{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T19:24:49Z","timestamp":1767900289961,"version":"3.49.0"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The clinical and serological characteristics of spotted fever group rickettsial (SFGR) infections in South Asia are poorly understood. We studied the clinical presentation and the IgM\/IgG response in cases enrolled at two health care centres in South India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We enrolled 77 patients. Fifty\u2010seven of these patients were recruited at a tertiary care centre, the remaining 20 at a community hospital (secondary care level). Diagnostic tests included IgM and IgG enzyme\u2010linked immunosorbent assay and polymerase chain reaction. Over a period of 1\u00a0year, 41 cases were followed up for repeated sero\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age was 9\u00a0years (range 1\u201379). A rash was present in 74% of cases (57\/77). In cases aged &lt;15\u00a0years, rash was present in 94% (44\/47) vs. 43% (13\/30) in cases aged \u226515\u00a0years. An eschar was found in two cases (3%). Severe infection or complications occurred in 10 cases (13%). These included central nervous system infection (6\/77, 8%), kidney injury (3\/77, 4%), shock (3\/77, 4%), lung involvement (2\/77, 3%) and peripheral gangrene (2\/77, 3%). IgM antibody levels increased faster after fever onset than IgG antibodies, peaking at 50 and 60\u00a0days, respectively. After the peak, IgM and IgG levels showed a slow decline over one year with less than 50% of cases showing persistent IgG antibody levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Spotted fever group rickettsial infections in South India may be under\u2010diagnosed, as many cases may not develop a rash. The proportion of cases developing severe infection seems lower than for scrub typhus in this region. IgG seroprevalence may substantially underestimate the proportion in a population with past SFGR infection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13682","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T17:50:10Z","timestamp":1633110610000},"page":"1616-1623","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical characteristics of and antibody response to spotted fever group rickettsial infections in South India: Case series and serological cohort study"],"prefix":"10.1111","volume":"26","author":[{"given":"Wolf\u2010Peter","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Christian Medical College Vellore India"},{"name":"Department for Disease Control London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol S.","family":"Devamani","sequence":"additional","affiliation":[{"name":"Rural Unit for Health &amp; Social Affairs Christian Medical College Vellore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divyaa","family":"Elangovan","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology Christian Medical College Vellore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Alexander","sequence":"additional","affiliation":[{"name":"MRC International Statistics and Epidemiology Group London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winsley","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Pediatric Infectious Diseases Christian Medical College Vellore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A. 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