{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T15:04:39Z","timestamp":1789916679990,"version":"4.0.1"},"reference-count":94,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Acute undifferentiated febrile illness (AUFI) is an important cause of admission to hospitals in the tropics. We prospectively recruited inpatients with AUFI at three hospitals in Western (\n                    <jats:italic>n<\/jats:italic>\n                    = 540) and Central (\n                    <jats:italic>n<\/jats:italic>\n                    = 260) Provinces, Sri Lanka from January 2022 to May 2023. We obtained clinical and environmental exposure data, blood cultures, acute blood samples, and nasopharyngeal samples at enrollment and convalescent blood samples. Laboratory testing for dengue and influenza viruses,\n                    <jats:italic>Leptospira<\/jats:italic>\n                    ,\n                    <jats:italic>Rickettsia<\/jats:italic>\n                    , and\n                    <jats:italic>Orientia<\/jats:italic>\n                    was conducted. Laboratory-confirmed etiology of AUFI was ascertained in 576 of 800 cases (72%). Dengue (\n                    <jats:italic>n<\/jats:italic>\n                    = 189\/540), leptospirosis (\n                    <jats:italic>n<\/jats:italic>\n                    = 173\/540), and scrub typhus\/rickettsial infection (\n                    <jats:italic>n<\/jats:italic>\n                    = 57\/540) were principal etiologies of AUFI in Western Province. Dengue (\n                    <jats:italic>n<\/jats:italic>\n                    = 69\/260), leptospirosis (\n                    <jats:italic>n<\/jats:italic>\n                    = 61\/260), and scrub typhus\/rickettsial infection (\n                    <jats:italic>n<\/jats:italic>\n                    = 35\/260) were causes of AUFI in Central Province. In both provinces, 82 of 800 cases of AUFI were because of influenza. There were no culture-confirmed cases of melioidosis or enteric fever. Of AUFI admissions, 96 of 800 were because of coinfections, with leptospirosis co-infection (\n                    <jats:italic>n<\/jats:italic>\n                    = 63\/800) being most frequent. False-positive scrub typhus lateral flow immunoassays were seen in 22 of 234 patients with confirmed leptospirosis. 84 of 274 dengue cases and 118 of 289 leptospirosis cases diagnosed and managed clinically (before laboratory diagnosis) were incorrect diagnoses. Clinical diagnosis of AUFI is often suboptimal, and coinfections are common in our study areas. The need for widespread availability of comprehensive molecular and serological testing of AUFI patients is highlighted.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0515","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:45:17Z","timestamp":1766069117000},"page":"551-560","source":"Crossref","is-referenced-by-count":1,"title":["Acute Undifferentiated Febrile Illness in Hospitalized Adults in Western and Central Provinces, Sri Lanka: High Levels of Coinfections and Clinical Misdiagnoses of Etiology"],"prefix":"10.4269","volume":"114","author":[{"given":"Neesha","family":"Rockwood","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;"},{"name":"Department of Infectious Diseases, Imperial College London, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpa","family":"Kariyawasam","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Naval Medical Research Command, Silver Spring, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajalingam","family":"Sutharsan","sequence":"additional","affiliation":[{"name":"Teaching Hospital Kalutara, Kalutara, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhammike","family":"Wijesundera","sequence":"additional","affiliation":[{"name":"District General Hospital Nawalapitiya, Nawalapitiya, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhammika","family":"Somarathne","sequence":"additional","affiliation":[{"name":"District General Hospital Nawalapitiya, Nawalapitiya, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zarook","family":"Sahabdeen","sequence":"additional","affiliation":[{"name":"Base Hospital Gampola, Gampola, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upul","family":"Vidanagama","sequence":"additional","affiliation":[{"name":"Base Hospital