{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:17:39Z","timestamp":1791505059331,"version":"4.3.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["Cooperative Agreement #5U2GGH000961-04"],"award-info":[{"award-number":["Cooperative Agreement #5U2GGH000961-04"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Southern China is at risk for arborvirus disease transmission, including Zika virus and dengue. Patients often present to clinical care with non-specific acute febrile illnesses (AFI). To better describe the etiology of AFI, we implemented a two-year AFI surveillance project at five sentinel hospitals in Yunnan and Guangdong Provinces.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between June 2017 and August 2019, we enrolled patients between 2 and 65 years of age presenting at one sentinel hospital in Mengla County, Yunnan, and four in Jiangmen City, Guangdong, with symptoms of AFI (acute onset of fever \u2265 37.5\u00b0C within the past 7 days) without respiratory symptoms or diarrhea. Demographic, epidemiologic, and clinical information was obtained and entered into a web-based AFI surveillance database. A custom TaqMan Array card (TAC) was used to test patients\u2019 whole blood specimens for 27 different pathogens using real-time polymerase chain reaction assays.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During the two-year project period, 836 patients were enrolled; 443 patients from Mengla County and 393 patients from Jiangmen City. The median age was 33 years [range: 2\u201365], and most were hospitalized [641, 77%]. Of 796 patients with valid TAC results, 341 (43%) were positive for at least one of the 10 unique pathogens detected. This included 205 (26%) patients positive for dengue virus, 60 (8%) for <jats:italic>Orientia tsutsugamushi<\/jats:italic>, and 42 (5%) for <jats:italic>Coxiella burnetii<\/jats:italic>. Ten patients (1%) in Jiangmen City tested positive for malaria, 8 of whom reported recent travel outside of China. TAC results were negative for 455 (57%) patients. None of the patients had a positive TAC detection for Zika virus.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The project detected variability in the etiology of AFI in Southern China and highlighted the importance of differential diagnosis. Dengue, <jats:italic>O<\/jats:italic>. <jats:italic>tsutsugamushi<\/jats:italic>, and <jats:italic>C<\/jats:italic>. <jats:italic>burnetii<\/jats:italic> were the most frequently identified pathogens among enrolled AFI patients. As a non-notifiable disease, the frequent detection of <jats:italic>C<\/jats:italic>. <jats:italic>burnetii<\/jats:italic> is noteworthy and warrants additional investigation. The project provided a framework for routine surveillance for persons presenting with AFI.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0270586","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T18:24:45Z","timestamp":1656440685000},"page":"e0270586","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Etiology of acute febrile illnesses in Southern China: Findings from a two-year sentinel surveillance project, 2017\u20132019"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3175-8784","authenticated-orcid":true,"given":"Jeanette 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