Author:
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1.
Acestor N, Cooksey R, Newton PN, Ménard D, Guerin PJ, Nakagawa J, Christophel E, González IJ, Bell D, 2012. Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review–terra incognita impairing treatment policies. PLoS ONE 7: e44269.
-
2.
Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87: 464–472.
-
3.
Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, Abraham AM, Abraham OC, Thomas K, 2010. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors—an experience from a tertiary care hospital in south India. Trop Doct 40: 230–234.
-
4.
Korea Centers for Disease Control and Prevention, 2013. Infectious Diseases Surveillance Yearbook 2012. Seoul, Korea: Korea Centers for Disease Control and Prevention.
-
5.
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: 37–42.
-
6.
Watt G, Parola P, 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16: 429–436.
-
7.
Rapsang AG, Bhattacharyya P, 2013. Scrub typhus. Indian J Anaesth 57: 127–134.
-
8.
Silpapojakul K, Varachit B, Silpapojakul K, 2004. Paediatric scrub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med Hyg 98: 354–359.
-
9.
Paris DH, Shelite TR, Day NP, Walker DH, 2013. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 89: 301–307.
-
10.
Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD, 2010. Diagnosis of scrub typhus. Am J Trop Med Hyg 82: 368–370.
-
11.
Lee KD, Moon C, Oh WS, Sohn KM, Kim BN, 2014. Diagnosis of scrub typhus: introduction of the immunochromatographic test in Korea. Korean J Intern Med 29: 253–255.
-
12.
Lyu Y, Tian L, Zhang L, Dou X, Wang X, Li W, Zhang X, Sun Y, Guan Z, Li X, Wang Q, 2013. A case-control study of risk factors associated with scrub typhus infection in Beijing, China. PLoS ONE 8: e63668.
-
13.
Rathi NB, Rathi AN, Goodman MH, Aghai ZH, 2011. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr 48: 867–872.
-
14.
Cunha BA, 2000. The diagnostic significance of relative bradycardia in infectious disease. Clin Microbiol Infect 6: 633–634.
-
15.
Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, 2006. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J Infect 52: 56–60.
-
16.
Chen NY, Huang PY, Leu HS, Chiang PC, Huang CT, 2008. Clinical prediction of endemic rickettsioses in northern Taiwan-relevance of peripheral blood atypical lymphocytes. J Microbiol Immunol Infect 41: 362–368.
-
17.
Kim DM, Lee YM, Back JH, Yang TY, Lee JH, Song HJ, Shim SK, Hwang KJ, Park MY, 2010. A serosurvey of Orientia tsutsugamushi from patients with scrub typhus. Clin Microbiol Infect 16: 447–451.
-
18.
Silpasakorn S, Waywa D, Hoontrakul S, Suttinont C, Losuwanaluk K, Suputtamongkol Y, 2012. Performance of SD Bioline Tsutsugamushi assays for the diagnosis of scrub typhus in Thailand. J Med Assoc Thai 5 (Suppl 2): S18–S22.
-
19.
Lee HW, 1989. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 11: S864–S876.
-
20.
Park SH, Lee MJ, Baek JH, Lee WC, 2011. Epidemiological aspects of exotic malaria and dengue fever in travelers in Korea. J Clin Med Res 3: 139–142.
-
21.
Kim KH, Yi J, Kim G, Choi SJ, Jun KI, Kim NH, Choe PG, Kim NJ, Lee JK, Oh MD, 2013. Severe fever with thrombocytopenia syndrome, South Korea, 2012. Emerg Infect Dis 19: 1892– 1894.
-
22.
Kim KH, Yi J, Oh WS, Kim NH, Choi SJ, Choe PG, Kim NJ, Lee JK, Oh MD, 2014. Human granulocytic anaplasmosis, South Korea, 2013. Emerg Infect Dis 20: 1708–1711.
-
23.
Kashinkunti MD, Gundikeri SK, Dhananjaya M, 2013. Acute undifferentiated febrile illness-clinical spectrum and outcome from a tertiary care teaching hospital of north Karnataka. Int J Biol Med Res 4: 3399–3402.
-
24.
Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam. A study of 87 cases. Ann Intern Med 79: 26–30.
-
25.
Bang HA, Lee MJ, Lee WC, 2008. Comparative research on epidemiological aspects of tsutsugamushi disease (scrub typhus) between Korea and Japan. Jpn J Infect Dis 61: 148–150.
-
26.
Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 1127–1129.
-
27.
Thangarasu S, Natarajan P, Rajavelu P, Rajagopalan A, Seelinger Devey JS, 2011. A protocol for the emergency department management of acute undifferentiated febrile illness in India. Int J Emerg Med 4: 57.
-
28.
