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Etiologies of Acute Undifferentiated Fever and Clinical Prediction of Scrub Typhus in a Non-Tropical Endemic Area

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  • Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Scrub typhus usually presents as acute undifferentiated fever. This cross-sectional study included adult patients presenting with acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection. Scrub typhus cases were defined by an antibody titer of a ≥ fourfold increase in paired sera, a ≥ 1:160 in a single serum using indirect immunofluorescence assay, or a positive result of the immunochromatographic test. Multiple regression analysis identified predictors associated with scrub typhus to develop a prediction rule. Of 250 cases with known etiology of acute undifferentiated fever, influenza (28.0%), hepatitis A (25.2%), and scrub typhus (16.4%) were major causes. A prediction rule for identifying suspected cases of scrub typhus consisted of age ≥ 65 years (two points), recent fieldwork/outdoor activities (one point), onset of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). The c statistic was 0.977 (95% confidence interval = 0.960–0.994). At a cutoff value ≥ 4, the sensitivity and specificity were 92.7% (79.0–98.1%) and 90.9% (86.0–94.3%), respectively. Scrub typhus, the third leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule.

Author Notes

* Address correspondence to Won Sup Oh, Department of Internal Medicine, Kangwon National University School of Medicine, Baengnyeong-ro 156, Chuncheon, 200-722 Republic of Korea. E-mail: onesbi@gmail.com† These authors contributed equally.

Authors' addresses: Ho-Chul Jung, Won Sup Oh, Dong-Hyun Lee, and Ho-Jin Lee, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea, E-mails: jhc0563@hanmail.net, onesbi@gmail.com, superhigh1@daum.net, and kobestman@hotmail.com. Sung-Bin Chon, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea, E-mail: 1tim4ezra7@gmail.com.

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