Gampola, Gampola, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyantha","family":"Senevirathne","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasana","family":"Kudugamana","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavithri","family":"Bandara","sequence":"additional","affiliation":[{"name":"Teaching Hospital Kalutara, Kalutara, Sri Lanka;"},{"name":"Teaching Hospital Kurunegala, Kurunegala, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesha","family":"Jayasundara","sequence":"additional","affiliation":[{"name":"Leptospirosis Research Laboratory, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anurhadapura, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Naval Medical Research Command, Silver Spring, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Peiris","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Hong Kong SAR, Hong Kong;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneth","family":"Agampodi","sequence":"additional","affiliation":[{"name":"Leptospirosis Research Laboratory, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anurhadapura, Sri Lanka;"},{"name":"International Vaccine Institute, Seoul, South Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enoka M.","family":"Corea","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen L.","family":"Richards","sequence":"additional","affiliation":[{"name":"Allen L Richards PhD Consulting, Damascus, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Clin Microbiol Infect","first-page":"815","article-title":"Febrile illness in Asia: Gaps in epidemiology, diagnosis and management for informing health policy","volume":"24","author":"Shrestha","year":"2018"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"337","article-title":"PCR-based diagnostics for infectious diseases: Uses, limitations, and future applications in acute-care settings","volume":"4","author":"Yang","year":"2004"},{"key":"b3","series-title":"PLoS One","first-page":"e0197395","article-title":"An assessment of false positive rates for malaria rapid diagnostic tests caused by non-Plasmodium infectious agents and immunological factors","volume":"13","author":"Gatton","year":"2018"},{"key":"b4","series-title":"Clin Vaccine Immunol","first-page":"106","article-title":"Utility of composite reference standards and latent class analysis in evaluating the clinical accuracy of diagnostic tests for pertussis","volume":"15","author":"Baughman","year":"2008"},{"key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0004995","article-title":"Emergence of epidemic dengue-1 virus in the southern province of Sri Lanka","volume":"10","author":"Bodinayake","year":"2016"},{"key":"b6","series-title":"Am J Trop Med Hyg","first-page":"672","article-title":"Respiratory viral infection: An underappreciated cause of acute febrile illness admissions in southern Sri Lanka","volume":"100","author":"Tillekeratne","year":"2019"},{"key":"b7","series-title":"BMC Infect Dis","first-page":"119","article-title":"Estimating the burden of leptospirosis in Sri Lanka; a systematic review","volume":"19","author":"Warnasekara","year":"2019"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"711","article-title":"Detection of rickettsioses and Q fever in Sri Lanka","volume":"86","author":"Angelakis","year":"2012"},{"key":"b9","series-title":"Trop Med Infect Dis","first-page":"22","article-title":"Melioidosis in Sri Lanka","volume":"3","author":"Corea","year":"2018"},{"key":"b10","series-title":"Ceylon Med J","first-page":"56","article-title":"A multi centre laboratory study of Gram negative bacterial blood stream infections in Sri Lanka","volume":"58","year":"2013"},{"key":"b11","article-title":"Weekly Epidemiological Report Week 52.","year":"2024"},{"key":"b12","series-title":"J Clin Virol","first-page":"61","article-title":"Development and validation of real-time one-step reverse transcription-PCR for the detection and typing of dengue viruses","volume":"45","author":"Leparc-Goffart","year":"2009"},{"key":"b13","series-title":"PLoS One","first-page":"e0128913","article-title":"Efficient detection of pathogenic leptospires using 16S ribosomal RNA","volume":"10","author":"Backstedt","year":"2015"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0009565","article-title":"Optimizing the microscopic agglutination test (MAT) panel for the diagnosis of leptospirosis in a low resource, hyper-endemic setting with varied microgeographic variation in reactivity","volume":"15","author":"Jayasundara","year":"2021"},{"key":"b15","article-title":"Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control.","year":"2003"},{"key":"b16","article-title":"Report