250 KASPER AND OTHERS FIGURE 3. Enrollment by month Dec. 2006–Dec. 2009 Testing acute serum samples (seroconversion-positive samples) by qPCR assays confirmed two cases of scrub typhus and one case of murine typhus. No species of the spotted fever group were identified by qPCR. Blood culture testing yielded a bacterial isolate in 6.3% (642 of 9,821) of study subjects (Table 4). The most common iso- lates were non-pathogenic skin flora (e.g., coagulase-negative Staphylococcus, micrococcus sp., bacillus sp. (non-anthracis); however, a number of known pathogens were also identified including Salmonella typhi (57), Staphylococcus aureus (4), Burkholderia pseudomallei (2), group C Streptococcus (1), and Moraxella catarrhalis (6) (Table 4). To identify active co-infections, we limited analysis to patients who were positive by a combination of PCR, blood culture, and/or malaria microscopy. There were 94 (1.0%) patients whose specimens were positive by two or more of these tests (Table 5). Influenza was identified with con- firmed dengue in 55 cases, with malaria in 8 cases, and an isolate from blood culture in 10 cases. Dengue was identi- fied with malaria in 15 cases and a blood culture isolate in 4 cases (1 B. pseudomallei/dengue-2, 2 S. typhi/dengue-4, and 1 S. typhi/dengue-2). In one patient, influenza was iden- tified with Salmonella cholerasuis and dengue-4. DISCUSSION The purpose of this study was to identify the infectious etiologies of AFI among patients 2 years of age and older TABLE 1 Demographics of enrolled patients from Dec. 2006 to Dec. 2009 n % Demographic and clinical information Demographic and clinical information Patients enrolled Age (years), mean (SD) Age (years), median (SD) Gender Male Female Medication Travel history Province/country Jungle Occupation Cattle/sheep farmer Grain farmer Poultry farmer Driver Factory worker Fisherman Office worker Other Exposure history Cats Dogs Cattle Horses Goat/sheep Pigs Monkeys Rodents Chickens Ducks 9,997 19.6(16.9) 13.0(16.9) 5,392 4,601 3,627 793 708 9 3,133 18 16 387 17 50 6,347 278 700 824 5 5 81 7 8 765 186 54.0 46.0 36.3 7.9 7.1 0.1 31.3 0.2 0.2 3.9 0.2 0.5 63.5 2.8 7.0 8.3 0.1 0.1 0.8 0.1 0.1 7.7 1.9 Temperature, mean (SD) Malaise Chills Muscle aches Rash Lesion Joint pain Headache Seizure Sore throat Cough Shortness of breath Nausea Vomiting Abdominal cramp Diarrhea Bloody stool Bloody urine Bleeding Jaundice Person same symptom Patient disposition Admitted at hospital Outpatient follow-up Referred to hospital n 39 (0.6) 4,675 4,807 2,319 197 96 1,894 6,947 83 4,655 5,748 964 876 1,332 2,412 580 66 20 25 132 893 990 8,975 15 % 46.8 48.1 23.2 2.0 1.0 19.0 69.5 0.8 46.6 57.5 9.7 8.8 13.4 24.2 5.8 0.7 0.2 0.3 1.4 9.0 9.9 89.9 0.2