Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study
The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus. The study was a retrospective cohort with a nested case-cont...
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| Veröffentlicht in: | PLoS neglected tropical diseases 2019-02, Vol.13 (2), p.e0007160-e0007160 |
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| description | The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus.
The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures.
The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these. |
| doi_str_mv | 10.1371/journal.pntd.0007160 |
| format | Article |
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The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures.
The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0007160</identifier><identifier>PMID: 30802243</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adequacy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory care ; Analysis ; Antibodies, Bacterial - blood ; Beef cattle ; Biology and Life Sciences ; Care and treatment ; Case studies ; Case-Control Studies ; Cohorts ; Communities ; Control ; Earth Sciences ; Endemic Diseases - statistics & numerical data ; Epidemiology ; Female ; Fever ; Fever - epidemiology ; Fever - etiology ; Health aspects ; Hospitalization ; Hospitalization - statistics & numerical data ; Hospitals ; Households ; Humans ; Illnesses ; Immunoglobulin G ; Immunoglobulin G - blood ; Incidence ; India - epidemiology ; Infection ; Infections ; Male ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Odds Ratio ; Orientia tsutsugamushi ; Orientia tsutsugamushi - immunology ; Outpatients ; Pilot Projects ; Prevalence ; Ratios ; Recall errors ; Research and Analysis Methods ; Retrospective Studies ; Rural areas ; Rural Population - statistics & numerical data ; Scrub typhus ; Scrub Typhus - complications ; Scrub Typhus - epidemiology ; Seasons ; Social Sciences ; Studies ; Towns ; Tropical diseases ; Typhus ; Villages ; Young Adult</subject><ispartof>PLoS neglected tropical diseases, 2019-02, Vol.13 (2), p.e0007160-e0007160</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Devamani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Devamani et al 2019 Devamani et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c624t-d268934ef331ad50718755ef0d6b4cc8710ec0efbc65833f3b326c29f1fc47403</citedby><cites>FETCH-LOGICAL-c624t-d268934ef331ad50718755ef0d6b4cc8710ec0efbc65833f3b326c29f1fc47403</cites><orcidid>0000-0001-7449-4152</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405239/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405239/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30802243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Devamani, Carol S</creatorcontrib><creatorcontrib>Prakash, John A J</creatorcontrib><creatorcontrib>Alexander, Neal</creatorcontrib><creatorcontrib>Suzuki, Motoi</creatorcontrib><creatorcontrib>Schmidt, Wolf-Peter</creatorcontrib><title>Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus.
The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures.
The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these.</description><subject>Adequacy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory care</subject><subject>Analysis</subject><subject>Antibodies, Bacterial - blood</subject><subject>Beef cattle</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Case studies</subject><subject>Case-Control Studies</subject><subject>Cohorts</subject><subject>Communities</subject><subject>Control</subject><subject>Earth Sciences</subject><subject>Endemic Diseases - statistics & numerical data</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - epidemiology</subject><subject>Fever - etiology</subject><subject>Health aspects</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Households</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Immunoglobulin G</subject><subject>Immunoglobulin G - blood</subject><subject>Incidence</subject><subject>India - epidemiology</subject><subject>Infection</subject><subject>Infections</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Odds Ratio</subject><subject>Orientia tsutsugamushi</subject><subject>Orientia tsutsugamushi - immunology</subject><subject>Outpatients</subject><subject>Pilot Projects</subject><subject>Prevalence</subject><subject>Ratios</subject><subject>Recall errors</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>Rural areas</subject><subject>Rural Population - statistics & numerical data</subject><subject>Scrub typhus</subject><subject>Scrub Typhus - complications</subject><subject>Scrub Typhus - epidemiology</subject><subject>Seasons</subject><subject>Social Sciences</subject><subject>Studies</subject><subject>Towns</subject><subject>Tropical diseases</subject><subject>Typhus</subject><subject>Villages</subject><subject>Young Adult</subject><issn>1935-2735</issn><issn>1935-2727</issn><issn>1935-2735</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkt2K2zAQhU1p6W63fYPSCgqlN0n1Y8l2LwrL0nYDC4X-XAtZGiUKjpVKciBP1NesnHiXpCy-sD0-883o-BTFa4LnhFXk49oPoVfdfNsnM8cYV0TgJ8UlaRif0YrxpyfPF8WLGNcY84bX5HlxwXCNKS3ZZfH31setS6pzUSXn-4hUb5Af0ja_Qp_QzkWXIrI-oKE3zloIuexUAoMs7CAglVJw7ZBU2wFKHkUdhhal_XY1ROR6FIagOvQzM1dokRHqE_oBKeS5oJPbAdJ-5UM6DO4hjmCtIsy077OqQzENZv-yeGZVF-HVdL8qfn_98uvmdnb3_dvi5vpupgUt08xQUTesBMsYUYZnU-qKc7DYiLbUuq4IBo3BtlrwmjHLWkaFpo0lVpdVidlV8fbI3XY-ysnjKCnllBFCCcmKxVFhvFrLbXAbFfbSKycPBR-WUoXkdAeytkRVpanqsrGlbmzbVtQIATUw0raaZ9bnadrQbsDo7Gz26gx6_qV3K7n0OylKnBdqMuDDBAj-z5DNkxsXNXSd6sEPeW9SC1JSwcdZ7_6TPn66SbVU-QCutz7P1SNUXvNK8IpyMbLmj6jyZWDj8n8D63L9rOH9ScMKVJdW0XfDIXLnwvIo1DkgMYB9MINgOeb-fms55l5Ouc9tb06NfGi6Dzr7B5zeA-Q</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Devamani, Carol S</creator><creator>Prakash, John A J</creator><creator>Alexander, Neal</creator><creator>Suzuki, Motoi</creator><creator>Schmidt, Wolf-Peter</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7SS</scope><scope>7T2</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F1W</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>H95</scope><scope>H97</scope><scope>K9.