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Am. J. Trop. Med. Hyg., 79(3), 2008, pp. 441-446
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Clinical Characteristics of Acute Q Fever, Scrub Typhus, and Murine Typhus with Delayed Defervescence Despite Doxycycline Treatment

Chung-Hsu Lai, Chun-Kai Huang, Hui-Ching Weng, Hsing-Chun Chung, Shiou-Haur Liang, Jiun-Nong Lin, Chih-Wen Lin, Chuan-Yuan Hsu, AND Hsi-Hsun Lin*
Section of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaoshiung County, Taiwan, Republic of China; Department of Health Management, I-Shou University, Kaohsiung County, Taiwan, Republic of China; Section of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaoshiung County, Taiwan, Republic of China

Doxycycline is the recommended antibiotic for acute Q fever, scrub typhus, and murine typhus and defervescence often occurs within 3 days of treatment. Patients with delayed defervescence (> 3 days) are troublesome for clinicians. To investigate the characteristics of such patients, 18 and 88 cases with and without delayed defervescence, respectively, were studied. By univariate analysis, absence of headache (P = 0.004), jaundice (P = 0.030), icteric sclera (P = 0.030), relative bradycardia (P = 0.003), and pulmonary involvement on chest x-ray (P = 0.028) were significant findings in patients with delayed defervescence. By multivariate analysis, absence of headache (odds ratio [OR] = 8.310; 95% confidence interval [CI] = 1.990–34.706, P = 0.004), jaundice (OR = 6.242; 95% CI = 1.374–28.365, P = 0.018), and relative bradycardia (OR = 10.449; 95% CI = 2.137–51.088, P = 0.004) were the independent characteristics of patients with delayed defervescence. In treating acute Q fever, scrub typhus, and murine typhus with doxycycline, clinicians should be aware that delayed defervescence may occur in patients presenting with jaundice, relative bradycardia, and absence of headache.

Received April 13, 2008. Accepted for publication June 11, 2008.

Financial support. This study was partially supported by a research grant from E-Da Hospital (EDAH-D-97(P)007A).

Disclaimer: All authors have no conflict of interest.

* Address correspondence to Hsi-Hsun Lin, Section of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China. E-mail: ed100233{at}yahoo.com.tw

Authors’ addresses: Chung-Hsu Lai, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5558, Fax: 886-7-615-0960, E-mail: laich6363{at}yahoo.com.tw. Chun-Kai Huang, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5555, Fax: 886-7-615-0960, E-mail: ed103536{at}edah.org.tw. Hui-Ching Weng, Department of Health Management, I-Shou University, 8 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan Kaohsiung County, Taiwan, Republic of China, Tel: 886-7-615-1100-7420, Fax: 886-7-615-0960, E-mail: weng{at}mail.isu.edu.tw. Hsing-Chun Chung, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5556, Fax: 886-7-615-0960, E-mail: ed102749{at}edah.org.tw. Shiou-Haur Liang, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5554, Fax: 886-7-615-0960, E-mail: ed103519{at}edah.org.tw. Jiun-Nong Lin, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5557, Fax: 886-7-615-0960, E-mail: ed103623{at}edah.org.tw. Chih-Wen Lin and Chuan-Yuan Hsu, Section of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011, Fax: 886-7-615-0960, E-mails: ed101968{at}edah.org.tw and ed101800{at}edah.org.tw. Hsi-Hsun Lin, Department of Infectious Disease, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China, Tel: 886-7-615-0011-5550, Fax: 886-7-615-0960, E-mail: ed100233{at}yahoo.org.tw.






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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.