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ACUTE RESPIRATORY DISTRESS SYNDROME IN SCRUB TYPHUS

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus. This study retrospectively reviewed the medical records of 72 patients diagnosed with scrub typhus from January 1998 to August 2006 in Kaohsiung Chang Gung Memorial Hospital in Taiwan. Eight of 72 scrub typhus patients with ARDS were included in the study; the other patients without ARDS were used as controls. The mortality rate for the scrub typhus patients with ARDS was 25%. The eight patients seldom had underlying diseases. Initial presentations of dyspnea and cough, white blood cell count, hematocrit, total bilirubin, and delayed used of appropriate antibiotics use were significant predictors of ARDS. Multivariate analysis showed that albumin, prothrombin time, and delayed use of appropriate antibiotics were independent predictors of ARDS. Identification of these relative risk factors may help clinicians evaluate clinical cases of scrub typhus with ARDS.

Received December 3, 2006. Accepted for publication January 23, 2007.

^* Address correspondence to Meng-Chih Lin, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Dabi Road, Niaosung, Shiang, Kaohsiung, Taiwan, Republic of China. E-mail: mengchih{at}adm.cgmh.org.tw

Authors’ addresses: Chin-Chou Wang, Shih-Feng Liu, Yu-Hsiu Chung, and Mao-Chang Su, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China. Jien-Wei Liu, Division of Infectious Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China. Meng-Chih Lin, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center; Department of Respiratory Care, Chang Gung Institute of Technology, Chiayi, Taiwan, Republic of China.

Reprint requests: Meng-Chih Lin, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Department of Respiratory Care, Chang Gung Institute of Technology, 123 Dabi Road, Niaosung Shiang, Kaohsiung, Taiwan, Chiayi, Taiwan, Republic of China, Telephone: 886-7-731-7123 extension 8199, Fax: 886-7-732-2402, E-mail: mengchih{at}adm.cgmh.org.tw.

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