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A Comparative Study of Hepatitis Caused by Scrub Typhus and Viral Hepatitis A in South Korea
We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P < 0.001). A bilirubin level ≥ 1.3 mg/dL was observed in 16.8% of scrub typhus patients and 90.4% of hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P < 0.001). Fever, headache, rash, and eschar are findings that indicate scrub typhus. An ALT level ≥ 500 U/L (adjusted odds ratio = 0.011) a bilirubin level ≥ 1.3 (adjusted odds ratio = 0.024), an ALT:lactate dehydrogenase ratio > 5, and hepatomegaly are indications of viral hepatitis A.
Author Notes
Dislosure: None of the authors have any commercials interests or other associations that might be conflicts of interest.
Authors' addresses: Jun Lee, Dong-Min Kim, Na Ra Yun, Yu Mi Byeon, Chan Guk Park, and Man Woo Kim, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-Gu, Gwangju 501-717, South Korea, E-mails: joon3640@hanmail.net, drongkim@chosun.ac.kr, shinenara@gmail.com, oboist98@hanmail.net, giydkim@chosun.ac.kr, drcgpark@chosun.ac.kr, and mwkim@chosun.ac.kr. Mi Ah Han, National Cancer Control Research Institute, National Cancer Center 323, Ilsandong-Gu, Goyang, Gyeonggi-do, South Korea, E-mail: mahan@ncc.re.kr.
Reprint requests: Dong-Min Kim, Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, South Korea, E-mail: drongkim@chosun.ac.kr.