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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 symptomsR. typhi casesDengue casesSalmonella casesLeptospira cases
N = 102N = 468N = 103N = 48
Symptoms, N (%)
 Fever102 (100)468 (100)103 (100)48 (100)
 Nausea73 (72)345 (74)74 (72)38 (76)
 Anorexia33 (32) b153 (33)49 (48)16 (33)
 Headache70 (69) ab261 (56)45 (44)26 (54)
 Vomiting44 (43)249 (53)52 (50)29 (60)
 Lethargy34 (33) a102 (22)46 (45)14 (29)
 Arthralgia31 (30)139 (30)25 (24)19 (40)
 Myalgia29 (28)103 (22)20 (19)20 (42)
 Chills29 (28) a65 (14)35 (34)20 (42)
 Epigastric pain29 (28)112 (24)32 (31)12 (25)
 Cough24 (24) b79 (17)48 (47)16 (33)
 Diarrhea15 (15) bc47 (10)41 (40)20 (42)
 Skin rash17 (17) b85 (18)3 (3)3 (6)
 Constipation19 (19) a23 (5)15 (15)6 (13)
 Altered mental status4 (4) a6 (1)3 (3)1 (2)
 Dysuria4 (4)9 (2)1 (1)3 (6)
 Icterus5 (5)2 (0.4)1 (1)6 (13)
 Rickettsia Triad: fever, headache and rash11 (11)b57 (12)2 (2)1 (2)
Hematology profiles: Mean (SD)
 Hb (mg/dl)14.04 (1.89) bc13.9 (1.84)12.4 (1.79)13.3 (2.06)
 Hematocrit (%)40.8 (5.18) b41 (5.21)36.3 (5.42)38.9 (6.16)
 Leukocyte count: /mm37354 (2975) ac4225 (2608)6902 (2974)10,924 (4246)
Platelet count123,426 (61,746) ab107,720 (67,522)158,402 (74,784)138,333 (75,491)
N (%)
 Leukopenia14 (14) ac312 (66.7)21 (20)2 (4.2)
 Leukocytosis17 (17) a9 (1.9)12 (11.7)25 (24.5)
 Platelet < 100,000/mm341 (40) ab266 (57)22 (21)13 (27)
 Platelet < 150,000/mm374 (73)373 (8)52 (50)26 (54)
 Thrombocytopenia (150,000) AND leukopenia (< 5000)19 (19) ac318 (68)22 (21)0
Leucocyte cell types; Mean (SD)
 Neutrophil (%)70.34 (10.87) abc60.59 (16.41)64.8 (14.2)84.2 (7.9)
 Neutrophil count5329 (2741) abc2672 (2227)4373 (2216)9001 (3453)
 Lymphocyte (%)21.9 (9.85) abc28.5 (15.1)26.5 (12.2)9.5 (6.4)
 Lymphocyte absolute1388 (484–4489)888 (192–7104)1521 (348–10,900)729 (243–2783)
N (%)
 Neutropenia9 (9)99 (21)17 (17)0
 Neutrophilia12 (12) c41 (9)14 (14)22 (46)
 Lymphocytopenia31 (30)110 (24)26 (25)32 (67)
 Lymphocytosis8 (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/dl21/98 (21) abc10/409 (2)5/96 (5)17/46 (37)
 Direct bilirubin > 0.4 mg/dl36/98 (37) abc27/409 (7)13/96 (14)26/46 (56)
 Indirect bilirubin> 0.6 mg/dl7/98 (7) c17/409 (4)2/96 (5)10/46 (22)
 Direct > Indirect bilirubin66/98 (67)a147/409 (36)55/97 (57)34/46 (74)
 ALT > 45 IU76/97 (78)326/409 (80)65/95 (68)16/45 (36)
 ALT > 100 IU35/97 (36) c147/409 (36)26/95 (27)7/45 (16)
 AST > 35 IU75/97 (77)197/409 (48)54/97 (56)16/45 (36)
 AST > 100 IU28/97 (29) abc60/409 (15)7/97 (7)2/45 (4)
 Urea N > 40 mg/dl4/31 (13) ac10/409 (2)4/44 (9)24/44 (55)
 Creatinine > 1.2 mg/dl15/98 (15) bc44/409 (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