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Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017
  1. Jason S Biswas1,2,
  2. J Lentaigne2,
  3. D S Burns2,
  4. J C Osborne3,
  5. A J Simpson3,
  6. E J Hutley1,
  7. N E Hill2 and
  8. M S Bailey2
  1. 1 Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
  1. Correspondence to Jason S Biswas, Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK; jason.biswas{at}


Undifferentiated febrile illnesses present diagnostic and treatment challenges in the Firm Base, let alone in the deployed austere environment. We report a series of 14 cases from Operation TRENTON in South Sudan in 2017 that coincided with the rainy season, increased insect numbers and a Relief in Place. The majority of patients had headaches, myalgia, arthralgia and back pain, as well as leucopenia and thrombocytopenia. No diagnoses could be made in theatre, despite a sophisticated deployed laboratory being available, and further testing in the UK, including next-generation sequencing, was unable to establish an aetiology. Such illnesses are very likely to present in tropical environments, where increasing numbers of military personnel are being deployed, and clinicians must be aware of the non-specific presentation and treatment, as well as the availability of Military Infection Reachback services to assist in the management of these cases.

  • fever of unknown origin
  • disease and non-battle injuries
  • military personnel
  • South Sudan

Statistics from


  • Contributors JSB, JL, NEH and MSB looked after the patients in South Sudan. DSB and MSB reviewed patients at Role 4. EJH provided reachback microbiology and logistical support. JCO and AJS provided reference laboratory testing and interpretation. JSB drafted the manuscript, which was reviewed and approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this article are those of the authors and do not reflect the official policy of the Defence Medical Services, Ministry of Defence or British Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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