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Table 2 Characteristics of R. typhi cases, compared to dengue, S. typhi, and leptospira cases

From: Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: observational study results

Clinical signs and symptoms

R. typhi cases

Dengue cases

Salmonella cases

Leptospira cases

N = 102†

N = 468

N = 103

N = 48

Symptoms, N (%)

 Fever

102 (100)

468 (100)

103 (100)

48 (100)

 Nausea

73 (72)

345 (74)

74 (72)

38 (76)

 Anorexia

33 (32) b

153 (33)

49 (48)

16 (33)

 Headache

70 (69) ab

261 (56)

45 (44)

26 (54)

 Vomiting

44 (43)

249 (53)

52 (50)

29 (60)

 Lethargy

34 (33) a

102 (22)

46 (45)

14 (29)

 Arthralgia

31 (30)

139 (30)

25 (24)

19 (40)

 Myalgia

29 (28)

103 (22)

20 (19)

20 (42)

 Chills

29 (28) a

65 (14)

35 (34)

20 (42)

 Epigastric pain

29 (28)

112 (24)

32 (31)

12 (25)

 Cough

24 (24) b

79 (17)

48 (47)

16 (33)

 Diarrhea

15 (15) bc

47 (10)

41 (40)

20 (42)

 Skin rash

17 (17) b

85 (18)

3 (3)

3 (6)

 Constipation

19 (19) a

23 (5)

15 (15)

6 (13)

 Altered mental status

4 (4) a

6 (1)

3 (3)

1 (2)

 Dysuria

4 (4)

9 (2)

1 (1)

3 (6)

 Icterus

5 (5)

2 (0.4)

1 (1)

6 (13)

 Rickettsia Triad: fever, headache and rash

11 (11)b

57 (12)

2 (2)

1 (2)

Hematology profiles: Mean (SD)

 Hb (mg/dl)

14.04 (1.89) bc

13.9 (1.84)

12.4 (1.79)

13.3 (2.06)

 Hematocrit (%)

40.8 (5.18) b

41 (5.21)

36.3 (5.42)

38.9 (6.16)

 Leukocyte count: /mm3

7354 (2975) ac

4225 (2608)

6902 (2974)

10,924 (4246)

Platelet count

123,426 (61,746) ab

107,720 (67,522)

158,402 (74,784)

138,333 (75,491)

N (%)

 Leukopenia

14 (14) ac

312 (66.7)

21 (20)

2 (4.2)

 Leukocytosis

17 (17) a

9 (1.9)

12 (11.7)

25 (24.5)

 Platelet < 100,000/mm3

41 (40) ab

266 (57)

22 (21)

13 (27)

 Platelet < 150,000/mm3

74 (73)

373 (8)

52 (50)

26 (54)

 Thrombocytopenia (150,000) AND leukopenia (< 5000)

19 (19) ac

318 (68)

22 (21)

0

Leucocyte cell types; Mean (SD)

 Neutrophil (%)

70.34 (10.87) abc

60.59 (16.41)

64.8 (14.2)

84.2 (7.9)

 Neutrophil count

5329 (2741) abc

2672 (2227)

4373 (2216)

9001 (3453)

 Lymphocyte (%)

21.9 (9.85) abc

28.5 (15.1)

26.5 (12.2)

9.5 (6.4)

 Lymphocyte absolute

1388 (484–4489)

888 (192–7104)

1521 (348–10,900)

729 (243–2783)

N (%)

 Neutropenia

9 (9)

99 (21)

17 (17)

0

 Neutrophilia

12 (12) c

41 (9)

14 (14)

22 (46)

 Lymphocytopenia

31 (30)

110 (24)

26 (25)

32 (67)

 Lymphocytosis

8 (8)

84 (18)

17 (17)

0

Biochemistry profiles: Median (range)

Bilirubin (mg/dl)

0.55 (0.12–12)

0.37 (0.08–3.46)

0.37 (0.1–2.09)

0.69 (0.13–16.83)

ALT (IU)

82 (12–604)

83 (1–6570)

66 (14–542)

38 (15–207)

AST (IU)

69 (0.71–466)

34 (1–1286)

40 (5–339)

32 (10–141)

Urea (mg/dl)

26 (9–181.2)

17 (0.3–121)

19 (6–59)

53 (13–459)

Creatinine (mg/dl)

0.9 (0.4–9.92)

0.85 (0.05–98)

0.7 (0.3–1.7)

1.2 (0.5–8.8)

N/available data (%)

 Bilirubin > 1 mg/dl

21/98 (21) abc

10/409 (2)

5/96 (5)

17/46 (37)

 Direct bilirubin > 0.4 mg/dl

36/98 (37) abc

27/409 (7)

13/96 (14)

26/46 (56)

 Indirect bilirubin> 0.6 mg/dl

7/98 (7) c

17/409 (4)

2/96 (5)

10/46 (22)

 Direct > Indirect bilirubin

66/98 (67)a

147/409 (36)

55/97 (57)

34/46 (74)

 ALT > 45 IU

76/97 (78)

326/409 (80)

65/95 (68)

16/45 (36)

 ALT > 100 IU

35/97 (36) c

147/409 (36)

26/95 (27)

7/45 (16)

 AST > 35 IU

75/97 (77)

197/409 (48)

54/97 (56)

16/45 (36)

 AST > 100 IU

28/97 (29) abc

60/409 (15)

7/97 (7)

2/45 (4)

 Urea N > 40 mg/dl

4/31 (13) ac

10/409 (2)

4/44 (9)

24/44 (55)

 Creatinine > 1.2 mg/dl

15/98 (15) bc

44/409 (11)

5/94 (5)

25/46 (54)

  1. Note: Significant (p < 0.05) a between R. typhi and dengue, b between R. typhi and S. typhi, c between R. typhi and leptospira. †One Rickettsia felis case is not included