headache, arthralgia, abdominal pain, elevated CRP | Viral infection (not specified) | No | No | 2 (but 19 d after return) | TG | IgM 1:256 |
*The numbers represent the timing of serologic sampling in days after onset of symptoms.
Abbreviations: CMV, cytomegalovirus; CRP, C-reactive protein; Hb, hemoglobin; IFA, immunofluorescence assays; IgG, immunoglobulin G; IgM, immunoglobulin M; SFG, spotted fever group; TG, typhus group.