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Concurrent Infections in Acute Febrile Illness Patients in Egypt

We report the occurrence of concurrent infections with multiple acute febrile illness (AFI) pathogens during an ongoing prospective laboratory-based surveillance in four infectious disease hospitals in urban and rural areas of Egypt from June 2005 to August 2006. Patients were screened for Leptospira, Rickettsia typhi, Brucella, or Salmonella enterica serogroup Typhi by various methods including serology, culture, and PCR. One hundred eighty-seven of 1,510 patients (12.4%) evaluated had supporting evidence for the presence of coinfections; 20 (1%) of these patients had 2 or more pathogens based upon confirmatory 4-fold rise in antibody titer, culture, and/or PCR. Most coinfected patients lived or worked in rural agricultural areas. The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.

Received February 4, 2007. Accepted for publication April 10, 2007.

Acknowledgments: This work was supported by Work Unit Number (WUN) 847705-25GB-3906 (T.M.P., M.O.W., M.A.F., T.I., and G.P.) and DoD GEIS WUN 847705.82000.25GB.A0074 (J.J. and A.L.R.). We are grateful to Mohammad A. Maksoud for his laboratory assistance.

Disclaimer: The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Navy Department or Egypt.

^* Address correspondence to Tina M. Parker, United States Naval Medical Unit No. 3, PSC 452, Box 124, FPO AE, Cairo, Egypt 09835. E-mail: tina-parker{at}uiowa.edu

Authors’ addresses: Tina M. Parker, Ahmed Samir, Tharwat Ismail, Moustafa Abdel Fadeel, Momtaz O. Wasfy, and Guillermo Pimentel, U.S. Naval Medical Research Unit No. 3, PSC 452 BOX 5000 (Attn: Code 304A), FPO AE 09835, Telephone: +2-02-342-1375, Fax: +2-02-342-8933, E-mails: tina-parker{at}uiowa.edu or parker.dr{at}gmail.com, ahmed.samir{at}namru3.med.navy.mil, ismailt{at}namru3.med.navy.mil, fadeelm{at}namru3.med.navy.mil, wasfym{at}namru3.med.navy.mil, and pimentelg{at}namru3.med.navy.mil. Clinton K. Murray, Brooke Army Medical Center, 3851 Roger Brooke Drive, 7 East, Fort Sam Houston, TX 78234, Telephone: +1 (210) 916-3847, Fax: +1 (210) 916-0388, E-mail: Clinton.Murray{at}amedd.army.mil. Allen L. Richards and Ju Jiang, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, Telephone: (301) 319-7668, Fax: +1 (301) 319-9458, E-mails: richardsa{at}nmrc.navy.mil and jiangj{at}nmrc.navy.mil.

Copyright statement: Some of the authors are employees of the U.S. government, and this work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.