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Serious complications in scrub typhus.
J Microbiol Immunol Infect 1998; 31(4):240-4JM

Abstract

Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is a disease endemic to Taiwan. Serious complications in scrub typhus were more common in the past 4 years than reported previously. Between August 1993 and July 1997, 33 cases of scrub typhus were admitted at Tri-Service General Hospital. Symptoms and signs were: fever (100%), chills (39%), cough (24%), headache (21%), diarrhea (18%), dyspnea (18%), eschar (60%), adenopathy (33%), and rash (21%). Nineteen percent (6/32) had obvious leukopenia (WBC < 4000/ mm3), 34% (11/32) had leukocytosis(WBC > 10,000/mm3) and 44% (14/32) had thrombocytopenia (platelet count < 100,000/mm3). Elevation of aspartate aminotransferase (AST) and elevation of alanine aminotransferase (ALT) were 81% (26/32) and 75% (24/32), respectively. Serious complications included pneumonitis 36% (12/33), acute respiratory distress syndrome (ARDS) 15% (5/33), acute renal failure 9% (3/33), myocarditis 3% (1/33) and septic shock 3% (1/33). One patient died of ARDS due to delay in diagnosis. Other patients recovered after appropriate antibiotic and intensive supportive treatments. Emerging virulent strains of O. tsutsugamushi in Taiwan might be biologically plausible. Scrub typhus should be considered in a patient with fever, varying degree of respiratory distress, particularly if there is an eschar or a history of environmental exposure in endemic areas. Prompt diagnosis, timely antimicrobial therapy and intensive supportive care are important for ARDS and other life-threatening complications.

Authors+Show Affiliations

Department of Internal Medicine, Tri-Services General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10496165

Citation

Tsay, R W., and F Y. Chang. "Serious Complications in Scrub Typhus." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 31, no. 4, 1998, pp. 240-4.
Tsay RW, Chang FY. Serious complications in scrub typhus. J Microbiol Immunol Infect. 1998;31(4):240-4.
Tsay, R. W., & Chang, F. Y. (1998). Serious complications in scrub typhus. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 31(4), pp. 240-4.
Tsay RW, Chang FY. Serious Complications in Scrub Typhus. J Microbiol Immunol Infect. 1998;31(4):240-4. PubMed PMID: 10496165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serious complications in scrub typhus. AU - Tsay,R W, AU - Chang,F Y, PY - 1999/9/25/pubmed PY - 1999/9/25/medline PY - 1999/9/25/entrez SP - 240 EP - 4 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 31 IS - 4 N2 - Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is a disease endemic to Taiwan. Serious complications in scrub typhus were more common in the past 4 years than reported previously. Between August 1993 and July 1997, 33 cases of scrub typhus were admitted at Tri-Service General Hospital. Symptoms and signs were: fever (100%), chills (39%), cough (24%), headache (21%), diarrhea (18%), dyspnea (18%), eschar (60%), adenopathy (33%), and rash (21%). Nineteen percent (6/32) had obvious leukopenia (WBC < 4000/ mm3), 34% (11/32) had leukocytosis(WBC > 10,000/mm3) and 44% (14/32) had thrombocytopenia (platelet count < 100,000/mm3). Elevation of aspartate aminotransferase (AST) and elevation of alanine aminotransferase (ALT) were 81% (26/32) and 75% (24/32), respectively. Serious complications included pneumonitis 36% (12/33), acute respiratory distress syndrome (ARDS) 15% (5/33), acute renal failure 9% (3/33), myocarditis 3% (1/33) and septic shock 3% (1/33). One patient died of ARDS due to delay in diagnosis. Other patients recovered after appropriate antibiotic and intensive supportive treatments. Emerging virulent strains of O. tsutsugamushi in Taiwan might be biologically plausible. Scrub typhus should be considered in a patient with fever, varying degree of respiratory distress, particularly if there is an eschar or a history of environmental exposure in endemic areas. Prompt diagnosis, timely antimicrobial therapy and intensive supportive care are important for ARDS and other life-threatening complications. SN - 1684-1182 UR - https://www.unboundmedicine.com/medline/citation/10496165/Serious_complications_in_scrub_typhus_ L2 - https://ClinicalTrials.gov/search/term=10496165 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -