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

One patient with R. felis infection presented with an eschar that generally resembled one found in cases of scrub typhus. Because the local clinicians are unaware of the existence of R. felis but are aware of scrub typhus, the patient was diagnosed with suspected scrub typhus and immediately prescribed doxycycline. An eschar sometimes appears in R. felis infection [27] and is an important diagnostic sign. Skin rash might present as maculopapular in 70% of patients with R. felis infection [18, 28] , but this symptom might also be absent. However, it appears that studies reporting the absence of rash included limited cases of R. felis infections [29, 30] . We believe that the suggestive manifestations (e.g. eschar and rash) of R. felis infection might be observed in a significant proportion of patients, but these are insufficiently reported due to the lack of a careful examination and the absence of epidemiological information. Because R. felis is an emerging agent and is known to be a cause of AUF in Vietnam, its presence should be examined in such patients with AUF, including local patients and travellers who returned from Vietnam and similar areas.