15th ICID Abstracts / International Journal of Infectious Diseases 16S (2012) e2–e157 e63 Chikungunya fever and Rift Valley fever are among them. Diag- nostics is rarely available, but PCR-based evaluations in Tanzanian hospitals showed that 7.9% of the fevers might be due to Chikun- gunya fever, and 9.5% might be due to Dengue fever. Our team specialises in emerging pathogens, and our research focuses primarily on fastidious bacteria. Since 2008 we survey the fastidious bacteria in DNA extracted in the field from the blood of acute febrile ambulatory patients in Africa, arriving to discover the causes up to 25% of fevers in rural Senegal. However, the found spectrum of bacteria causing acute febrile diseases in Senegal is surprising. There is a high incidence of Rickettsia felis in Senegal (another team performed a parallel study under the same condi- tions in Kenya and observed a comparable incidence). Moreover, tick-borne relapsing fever (TBRF) (caused by Borrelia spp.) in West Africa has an extremely high incidence that is similar to the levels found in East Africa. The incidence of Tropheryma whipplei bacter- aemia may be as high as 6.4%. We identified also different Bartonella (including Bartonella quintana) and Coxiella burnetii as the agents. http://dx.doi.org/10.1016/j.ijid.2012.05.155 Type: Invited Presentation Final Abstract Number: 38.002 Session: Acute Febrile Illness in the Tropics Date: Saturday, June 16, 2012 Time: 15:45-17:45 Room: Lotus 1-4 Acute febrile illness: Epidemiology versus clinical judgement R. Premaratna University of Kelaniya, Kelaniya, Sri Lanka Both epidemiology and clinical judgment are teachings by the father of medicine, the Greek physician Hippocrates. The term Epidemiology derives from the Greek: epi “upon/among” demos “people/district”, logos “study/disclosure”, so literally it means “the study of what is upon the people”. Hippocrates coined the terms endemic for diseases usually found in some places but not in oth- ers and epidemic for diseases that are seen at some times but not others. Clinical judgment is the application of information based on actual observation of a patient combined with subjective and objec- tive data that lead to a conclusion; process by which the doctor decides on data to be collected, makes an interpretation of the data, arrives at a clinical diagnosis, and identifies appropriate manage- ment actions; this involves critical thinking, problem solving, and decision making. The knowledge of epidemiology is important to narrow down a differential diagnosis in a given situation. However, it should not result in tunnel vision. Furthermore, today epidemiological data together with the advancement of science seem to have shadowed or replaced the most valued history taking and examination taught by Hippocrates. For example, some infections have been overlooked in the middle of a known disease outbreak leading to extended morbidity by the former illness simply due to poor history taking and or examination. Similarly increasingly introduced epidemiol- ogy based sophisticated rapid diagnostic tools such as multi-test strips are likely to be misused, misinterpreted or wasted ignoring the value of systematic clinical approach in arriving at a diagno- sis. At the same time, today infectious disease aetiologies are fast changing due to globalization, expansion of human travel, travel of bugs and hosts, expanding animal industry, and re-emergence of old bugs. Therefore in addition to having a good knowledge on local, regional and global epidemiology, an infectious disease physician today, should ensure a good clinical sense, broader thinking and an open mind in order to tackle an individual patient. This is the great- est challenge faced by an infectious disease physician compared to a physician attending to a well streamlined management plan of a non-communicable disease. This talk will be supported by case scenarios. http://dx.doi.org/10.1016/j.ijid.2012.05.156 Type: Invited Presentation Final Abstract Number: 38.003 Session: Acute Febrile Illness in the Tropics Date: Saturday, June 16, 2012 Time: 15:45-17:45 Room: Lotus 1-4 Laboratory diagnosis of acute febrile illness: Where are we now? C.-C. Chao Naval Medical Research Center, Silver Spring, MD, USA Acute febrile illness has been recognized as an important group of illness that is difficult to differentiate due to their similarity in symptoms. Consequently, a timely and accurate diagnosis has been challenging. Most of the illnesses show non-specific symptoms with typical sudden on-set of fever, headache and malaise. Among these acute febrile illnesses, rickettsial related diseases, such as scrub typhus, murine typhus, spotted fever group rickettsia, Q fever and leptospirosis, have emerged or re-emerged in different area around the globe. The under estimated cases of rickettsial infection has long been realized. This can be attributed to the unawareness of clinicians in the recently emerged area, possibly the lack of exten- sive experience of clinicians in the re-emerged area and the lack of a simple, rapid, cheap and accurate test. Therefore, sensitive and specific laboratory diagnostic assays are in need to provide timely diagnosis in order to properly treat the patients with antibiotics. The laboratory diagnosis of rickettsial diseases has generally been the use of IFA as the gold standard along with recent development of immunochromatographic test (ICT) and PCR for serological and nucleic acid detection, respectively. Although each test offers its unique benefit for different sample matrices and may only apply to samples collected at certain time after infection due to the detection window of individual assay, yet the use of these assays individually or in combination does provide more definitive answers for diag- nosis. More recently, assay has been developed for a high through put screening of antigens from multiple rickettsial-related febrile diseases to determine whether patient serum samples containing antibodies reactive to any of these antigens. Furthermore, addi- tional nucleic acid tests other than PCR and real-time PCR have also been developed for these rickettsial-related diseases. These tests are easy to perform and require no special instrument, such as PCR, and these tests are ideal for areas where resources may be limited. Different perspectives of these assays will be discussed. http://dx.doi.org/10.1016/j.ijid.2012.05.157