of the Second Meeting of the Leptospirosis Burden Epidemiology Reference Group.","year":"2011"},{"key":"b17","article-title":"Nationa Sri Lanka. Guidelines on Management of Leptospirosis.","year":"2016"},{"key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e0008309","article-title":"Seroprevalence of leptospirosis in an endemic mixed urban and semi-urban setting\u2014A community-based study in the district of Colombo, Sri Lanka","volume":"14","author":"Rajapakse","year":"2020"},{"key":"b19","series-title":"Am J Trop Med Hyg","first-page":"351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi.","volume":"70","author":"Jiang","year":"2004"},{"key":"b20","series-title":"Vector Borne Zoonotic Dis","first-page":"175","article-title":"Detection of Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Gulf Coast ticks collected from humans in the United States","volume":"12","author":"Jiang","year":"2012"},{"key":"b21","series-title":"Ticks Tick Borne Dis","first-page":"101503","article-title":"Human seroepidemiology of Rickettsia and Orientia species in Chile\u2014A cross-sectional study in five regions","volume":"11","author":"Weitzel","year":"2020"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"1084","article-title":"Seroprevalence of scrub typhus, typhus, and spotted fever among rural and urban populations of northern Vietnam","volume":"96","author":"Trung","year":"2017"},{"key":"b23","series-title":"Pediatrics","first-page":"e615","article-title":"Comparing nose-throat swabs and nasopharyngeal aspirates collected from children with symptoms for respiratory virus identification using real-time polymerase chain reaction","volume":"122","author":"Lambert","year":"2008"},{"key":"b24","series-title":"Virol J","first-page":"110","article-title":"Resource-efficient internally controlled in-house real-time PCR detection of SARS-CoV-2","volume":"18","author":"Michel","year":"2021"},{"key":"b25","series-title":"Appl Microbiol","first-page":"825","article-title":"Serological diagnosis of human melioidosis with indirect hemagglutination and complement fixation tests","volume":"20","author":"Alexander","year":"1970"},{"key":"b26","series-title":"Clin Microbiol Rev","first-page":"383","article-title":"Melioidosis: Epidemiology, pathophysiology, and management","volume":"18","author":"Cheng","year":"2005"},{"key":"b27","series-title":"PLoS Negl Trop Dis","first-page":"e2163","article-title":"Concurrent infection with murine typhus and scrub typhus in southern Laos\u2014The mixed and the unmixed","volume":"7","author":"Phommasone","year":"2013"},{"key":"b28","series-title":"Trop Med Int Health","first-page":"271","article-title":"Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia","volume":"27","author":"Akelew","year":"2022"},{"key":"b29","series-title":"PLoS One","first-page":"e0189712","article-title":"A diagnostic and epidemiologic investigation of acute febrile illness (AFI) in Kilombero, Tanzania","volume":"12","author":"Hercik","year":"2017"},{"key":"b30","series-title":"J Glob Infect Dis","first-page":"147","article-title":"Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: Clinical spectrum and outcome","volume":"8","author":"Abhilash","year":"2016"},{"key":"b31","series-title":"BMJ Public Health","first-page":"e000073","article-title":"Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: A prospective cohort study","volume":"1","author":"Bodinayake","year":"2023"},{"key":"b32","series-title":"PLoS One","first-page":"e95868","article-title":"Acute undifferentiated febrile illness in rural Cambodia: A 3-year prospective observational study","volume":"9","author":"Mueller","year":"2014"},{"key":"b33","series-title":"Lancet Glob Health","first-page":"e46","article-title":"Causes of non-malarial fever in Laos: A prospective study","volume":"1","author":"Mayxay","year":"2013"},{"key":"b34","series-title":"Emerg Microbes Infect","first-page":"339","article-title":"Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam","volume":"8","author":"Le-Viet","year":"2019"},{"key":"b35","series-title":"BMC Infect Dis","first-page":"111","article-title":"Prevalence of dengue and leptospirosis coinfection and associated mortality rates: A systematic review and meta-analysis","volume":"25","author":"Tiwari","year":"2025"},{"key":"b36","series-title":"J Clin Diagn Res","first-page":"DC22","article-title":"Aetiologies of acute undifferentiated febrile illness in adult patients\u2014An experience from a tertiary