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Volume 78, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

We retrospectively analyzed 92 cases of severe rickettsial infections in patients (median age = 49 years, 57% male, 37.0% with scrub typhus) in Hong Kong. Immunofluorescence assay was used for diagnostic confirmation. Identification of ≥ 1 diagnostic sign (exposure history, rash, or eschar) was possible in 94.6% of the cases. Multivariate analysis suggested that pulmonary infiltrates (odds ratio [OR] = 25.2, 95% confidence interval [CI] = 3.9–160.9, = 0.001) and leukocytosis (OR = 1.3, 95% CI = 1.0–1.5 per unit increase, = 0.033) were independent predictors of admission to an intensive care unit (14.1%). Delayed administration of doxycycline was independently associated with major organ dysfunction (23.9%; oxygen desaturation, renal failure, severe jaundice, encephalopathy, cardiac failure) (OR = 1.2, 95% CI = 1.0–1.5 per day delay, = 0.046; adjusted for age and rickettsia biogroup) and prolonged hospitalization > 10 days (25%) (OR = 1.4, 95% CI = 1.1–1.9 per day delay, = 0.014). Treatment with fluoroquinolone/clarithromycin did not correlate with clinical outcomes ( > 0.05). Early empirical doxycycline therapy should be considered if clinico-epidemiologic signs of rickettsial infections are present.

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2008-06-01
2017-11-23
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References

