RICKETTSIAL FEVER conference 7th Dec 2024 final.pdf

Rickettsial fever is a re- emerging infectious disease in the northern region of Bangladesh. This study is conducted to determine the prevalence of rickettsial fever in the patients who were presented with fever complaints in the tertiary care hospital of northern region of Bangladesh. The significant prevalence of Rickettsial infection may be due to low socio economic status of the study population, environmental factors and overlapping clinical features of Rickettsial fever with other febrile illness.

1. RICKETTSIAL FEVER
AS AN EMERGING INFECTIOUS DISEASE IN
NORTHERN REGION OF BANGLADESH
Md. Zakir Hossain, Ahmed Al Montasir, Karma Dicky Sherpa,
Fahim Ahmed, NilufaYeasmin, BishnuDhakalSharma
Department of Medicine, TMSS Medical College, Bangladesh
10th International Public Health Conference -2024

2. BACKGROUND
❖Rickettsialinfections, caused by microscopic, obligate Gram-
negative bacteria, are an emerging zoonosis in Bangladesh
1
.
❖They cause Spotted fever and Typhus fever, transmittedby arthropod
vectors such as ticks, fleas, mites and lice
1,2,3
.
❖These disease presents with vague flu like symptomsas an initial
manifestation
2,3
.
❖Diagnosis usually done on the basis of clinical suspicions, exclusions of
other causes of fever and Laboratory test like Weil-Felix test, IFA and
PCR
2,3,5
.

3. BACKGROUND
❖In Southeast Asia, an estimated one million cases of scrub typhus occur
annually
2,3,4
.
❖There are 50,000–80,000 deathsper year caused by this disease
3,4
.
❖Rickettsialdisease in India has been documented
1,3
. Since
Bangladeshis very adjacent to the India, it is very likely that the
Rickettsia would be responsible for certain febrile illnesses
1,34
.
❖There is little published evidencefor the occurrence of rickettsial
infection in Bangladesh
1,3,4
.

4. OBJECTIVE
1.To determine the prevalenceof Rickettsialfever in
patients who presented with fever complaints in the
tertiary care hospital ofNorthern Bangladesh.
2.To study demographic profilesof population
diagnosed as suffering from Rickettsial fever.

5. METHODOLOGY
❖Study type: Cross-sectional, observational.
❖Study period: 01 September 2023 to 30 August 2024.
❖Study place: OPD of medicine dept, RafatullahCommunity
Hospital, TMSS medical college.
❖Sample size: 675 patients.
❖Sampling technique: Convenience sampling.

6. METHODOLOGY
❖Inclusion criteria:
Patients aged 18 years or more with fever (102-104°F)formore than7
days,not responding tocommonly used antibiotics and clinical features
including headache,rash, lymphadenopathy, organomegaly, or myalgia
and eschars on theskin were included in this study.
❖Exclusion criteria:
Patients with evidentcause of fever (like malaria diagnosed by blood
smearorimmunochromatography) and on antibioticswere excluded from
thestudy.

7. METHODOLOGY
❖Study Procedure:
1.Informed written consent was takenfromthepatients or their legal
guardians.
2.A set of questionnaire was usedfor each of the cases.
3.All the relevant information likehistory, clinical and laboratory findings
and data weresystematically recorded in a pre-designed data sheet.
❖Statistical Analysis:
1.Statistical analyses wereperformed with SPSS software, versions
27.0.

8. RESULTS
WEIL FELIXTEST
POSITIVE
NEGATIVE
The Weil-Felix test yielded positive results in 165 cases
(24.4%) and negative results in 510 (75.56%) of the total
675 samples
Fig 1:

9. RESULTS
Spotted fever
90%
Scrub typhus
6%
Typhus fever
1%
Others
3%
Spotted fever
Scrub typhus
Typhus fever
Other
Fig 2:Distribution of Rickettsialfever types in study population

10. RESULTS
WEIL FELIXTEST
POSITIVE
NEGATIVE
Gender distribution of patients having significant Weil Felix titreFig 3:

11. RESULTS
Age distribution of patients diagnosed with Rickettsialfever
Age Group Percentage
42%
31-45 36.37%
46-60 18.18%
61-75 4.24%
Table 1:

12. RESULTS
Fig 4 (b): Weil Felix titreafter 7 days
from clinical presentation at OPD
Fig 4 (a): Weil Felix titreat first
presentation at OPD

13. CLINICAL FEATURES NUMBER PERCENTAGE %
Fever 165 100
Headache 120 72.72
Body ache 125 75.76
Cough 50 12.12
Rash 20 30.30
Nausea 15 9.09
Table 2:Presenting symptoms of 165 Weil Felix titrepositive cases

14. RESULTS
Differentials set by clinicians at presentation of 675 study
population
Fig 5:

15. Fig 6: Association of
different factors in two
groups of patients with
fever
RESULTS
Stray cat exposure
Primary education or more
completed
Monthly income < 12,500 BD
Tk
Two or more factors present

16. CONCLUSION
❖ThisstudyrevealedsignificantRickettsialinfectioninindividualsof
NorthernBangladeshwhoweresufferingfromunexplainedfebrile
illness.
❖ThesignificantprevalenceofRickettsialinfectionmaybeduetolow
socioeconomicstatusofthestudypopulation,environmental
factors,limitedpublichealthawarenessoroverlappingclinical
features.
❖Hence,ourstudyhighlightstheneedforimprovedawareness,early
identificationandheightenedclinicalsuspiciontoprevent
misdiagnosisandmitigatetheinappropriateuseofantibiotics.

17. RECOMMENDATION
1.Extensive nationwide studies are needed to be conducted to explore
this disease burden, confirm the dissemination and identify the risk
factors.
2.Enhanced awareness, diagnostic facilities and routine screening for
rickettsialinfections are essential with stronger public health efforts
to address this overlooked disease.

18. REFERENCES
1.Ahmed, R., Jahan, T., Sharmi, R. H., Begum, H., Boby, F., Rawnuck, T., Paul, S. K., & Hossain,
M. A. (2023). Demographic and Clinical Profiles of PCR Positive Rickettsia felis Infected Patients
at A Tertiary Care Hospital in Bangladesh. Bangladesh Journal of Medical Microbiology, 17(2),
71–76. https://doi.org/10.3329/bjmm.v17i2.68131
2.Yazid Abdad M, Stenos J, Graves S. Rickettsia felis, an emergingflea-transmitted human
pathogen. Emerging Health Threats Journal.2011;4(1):7168.
3.Pérez-Osorio CE, Zavala-Velázquez JE, León JJ, Zavala-CastroJE. Rickettsia felis as emergent
global threat for humans. Emerginginfectious diseases. 2008;14(7):1019.
4.Mittal V, Gupta N, Bhattacharya D, Kumar K, Ichhpujani RL,Singh S, et al. Serological evidence
of rickettsial infections in Delhi.The Indian journal of medical research. 2012;135(4):538.
5.Hun L, Troyo A. An update on the detection and treatment ofRickettsia felis. Research and
Reports in Tropical Medicine.2012;3:47