care hospital in northern India","volume":"9","author":"Mittal","year":"2015"},{"key":"b37","series-title":"BMC Infect Dis","first-page":"665","article-title":"Acute undifferentiated fever in India: A multicentre study of aetiology and diagnostic accuracy","volume":"17","author":"M\u00f8rch","year":"2017"},{"key":"b38","series-title":"Trop J Pathol Microbiol","first-page":"555","article-title":"Prevalence of acute undifferentiated febrile illnesses in a tertiary care centre in Telangana, South India","volume":"5","author":"Mohan","year":"2019"},{"key":"b39","series-title":"BMC Infect Dis","first-page":"577","article-title":"Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in South and Southeast Asia: A systematic review","volume":"19","author":"Wangdi","year":"2019"},{"key":"b40","series-title":"Am J Trop Med Hyg","first-page":"650","article-title":"Demographic and clinical factors associated with bacterial or nonbacterial etiologies of acute undifferentiated febrile illness: Findings from a 3-year observational study in Thailand, 2017\u20132020","volume":"111","author":"Wodniak","year":"2024"},{"key":"b41","series-title":"Am J Trop Med Hyg","first-page":"731","article-title":"Assessment of the efficacy of an IgM-ELISA and microscopic agglutination test (MAT) in the diagnosis of acute leptospirosis","volume":"61","author":"Cumberland","year":"1999"},{"key":"b42","series-title":"Clin Microbiol Rev","first-page":"296","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001"},{"key":"b43","series-title":"BMC Infect Dis","first-page":"193","article-title":"An outbreak investigation of scrub typhus in Nepal: Confirmation of local transmission","volume":"21","author":"Dhimal","year":"2021"},{"key":"b44","series-title":"Sci Rep","first-page":"1532","article-title":"Climate influences scrub typhus occurrence in Vellore, Tamil Nadu, India: Analysis of a 15-year dataset","volume":"14","author":"D\u2019Cruz","year":"2024"},{"key":"b45","series-title":"Sri Lankan J Infec Dis","first-page":"83","article-title":"Spatial and seasonal analysis of human leptospirosis in the District of Gampaha, Sri Lanka","volume":"6","author":"Denipitiya","year":"2016"},{"key":"b46","series-title":"IJID Reg","first-page":"100436","article-title":"Epidemiological burden of dengue in Sri Lanka: A systematic review of literature from 2000\u20132020","volume":"13","author":"Fernando","year":"2024"},{"key":"b47","series-title":"Virusdisease","first-page":"225","article-title":"History and current trends in influenza virus infections with special reference to Sri Lanka","volume":"28","author":"Rafeek","year":"2017"},{"key":"b1","series-title":"Clin Microbiol Infect","first-page":"815","article-title":"Febrile illness in Asia: Gaps in epidemiology, diagnosis and management for informing health policy","volume":"24","author":"Shrestha","year":"2018"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"337","article-title":"PCR-based diagnostics for infectious diseases: Uses, limitations, and future applications in acute-care settings","volume":"4","author":"Yang","year":"2004"},{"key":"b3","series-title":"PLoS One","first-page":"e0197395","article-title":"An assessment of false positive rates for malaria rapid diagnostic tests caused by non-Plasmodium infectious agents and immunological factors","volume":"13","author":"Gatton","year":"2018"},{"key":"b4","series-title":"Clin Vaccine Immunol","first-page":"106","article-title":"Utility of composite reference standards and latent class analysis in evaluating the clinical accuracy of diagnostic tests for pertussis","volume":"15","author":"Baughman","year":"2008"},{"key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0004995","article-title":"Emergence of epidemic dengue-1 virus in the southern province of Sri Lanka","volume":"10","author":"Bodinayake","year":"2016"},{"key":"b6","series-title":"Am J Trop Med Hyg","first-page":"672","article-title":"Respiratory viral infection: An underappreciated cause of acute febrile illness admissions in southern Sri Lanka","volume":"100","author":"Tillekeratne","year":"2019"},{"key":"b7","series-title":"BMC Infect Dis","first-page":"119","article-title":"Estimating the burden of leptospirosis in Sri Lanka; a systematic review","volume":"19","author":"Warnasekara","year":"2019"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"711","article-title":"Detection of rickettsioses and Q fever in Sri Lanka","volume":"86","author":"Angelakis","year":"2012"},{"key":"b9","series-title":"Trop