1921
Volume 95, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26–166.44, = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77–92.07, = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12–286.61, = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.16-0088
2016-10-05
2017-11-19
Loading full text...

Full text loading...

/deliver/fulltext/14761645/95/4/769.html?itemId=/content/journals/10.4269/ajtmh.16-0088&mimeType=html&fmt=ahah

References

  1. Watt G, Parola P, , 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16: 429436.[Crossref]
  2. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD, , 2010. Diagnosis of scrub typhus. Am J Trop Med Hyg 82: 368370.[Crossref]
  3. Rajapakse S, Rodrigo C, Fernando D, , 2012. Scrub typhus: pathophysiology, clinical manifestations and prognosis. Asian Pac J Trop Med 5: 261264.[Crossref]
  4. Peter JV, Sudarsan TI, Prakash JA, Varghese GM, , 2015. Severe scrub typhus infection: clinical features, diagnostic challenges and management. World J Crit Care Med 4: 244250.
  5. Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai S, Chinprasatsak S, Phonrat B, , 2002. Septic shock secondary to scrub typhus: characteristics and complications. Southeast Asian J Trop Med Public Health 33: 780786.
  6. Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC, , 2007. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg 76: 11481152.
  7. Wu K-M, Wu Z-W, Peng G-Q, Wu JL, Lee S-Y, , 2009. Radiologic pulmonary findings, clinical manifestations and serious complications in scrub typhus: experiences from a teaching hospital in eastern Taiwan. Int J Gerontol 3: 223232.[Crossref]
  8. Yen TH, Chang CT, Lin JL, Jiang JR, Lee KF, , 2003. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Fail 25: 397410.[Crossref]
  9. Kim DM, Kang DW, Kim JO, Chung JH, Kim HL, Park CY, Lim SC, , 2008. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi . J Clin Microbiol 46: 15481550.[Crossref]
  10. Kim DM, Chung JH, Yun NR, Kim SW, Lee JY, Han MA, Lee YB, , 2013. Scrub typhus meningitis or meningoencephalitis. Am J Trop Med Hyg 89: 12061211.[Crossref]
  11. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V, , 2008. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr 28: 149154.[Crossref]
  12. Lee S, Kang KP, Kim W, Kang SK, Lee HB, Park SK, , 2003. A case of acute renal failure, rhabdomyolysis and disseminated intravascular coagulation associated with scrub typhus. Clin Nephrol 60: 5961.[Crossref]
  13. Kim DM, Kim SW, Choi SH, Yun NR, , 2010. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 10: 108.[Crossref]
  14. Kelly DJ, Fuerst PA, Ching WM, Richards AL, , 2009. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi . Clin Infect Dis 48 (Suppl 3): S203S230.[Crossref]
  15. Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP, Peacock SJ, , 2009. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol 47: 430434.[Crossref]
  16. Lee CS, Hwang JH, Lee HB, Kwon KS, , 2009. Risk factors leading to fatal outcome in scrub typhus patients. Am J Trop Med Hyg 81: 484488.[Crossref]
  17. Yasunaga H, Horiguchi H, Kuwabara K, Hashimoto H, Matsuda S, , 2011. Delay in tetracycline treatment increases the risk of complications in Tsutsugamushi disease: data from the Japanese Diagnosis Procedure Combination database. Intern Med 50: 3742.[Crossref]
  18. Watt G, Chouriyagune C, Ruangweerayud R, Watcharapichat P, Phulsuksombati D, Jongsakul K, Teja-Isavadharm P, Bhodhidatta D, Corcoran KD, Dasch GA, Strickman D, , 1996. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet 348: 8689.[Crossref]
  19. Brown GW, Shirai A, Rogers C, Groves MG, , 1983. Diagnostic criteria for scrub typhus: probability values for immunofluorescent antibody and Proteus OXK agglutinin titers. Am J Trop Med Hyg 32: 11011107.
  20. Department of Disease Control MOPH, Thailand, 2001. Classification of Diseases Surveillance. Available at: www.boe.moph.go.th/publication/2544/cdsur/ANALYSIS.htm. Accessed March 1, 2016.
  21. Suputtamongkol Y, Suttinont C, Niwatayakul K, Hoontrakul S, Limpaiboon R, Chierakul W, Losuwanaluk K, Saisongkork W, , 2009. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci 1166: 172179.[Crossref]
  22. Jiang J, Chan TC, Temenak JJ, Dasch GA, Ching WM, Richards AL, , 2004. Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi . Am J Trop Med Hyg 70: 351356.
  23. Bakshi D, Singhal P, Mahajan SK, Subramaniam P, Tuteja U, Batra HV, , 2007. Development of a real-time PCR assay for the diagnosis of scrub typhus cases in India and evidence of the prevalence of new genotype of O. tsutsugamushi . Acta Trop 104: 6371.[Crossref]
  24. Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, , 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87: 464472.
  25. Suttinont C, Losuwanaluk K, Niwatayakul K, Hoontrakul S, Intaranongpai W, Silpasakorn S, Suwancharoen D, Panlar P, Saisongkorh W, Rolain JM, Raoult D, Suputtamongkol Y, , 2006. Causes of acute, undifferentiated, febrile illness in rural Thailand: results of a prospective observational study. Ann Trop Med Parasitol 100: 363370.[Crossref]