</scope><scope>L.G</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-7449-4152</orcidid></search><sort><creationdate>20190201</creationdate><title>Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study</title><author>Devamani, Carol S ; Prakash, John A J ; Alexander, Neal ; Suzuki, Motoi ; Schmidt, Wolf-Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c624t-d268934ef331ad50718755ef0d6b4cc8710ec0efbc65833f3b326c29f1fc47403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adequacy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory care</topic><topic>Analysis</topic><topic>Antibodies, Bacterial - blood</topic><topic>Beef cattle</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>Case studies</topic><topic>Case-Control Studies</topic><topic>Cohorts</topic><topic>Communities</topic><topic>Control</topic><topic>Earth Sciences</topic><topic>Endemic Diseases - statistics & numerical data</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fever</topic><topic>Fever - epidemiology</topic><topic>Fever - etiology</topic><topic>Health aspects</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Households</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Immunoglobulin G</topic><topic>Immunoglobulin G - blood</topic><topic>Incidence</topic><topic>India - epidemiology</topic><topic>Infection</topic><topic>Infections</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Odds Ratio</topic><topic>Orientia tsutsugamushi</topic><topic>Orientia tsutsugamushi - immunology</topic><topic>Outpatients</topic><topic>Pilot Projects</topic><topic>Prevalence</topic><topic>Ratios</topic><topic>Recall errors</topic><topic>Research and Analysis Methods</topic><topic>Retrospective Studies</topic><topic>Rural areas</topic><topic>Rural Population - statistics & numerical data</topic><topic>Scrub typhus</topic><topic>Scrub Typhus - complications</topic><topic>Scrub Typhus - epidemiology</topic><topic>Seasons</topic><topic>Social Sciences</topic><topic>Studies</topic><topic>Towns</topic><topic>Tropical diseases</topic><topic>Typhus</topic><topic>Villages</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Devamani, Carol S</creatorcontrib><creatorcontrib>Prakash, John A J</creatorcontrib><creatorcontrib>Alexander, Neal</creatorcontrib><creatorcontrib>Suzuki, Motoi</creatorcontrib><creatorcontrib>Schmidt, Wolf-Peter</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database (ProQuest)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Devamani, Carol S</au><au>Prakash, John A J</au><au>Alexander, Neal</au><au>Suzuki, Motoi</au><au>Schmidt, Wolf-Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>13</volume><issue>2</issue><spage>e0007160</spage><epage>e0007160</epage><pages>e0007160-e0007160</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus.
The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures.
The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30802243</pmid><doi>10.1371/journal.pntd.0007160</doi><orcidid>https://orcid.org/0000-0001-7449-4152</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1935-2735 |
| ispartof | PLoS neglected tropical diseases, 2019-02, Vol.13 (2), p.e0007160-e0007160 |
| issn | 1935-2735 1935-2727 1935-2735 |
| language | eng |
| recordid | cdi_plos_journals_2252311211 |
| source | MEDLINE; Public Library of Science; DOAJ Directory of Open Access Journals; PubMed Central; EZB Electronic Journals Library; PubMed Central Open Access |
| subjects | Adequacy Adolescent Adult Aged Aged, 80 and over Ambulatory care Analysis Antibodies, Bacterial - blood Beef cattle Biology and Life Sciences Care and treatment Case studies Case-Control Studies Cohorts Communities Control Earth Sciences Endemic Diseases - statistics & numerical data Epidemiology Female Fever Fever - epidemiology Fever - etiology Health aspects Hospitalization Hospitalization - statistics & numerical data Hospitals Households Humans Illnesses Immunoglobulin G Immunoglobulin G - blood Incidence India - epidemiology Infection Infections Male Medicine Medicine and Health Sciences Middle Aged Mortality Odds Ratio Orientia tsutsugamushi Orientia tsutsugamushi - immunology Outpatients Pilot Projects Prevalence Ratios Recall errors Research and Analysis Methods Retrospective Studies Rural areas Rural Population - statistics & numerical data Scrub typhus Scrub Typhus - complications Scrub Typhus - epidemiology Seasons Social Sciences Studies Towns Tropical diseases Typhus Villages Young Adult |
| title | Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T18%3A17%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hospitalisations%20and%20outpatient%20visits%20for%20undifferentiated%20fever%20attributable%20to%20scrub%20typhus%20in%20rural%20South%20India:%20Retrospective%20cohort%20and%20nested%20case-control%20study&rft.jtitle=PLoS%20neglected%20tropical%20diseases&rft.au=Devamani,%20Carol%20S&rft.date=2019-02-01&rft.volume=13&rft.issue=2&rft.spage=e0007160&rft.epage=e0007160&rft.pages=e0007160-e0007160&rft.issn=1935-2735&rft.eissn=1935-2735&rft_id=info:doi/10.1371/journal.pntd.0007160&rft_dat=%3Cgale_plos_%3EA576572565%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2252311211&rft_id=info:pmid/30802243&rft_galeid=A576572565&rft_doaj_id=oai_doaj_org_article_8f1a74d7849f4c9fbb72d66e8e31bbc5&rfr_iscdi=true |