Med Infect Dis","first-page":"22","article-title":"Melioidosis in Sri Lanka","volume":"3","author":"Corea","year":"2018"},{"key":"b10","series-title":"Ceylon Med J","first-page":"56","article-title":"A multi centre laboratory study of Gram negative bacterial blood stream infections in Sri Lanka","volume":"58","year":"2013"},{"key":"b11","article-title":"Weekly Epidemiological Report Week 52.","year":"2024"},{"key":"b12","series-title":"J Clin Virol","first-page":"61","article-title":"Development and validation of real-time one-step reverse transcription-PCR for the detection and typing of dengue viruses","volume":"45","author":"Leparc-Goffart","year":"2009"},{"key":"b13","series-title":"PLoS One","first-page":"e0128913","article-title":"Efficient detection of pathogenic leptospires using 16S ribosomal RNA","volume":"10","author":"Backstedt","year":"2015"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0009565","article-title":"Optimizing the microscopic agglutination test (MAT) panel for the diagnosis of leptospirosis in a low resource, hyper-endemic setting with varied microgeographic variation in reactivity","volume":"15","author":"Jayasundara","year":"2021"},{"key":"b15","article-title":"Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control.","year":"2003"},{"key":"b16","article-title":"Report of the Second Meeting of the Leptospirosis Burden Epidemiology Reference Group.","year":"2011"},{"key":"b17","article-title":"Nationa Sri Lanka. Guidelines on Management of Leptospirosis.","year":"2016"},{"key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e0008309","article-title":"Seroprevalence of leptospirosis in an endemic mixed urban and semi-urban setting\u2014A community-based study in the district of Colombo, Sri Lanka","volume":"14","author":"Rajapakse","year":"2020"},{"key":"b19","series-title":"Am J Trop Med Hyg","first-page":"351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi.","volume":"70","author":"Jiang","year":"2004"},{"key":"b20","series-title":"Vector Borne Zoonotic Dis","first-page":"175","article-title":"Detection of Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Gulf Coast ticks collected from humans in the United States","volume":"12","author":"Jiang","year":"2012"},{"key":"b21","series-title":"Ticks Tick Borne Dis","first-page":"101503","article-title":"Human seroepidemiology of Rickettsia and Orientia species in Chile\u2014A cross-sectional study in five regions","volume":"11","author":"Weitzel","year":"2020"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"1084","article-title":"Seroprevalence of scrub typhus, typhus, and spotted fever among rural and urban populations of northern Vietnam","volume":"96","author":"Trung","year":"2017"},{"key":"b23","series-title":"Pediatrics","first-page":"e615","article-title":"Comparing nose-throat swabs and nasopharyngeal aspirates collected from children with symptoms for respiratory virus identification using real-time polymerase chain reaction","volume":"122","author":"Lambert","year":"2008"},{"key":"b24","series-title":"Virol J","first-page":"110","article-title":"Resource-efficient internally controlled in-house real-time PCR detection of SARS-CoV-2","volume":"18","author":"Michel","year":"2021"},{"key":"b25","series-title":"Appl Microbiol","first-page":"825","article-title":"Serological diagnosis of human melioidosis with indirect hemagglutination and complement fixation tests","volume":"20","author":"Alexander","year":"1970"},{"key":"b26","series-title":"Clin Microbiol Rev","first-page":"383","article-title":"Melioidosis: Epidemiology, pathophysiology, and management","volume":"18","author":"Cheng","year":"2005"},{"key":"b27","series-title":"PLoS Negl Trop Dis","first-page":"e2163","article-title":"Concurrent infection with murine typhus and scrub typhus in southern Laos\u2014The mixed and the unmixed","volume":"7","author":"Phommasone","year":"2013"},{"key":"b28","series-title":"Trop Med Int Health","first-page":"271","article-title":"Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia","volume":"27","author":"Akelew","year":"2022"},{"key":"b29","series-title":"PLoS One","first-page":"e0189712","article-title":"A diagnostic and epidemiologic investigation of acute febrile illness (AFI) in Kilombero, Tanzania","volume":"12","author":"Hercik","year":"2017"},{"key":"b30","series-title":"J Glob Infect Dis","first-page":"147","article-title":"Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: Clinical spectrum