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: 391–401.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1724 | 1539 | 38 |
| Full Text Views | 506 | 8 | 0 |
| PDF Downloads | 175 | 8 | 0 |
Etiologies of Acute Undifferentiated Fever and Clinical Prediction of Scrub Typhus in a Non-Tropical Endemic Area
Ho-Chul Jung
Ho-Chul Jung
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
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Sung-Bin Chon
Sung-Bin Chon
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
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Won Sup Oh
Won Sup Oh
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
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Dong-Hyun Lee
Dong-Hyun Lee
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
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Ho-Jin Lee
Ho-Jin Lee
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
Search for other papers by Ho-Jin Lee in
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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
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Acestor N, Cooksey R, Newton PN, Ménard D, Guerin PJ, Nakagawa J, Christophel E, González IJ, Bell D, 2012. Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review–terra incognita impairing treatment policies. PLoS ONE 7: e44269.
-
2.
Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87: 464–472.
-
3.
Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, Abraham AM, Abraham OC, Thomas K, 2010. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors—an experience from a tertiary care hospital in south India. Trop Doct 40: 230–234.
-
4.
Korea Centers for Disease Control and Prevention, 2013. Infectious Diseases Surveillance Yearbook 2012. Seoul, Korea: Korea Centers for Disease Control and Prevention.
-
5.
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: 37–42.
-
6.
Watt G, Parola P, 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16: 429–436.
-
7.
Rapsang AG, Bhattacharyya P, 2013. Scrub typhus. Indian J Anaesth 57: 127–134.
-
8.
Silpapojakul K, Varachit B, Silpapojakul K, 2004. Paediatric scrub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med Hyg 98: 354–359.
-
9.
Paris DH, Shelite TR, Day NP, Walker DH, 2013. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 89: 301–307.
-
10.
Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD, 2010. Diagnosis of scrub typhus. Am J Trop Med Hyg 82: 368–370.
-
11.
Lee KD, Moon C, Oh WS, Sohn KM, Kim BN, 2014. Diagnosis of scrub typhus: introduction of the immunochromatographic test in Korea. Korean J Intern Med 29: 253–255.
-
12.
Lyu Y, Tian L, Zhang L, Dou X, Wang X, Li W, Zhang X, Sun Y, Guan Z, Li X, Wang Q, 2013. A case-control study of risk factors associated with scrub typhus infection in Beijing, China. PLoS ONE 8: e63668.
-
13.
Rathi NB, Rathi AN, Goodman MH, Aghai ZH, 2011. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr 48: 867–872.
-
14.
Cunha BA, 2000. The diagnostic significance of relative bradycardia in infectious disease. Clin Microbiol Infect 6: 633–634.
-
15.
Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, 2006. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J Infect 52: 56–60.
-
16.
Chen NY, Huang PY, Leu HS, Chiang PC, Huang CT, 2008. Clinical prediction of endemic rickettsioses in northern Taiwan-relevance of peripheral blood atypical lymphocytes. J Microbiol Immunol Infect 41: 362–368.
-
17.
Kim DM, Lee YM, Back JH, Yang TY, Lee JH, Song HJ, Shim SK, Hwang KJ, Park MY, 2010. A serosurvey of Orientia tsutsugamushi from patients with scrub typhus. Clin Microbiol Infect 16: 447–451.
-
18.
Silpasakorn S, Waywa D, Hoontrakul S, Suttinont C, Losuwanaluk K, Suputtamongkol Y, 2012. Performance of SD Bioline Tsutsugamushi assays for the diagnosis of scrub typhus in Thailand. J Med Assoc Thai 5 (Suppl 2): S18–S22.
-
19.
Lee HW, 1989. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 11: S864–S876.
-
20.
Park SH, Lee MJ, Baek JH, Lee WC, 2011. Epidemiological aspects of exotic malaria and dengue fever in travelers in Korea. J Clin Med Res 3: 139–142.
-
21.
Kim KH, Yi J, Kim G, Choi SJ, Jun KI, Kim NH, Choe PG, Kim NJ, Lee JK, Oh MD, 2013. Severe fever with thrombocytopenia syndrome, South Korea, 2012. Emerg Infect Dis 19: 1892– 1894.
-
22.
Kim KH, Yi J, Oh WS, Kim NH, Choi SJ, Choe PG, Kim NJ, Lee JK, Oh MD, 2014. Human granulocytic anaplasmosis, South Korea, 2013. Emerg Infect Dis 20: 1708–1711.
-
23.
Kashinkunti MD, Gundikeri SK, Dhananjaya M, 2013. Acute undifferentiated febrile illness-clinical spectrum and outcome from a tertiary care teaching hospital of north Karnataka. Int J Biol Med Res 4: 3399–3402.
-
24.
Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam. A study of 87 cases. Ann Intern Med 79: 26–30.
-
25.
Bang HA, Lee MJ, Lee WC, 2008. Comparative research on epidemiological aspects of tsutsugamushi disease (scrub typhus) between Korea and Japan. Jpn J Infect Dis 61: 148–150.
-
26.
Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 1127–1129.
-
27.
Thangarasu S, Natarajan P, Rajavelu P, Rajagopalan A, Seelinger Devey JS, 2011. A protocol for the emergency department management of acute undifferentiated febrile illness in India. Int J Emerg Med 4: 57.
-
28.
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: 391–401.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1724 | 1539 | 38 |
| Full Text Views | 506 | 8 | 0 |
| PDF Downloads | 175 | 8 | 0 |