Radiologic Pulmonary Findings, Clinical Manifestations and Serious Complications in Scrub Typhus: Experiences From A Teaching Hospital in Eastern Taiwan
Accepted 7 April 2009.
Summary
Background
Scrub typhus (tsutsugamushi disease) is an endemic infectious disease in eastern Taiwan caused by Orientia tsutsugamushi.
Methods
A total of 136 cases of scrub typhus were diagnosed from patients' blood samples. Medical records were reviewed and clinical manifestations and chest X-rays were analyzed.
Results
Scrub typhus was diagnosed in 136 patients, with a mean age of 40.7 ± 21.5 years. The most common symptom was fever in 134 patients (98.5%), and the most common sign was eschar in 82 (60.3%). Chest X-rays were performed in 115 cases and showed abnormalities in 63 patients (54.8%). Patients with chest X-rays abnormalities had an increased incidence of cough (p < 0.001), septic shock (p = 0.006), congestive heart failure (p < 0.001), acute respiratory failure (p < 0.001), severe jaundice (p = 0.03) and acute renal failure (p = 0.007), and requirement for intensive care unit treatment (p < 0.001) and prolonged length of hospital stay (p = 0.002), compared with patients without chest X-rays abnormalities. Patients aged £ 16 years had an increased incidence of meningoencephalitis (p = 0.006) compared with the others. Patients aged ≥ 65 years had a higher incidence of complications and requirement for intensive care unit care (p = 0.02) compared with the other two groups.
Conclusion
Patients with abnormal chest X-rays had higher rates of serious complications. Central nervous system infection was most frequent in pediatric patients. Patients aged ≥ 65 years had a higher incidence of serious complications. Physicians should have increased awareness of scrub typhus when caring for patients with acute febrile illness in endemic areas.
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aChest Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
bChest Division, Department of Internal Medicine, Taitung, Taiwan
cDepartment of Radiology, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan
dDivision of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
eMackay Medicine, Nursing and Management College, Taipei, Taiwan
Correspondence to: Dr Shih-Yi Lee, Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan
ABSTRACT