and outcome","volume":"8","author":"Abhilash","year":"2016"},{"key":"b31","series-title":"BMJ Public Health","first-page":"e000073","article-title":"Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: A prospective cohort study","volume":"1","author":"Bodinayake","year":"2023"},{"key":"b32","series-title":"PLoS One","first-page":"e95868","article-title":"Acute undifferentiated febrile illness in rural Cambodia: A 3-year prospective observational study","volume":"9","author":"Mueller","year":"2014"},{"key":"b33","series-title":"Lancet Glob Health","first-page":"e46","article-title":"Causes of non-malarial fever in Laos: A prospective study","volume":"1","author":"Mayxay","year":"2013"},{"key":"b34","series-title":"Emerg Microbes Infect","first-page":"339","article-title":"Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam","volume":"8","author":"Le-Viet","year":"2019"},{"key":"b35","series-title":"BMC Infect Dis","first-page":"111","article-title":"Prevalence of dengue and leptospirosis coinfection and associated mortality rates: A systematic review and meta-analysis","volume":"25","author":"Tiwari","year":"2025"},{"key":"b36","series-title":"J Clin Diagn Res","first-page":"DC22","article-title":"Aetiologies of acute undifferentiated febrile illness in adult patients\u2014An experience from a tertiary care hospital in northern India","volume":"9","author":"Mittal","year":"2015"},{"key":"b37","series-title":"BMC Infect Dis","first-page":"665","article-title":"Acute undifferentiated fever in India: A multicentre study of aetiology and diagnostic accuracy","volume":"17","author":"M\u00f8rch","year":"2017"},{"key":"b38","series-title":"Trop J Pathol Microbiol","first-page":"555","article-title":"Prevalence of acute undifferentiated febrile illnesses in a tertiary care centre in Telangana, South India","volume":"5","author":"Mohan","year":"2019"},{"key":"b39","series-title":"BMC Infect Dis","first-page":"577","article-title":"Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in South and Southeast Asia: A systematic review","volume":"19","author":"Wangdi","year":"2019"},{"key":"b40","series-title":"Am J Trop Med Hyg","first-page":"650","article-title":"Demographic and clinical factors associated with bacterial or nonbacterial etiologies of acute undifferentiated febrile illness: Findings from a 3-year observational study in Thailand, 2017\u20132020","volume":"111","author":"Wodniak","year":"2024"},{"key":"b41","series-title":"Am J Trop Med Hyg","first-page":"731","article-title":"Assessment of the efficacy of an IgM-ELISA and microscopic agglutination test (MAT) in the diagnosis of acute leptospirosis","volume":"61","author":"Cumberland","year":"1999"},{"key":"b42","series-title":"Clin Microbiol Rev","first-page":"296","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001"},{"key":"b43","series-title":"BMC Infect Dis","first-page":"193","article-title":"An outbreak investigation of scrub typhus in Nepal: Confirmation of local transmission","volume":"21","author":"Dhimal","year":"2021"},{"key":"b44","series-title":"Sci Rep","first-page":"1532","article-title":"Climate influences scrub typhus occurrence in Vellore, Tamil Nadu, India: Analysis of a 15-year dataset","volume":"14","author":"D\u2019Cruz","year":"2024"},{"key":"b45","series-title":"Sri Lankan J Infec Dis","first-page":"83","article-title":"Spatial and seasonal analysis of human leptospirosis in the District of Gampaha, Sri Lanka","volume":"6","author":"Denipitiya","year":"2016"},{"key":"b46","series-title":"IJID Reg","first-page":"100436","article-title":"Epidemiological burden of dengue in Sri Lanka: A systematic review of literature from 2000\u20132020","volume":"13","author":"Fernando","year":"2024"},{"key":"b47","series-title":"Virusdisease","first-page":"225","article-title":"History and current trends in influenza virus infections with special reference to Sri Lanka","volume":"28","author":"Rafeek","year":"2017"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/3\/article-p551.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/3\/article-p551.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/3\/article-p551.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T19:12:00Z","timestamp":1772737920000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/3\/article-p551.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":94,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0515","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}