  1. Parola P, Paddock CD, Raoult D, 2005. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 18 : 719–756.
  2. Jensenius M, Fournier P, Raoult D, 2004. Rickettsioses and the international traveler. Clin Infect Dis 39 : 1493–1499.
  3. Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, Sexton DJ, Buckingham SC, Marshall GC, Storch GA, Dasch GA, McQuiston JH, Swerdlow DL, Dumler SJ, Nicholson WL, Walker DH, Eremeeva ME, Ohl CA, 2006. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis–United States. A practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 55 : 1–27.
  4. Kodama K, Senba T, Yamauchi H, Nomura T, Chikahira Y, 2003. Clinical study of Japanese spotted fever and its aggravating factors. J Infect Chemother 9 : 83–87.
  5. Jang WJ, Kim JH, Choi YJ, Jung KD, Kim YG, Lee SH, Choi MS, Kim IS, Walker DH, Park KH, 2004. First serologic evidence of human spotted fever group rickettsiosis in Korea. J Clin Microbiol 42 : 2310–2313.
  6. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, Keystone JS, Pandey P, Cetron MS, 2006. Geo-Sentinel Surveillance Network. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 354 : 119–130.
  7. Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, Schwartz E, 2007. GeoSentinel Surveillance Network. Fever in returned travelers: results from the Geo-Sentinel Surveillance Network. Clin Infect Dis 44 : 1560–1568.
  8. McQuiston JG, Paddock CE, Singleton J Jr, Wheeling JT, Zaki S, Childs JE, 2004. Imported spotted fever rickettsioses in United States travelers returning from Africa: a summary of cases confirmed by laboratory testing at the centers for disease control and prevention, 1999–2002. Am J Trop Med Hyg 70 : 98–101.
  9. Centre for Health Protection, Hong Kong SAR, 2005. Epidemiology of Spotted Fever, Scrub Typhus and Murine Typhus in Hong Kong, 1995–2004. Public Health and Epidemiology Bulletin. Available at: http://www.chp.gov.hk/files/pdf/grp-PHEB-V14n1-en-20050322.pdf
  10. Centre for Health Protection, Hong Kong SAR, 2005. Rickettsial Disease Associated with Outdoor Settings. Communicable Diseases Watch. Available at: http://www.chp.gov.hk/files/pdf/CDW_V2_23b.pdf
  11. Walker DH, 2002. Rickettsia rickettsii: as virulent as ever. Am J Trop Med Hyg 66 : 448–449.
  12. Walker DH, 2006. Targeting rickettsia. N Engl J Med 354 : 1418–1420.
  13. Walker DH, 2007. Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis 45 (Suppl 1): S39–S44.
  14. Conlon PJ, Procop GW, Fowler V, Ali Eloubeildi M, Smith SR, Sexton DJ, 1996. Predictors of prognosis and risk of acute renal failure in patients with Rocky Mountain spotted fever. Am J Med 101 : 621–626.
  15. Childs JE, Paddock CD, 2002. Passive surveillance as an instrument to identify risk factors for fatal Rocky Mountain spotted fever: is there more to learn? Am J Trop Med Hyg 66 : 450–457.
  16. Holman RC, Paddock CD, Curns AT, Krebs JW, McQuiston JH, Childs JE, 2001. Analysis of risk factors for fatal Rocky Mountain spotted fever: evidence for superiority of tetracyclines for therapy. J Infect Dis 184 : 1437–1444.
  17. Lui G, Lee N, Ip M, Choi KW, Tso YK, Lam E, Chau S, Lai R, Cockram CS, 2006. Cryptococcosis in apparently immunocompetent patients. QJM 99 : 143–151.
  18. Sung JJ, Wu A, Joynt GM, Yuen KY, Lee N, Chan PK, Cockram CS, Ahuja AT, Yu LM, Wong VW, Hui DS, 2004. Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak. Thorax 59 : 414–420.
  19. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, Ahuja A, Yung MY, Leung CB, To KF, Lui SF, Szeto CC, Chung S, Sung JJ, 2003. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 248 : 1986–1994.
  20. Weiss E, 1992. Encyclopedia of Microbiology. Volume 3. San Diego, CA: Academic Press, 585–610.
  21. Centre for Health Protection, Hong Kong SAR, 2005. Laboratory Diagnosis of Spotted Fever and Typhus. Public Health and Epidemiology Bulletin. Mar 2005. Available at: http://www.chp.gov.hk/files/pdf/grp-PHEB-V14n1-en-20050322.pdf
  22. Graves S, Wang L, Nack Z, Jones S, 1999. Rickettsia serosurvey in Kimberley, Western Australia. Am J Trop Med Hyg 60 : 786–789.
  23. Basnyat B, Belbase RH, Zimmerman MD, Woods CW, Reller LB, Murdoch DR, 2006. Clinical features of scrub typhus. Clin Infect Dis 42 : 1505–1506.
  24. Dumler JS, Walker DH, 2005. Rocky Mountain spotted fever–changing ecology and persisting virulence. N Engl J Med 353 : 551–553.
  25. Archibald LK, Sexton DJ, 1995. Long-term sequelae of Rocky Mountain spotted fever. Clin Infect Dis 20 : 1122–1125.
  26. 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 : 780–786.
  27. 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 : 1148–1152.
  28. Charoensak A, Chawalparit O, Suttinont C, Niwattayakul L, Losuwanaluk K, Silpasakorn S, Suputtamongkol Y, 2006. Scrub typhus: chest radiographic and clinical findings in 130 Thai patients. J Med Assoc Thai 89 : 600–607.
  29. Kirkland KB, Wilkinson WE, Sexton DJ, 1995. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis 20 : 1118–1121.
  30. 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 : 806–809.
  31. Demma LJ, Traeger MS, Nicholson WL, Paddock CD, Blau DM, Eremeeva ME, Dasch GA, Levin ML, Singleton J Jr, Zaki SR, Cheek JE, Swerdlow DL, McQuiston JH, 2005. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. N Engl J Med 535 : 587–594.
  32. Zanetti G, Francioli P, Tagan D, Paddock CD, Zaki SR, 1998. Imported epidemic typhus. Lancet 352 : 1709.
  33. Cascio A, Colomba C, Antinori S, Paterson DL, Titone L, 2002. Clarithromycin versus azithromycin in the treatment of Mediterranean spotted fever in children: a randomized controlled trial. Clin Infect Dis 34 : 154–158.
  34. Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, Chierakul W, Suwancharoen D, Silpasakorn S, Saisongkorh W, Peacock SJ, Day NP, Suputtamongkol Y, 2007. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother 51 : 3259–3263.
  35. Kim DM, Kim HL, Park CY, Yang TY, Lee JH, Yang JT, Shim SK, Lee SH, 2006. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin Infect Dis 43 : 1296–1300.
  36. Lee N, Rainer TH, Ip M, Zee B, Ng MH, Antonio GE, Chan E, Lui G, Cockram CS, Sung JJ, Hui DS, 2006. Role of laboratory variables in differentiating SARS-coronavirus from other causes of community-acquired pneumonia within the first 72 h of hospitalization. Eur J Clin Microbiol Infect Dis 25 : 765–772.
  37. Leung GM, Rainer TH, Lau FL, Wong IO, Tong A, Wong TW, Kong JH, Hedley AJ, Lam TH; Hospital Authority SARS Collaborative Group, 2004. A clinical prediction rule for diagnosing severe acute respiratory syndrome in the emergency department. Ann Intern Med 141 : 333–342.
  38. Watt G, Jongsakul K, Chouriyagune C, Paris R, 2003. Differentiating dengue virus infection from scrub typhus in Thai adults with fever. Am J Trop Med Hyg 68 : 536–538.
  39. Sonthayanon P, Chierakul W, Wuthiekanun V, Blacksell SD, Pimda K, Suputtamongkol Y, Pukrittayakamee S, White NJ, Day NP, Peacock SJ, 2006. Rapid diagnosis of scrub typhus in rural Thailand using polymerase chain reaction. Am J Trop Med Hyg 75 : 1099–1102.
  40. Singhsilarak T, Leowattana W, Looareesuwan S, Wongchotigul V, Jiang J, Richards AL, Watt G, 2005. Short report: detection of Orientia tsutsugamushi in clinical samples by quantitative real-time polymerase chain reaction. Am J Trop Med Hyg 72 : 640–641.
  41. 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 : 86–89.
  42. Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, Strickman D, 2000. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet 356 : 1057–1061.
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  • Received : 01 Nov 2007
  • Accepted : 15 Feb 2008

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