  26. Department of Disease Control MOPH, Thailand, 2001. Scrub Typhus Surveillance. Available at: www.thaivbd.org. Accessed March 1, 2016.
  27. Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP, , 2007. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion. Clin Infect Dis 44: 391401.[Crossref]
  28. Manosroi J, Chutipongvivate S, Auwanit W, Manosroi A, , 2006. Determination and geographic distribution of Orientia tsutsugamushi serotypes in Thailand by nested polymerase chain reaction. Diagn Microbiol Infect Dis 55: 185190.[Crossref]
  29. Berman SJ, Kundin WD, , 1973. Scrub typhus in south Vietnam. A study of 87 cases. Ann Intern Med 79: 2630.[Crossref]
  30. Johnson DE, Crum JW, Hanchalay S, Saengruchi C, , 1982. Sero-epidemiological survey of Rickettsia tsutsugamushi infection in a rural Thai village. Trans R Soc Trop Med Hyg 76: 13.[Crossref]
  31. Takada N, Khamboonruang C, Yamaguchi T, Thitasut P, Vajrasthira S, , 1984. Scrub typhus and chiggers in northern Thailand. Southeast Asian J Trop Med Public Health 15: 402406.
  32. Eamsila C, Singsawat P, Duangvaraporn A, Strickman D, , 1996. Antibodies to Orientia tsutsugamushi in Thai soldiers. Am J Trop Med Hyg 55: 556559.
  33. Chanyasanha C, Kaeburong K, Chenchittikul M, Sujirarat D, , 1998. Seroprevalence of scrub typhus infection in patients with pyrexia at some malaria clinics in three western provinces of Thailand. Asian Pac J Allergy Immunol 16: 119125.
  34. Lim C, Blacksell SD, Laongnualpanich A, Kantipong P, Day NP, Paris DH, Limmathurotsakul D, , 2015. Optimal cutoff titers for indirect immunofluorescence assay for diagnosis of scrub typhus. J Clin Microbiol 53: 36633666.[Crossref]
  35. Saisongkorh W, Chenchittikul M, Silpapojakul K, , 2004. Evaluation of nested PCR for the diagnosis of scrub typhus among patients with acute pyrexia of unknown origin. Trans R Soc Trop Med Hyg 98: 360366.[Crossref]
  36. Paris DH, Blacksell SD, Newton PN, Day NP, , 2008. Simple, rapid and sensitive detection of Orientia tsutsugamushi by loop-isothermal DNA amplification. Trans R Soc Trop Med Hyg 102: 12391246.[Crossref]
  37. Sirisanthana V, Puthanakit T, Sirisanthana T, , 2003. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 22: 341345.
  38. Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, Yoshida LM, Mai LQ, Duc-Anh D, Ando S, Arikawa J, Parry CM, Ariyoshi K, Thuy PT, , 2015. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in northern Vietnam. Am J Trop Med Hyg 92: 972978.[Crossref]
  39. Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY, Lee JH, Kim HK, Song HJ, Lee SH, Shin H, , 2007. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg 76: 806809.
  40. Watt G, Kantipong P, Jirajarus K, , 2002. Acute scrub typhus in northern Thailand: EKG changes. Southeast Asian J Trop Med Public Health 33: 312313.
  41. Choi YH, Kim SJ, Lee JY, Pai HJ, Lee KY, Lee YS, , 2000. Scrub typhus: radiological and clinical findings. Clin Radiol 55: 140144.[Crossref]
  42. Varghese GM, Trowbridge P, Janardhanan J, Thomas K, Peter JV, Mathews P, Abraham OC, Kavitha ML, , 2014. Clinical profile and improving mortality trend of scrub typhus in south India. Int J Infect Dis 23: 3943.[Crossref]
  43. Premaratna R, Chandrasena TG, Dassayake AS, Loftis AD, Dasch GA, de Silva HJ, , 2006. Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin Infect Dis 42: e6e8.[Crossref]
  44. Rajapakse S, Rodrigo C, Fernando SD, , 2011. Drug treatment of scrub typhus. Trop Doct 41: 14.[Crossref]
  45. Fang Y, Huang Z, Tu C, Zhang L, Ye D, Zhu BP, , 2012. Meta-analysis of drug treatment for scrub typhus in Asia. Intern Med 51: 23132320.[Crossref]
  46. Jang MO, Kim JE, Kim UJ, Ahn JH, Kang SJ, Jang HC, Jung SI, Park KH, , 2014. Differences in the clinical presentation and the frequency of complications between elderly and non-elderly scrub typhus patients. Arch Gerontol Geriatr 58: 196200.[Crossref]
  47. Sun IO, Kim MC, Park JW, Yang MA, Lee CB, Yoon HJ, Kim JG, Lee KY, , 2014. Clinical characteristics of acute kidney injury in patients with scrub typhus: RIFLE criteria validation. J Infect Chemother 20: 9396.[Crossref]
  48. Young PC, Hae CC, Lee KH, Hoon CJ, , 2003. Tsutsugamushi infection-associated acute rhabdomyolysis and acute renal failure. Korean J Intern Med 18: 248250.[Crossref]
  49. Hu ML, Liu JW, Wu KL, Lu SN, Chiou SS, Kuo CH, Chuah SK, Wang JH, Hu TH, Chiu KW, Lee CM, Changchien CS, , 2005. Short report: abnormal liver function in scrub typhus. Am J Trop Med Hyg 73: 667668.
  50. Kanno A, Yamada M, Murakami K, Torinuki W, , 1996. Liver involvement in Tsutsugamushi disease. Tohoku J Exp Med 179: 213217.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.16-0088
Loading
/content/journals/10.4269/ajtmh.16-0088
Loading

Data & Media loading...

  • Received : 05 Feb 2016
  • Accepted : 07 Jul 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error