Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam

Le-Viet, Nhiem; Le, Viet-Nho; Chung, Hai; Phan, Duc-Tuan; Phan, Quang-Duong; Cao, Thanh-Van; Abat, Cédric; Raoult, Didier; Parola, Philippe

Epidemiological studies on fever aetiologies in the rural tropics are highly needed. The extensive and systematic workup of this study provided unique data on the causes of AUF in Vietnam because we used reference methods and local afebrile subjects as controls, which allowed us to better clarify differences between infection and colonization. These data have implications for the management of patients with AUF in Vietnam and even Southeast Asia. We recommend that in addition to RDTs for dengue and microscopy for malaria, local hospitals should be equipped with diagnostic tools (e.g. RDTs, serological tests, and molecular biology tests) for rickettsial infections, leptospirosis, and influenza. More importantly, a significant proportion (15.6% if we include rickettsial diseases and leptospirosis) of the causative agents of AUF are susceptible to doxycycline. Therefore, this drug needs to be included in the panel used to treat patients with AUF. Empirical treatment with a combination of β-lactam (e.g. ceftriaxone) and doxycycline might be used to treat AUF patients with a severe clinical presentation because some agents detected here could result in fatality.